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Cichońska D, Komandera D, Mazuś M, Kusiak A. Chronic Ulcerative Stomatitis (CUS) as an Interdisciplinary Diagnostic Challenge: A Literature Review. Int J Mol Sci 2022; 23:ijms232213772. [PMID: 36430253 PMCID: PMC9692827 DOI: 10.3390/ijms232213772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic ulcerative stomatitis (CUS) is a rarely reported disease affecting the oral cavity, most often affecting middle-aged Caucasian females. The aim of the present study is to present the diagnosis, differentiation, and interdisciplinary treatment of this rare disease. CUS is characterized by the presence of an oral erosive or ulcerative lesion. The autoimmune pathogenesis of CUS includes affecting the antigen's activity by DNA-breaking and protein-hydrolyzing enzymes. The stratified epithelium-specific antinuclear antibodies (SES-ANA) are associated with CUS development. Clinically, the lesions presented in oral mucosa might resemble an erosive form of oral lichen planus, whereas gingival lesions seem to be similar to desquamative gingivitis related to dermatological diseases manifested in the oral cavity. Patients often report subjective symptoms related to oral mucosa and general symptoms. Histopathological presentation of CUS is often non-specific and includes sub-epithelial separation from underlying connective tissue, atrophic epithelium, and inflammatory infiltrate with an increased number of plasma cells and lymphocytes. Direct immunofluorescence (DIF) might be used in CUS diagnostics. CUS generally remains nonsusceptible to corticosteroid treatments; however, antimalarial drugs and calcineurin inhibitors are more effective. Further research should be conducted in order to implement a diagnostic protocol and observe the long-term results of CUS management.
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Affiliation(s)
- Dominika Cichońska
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdansk, 80-200 Gdansk, Poland
- Correspondence:
| | - Dominika Komandera
- Student Research Group at the Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdansk, 80-200 Gdansk, Poland
| | - Magda Mazuś
- Student Research Group at the Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdansk, 80-200 Gdansk, Poland
| | - Aida Kusiak
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdansk, 80-200 Gdansk, Poland
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Schroeder F, Palma V, Rados P, Visioli F. Clinical and immunological features of chronic ulcerative stomatitis: a systematic review. J Oral Pathol Med 2022; 51:501-509. [DOI: 10.1111/jop.13279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/14/2021] [Accepted: 01/06/2022] [Indexed: 11/27/2022]
Affiliation(s)
- F.M.M. Schroeder
- Oral Medicine Department School of Dentistry Universidade Federal do Rio Grande do Sul Porto Alegre RS Brazil 90035‐003
| | - V.M. Palma
- Oral Medicine Department School of Dentistry Universidade Federal do Rio Grande do Sul Porto Alegre RS Brazil 90035‐003
| | - P.V. Rados
- Oral Medicine Department School of Dentistry Universidade Federal do Rio Grande do Sul Porto Alegre RS Brazil 90035‐003
| | - F. Visioli
- Oral Medicine Department School of Dentistry Universidade Federal do Rio Grande do Sul Porto Alegre RS Brazil 90035‐003
- Experimental Center Research Hospital de Clínicas de Porto Alegre Porto Alegre RS Brazil 90035‐903
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Herzum A, Burlando M, Cozzani E, Parodi A. The 30th birthday of chronic ulcerative stomatitis: A systematic review. Int J Immunopathol Pharmacol 2021; 35:20587384211052437. [PMID: 34666534 PMCID: PMC8532222 DOI: 10.1177/20587384211052437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Chronic ulcerative stomatitis (CUS) is a chronic, ulcerative condition of the oral cavity, clinically and histologically similar to oral lichen planus (OLP), first described as a new disease entity in 1990 by Parodi et al. In this review, 30 years after our first description of CUS, we aimed to systematically review the literature of CUS cases reported ever since. METHODS We present a systematic review of CUS literature cases, performed in compliance with the PRISMA statement. RESULTS Of 125 retrieved articles, 20 satisfied inclusion criteria. These described 76 CUS cases, all presenting orally evident disease: erosions (55%), white lesions (49%), erythema (49%), ulcerations (34%) were the most frequent signs; 54% experienced discomfort/pain. Topographically, buccal mucosa (68%) and gingiva (54%) were the most affected locations, followed by tongue (42%), hard palate (27%), labial mucosa (22%), and widespread involvement (15%). Great diagnostic delay (6.3 years) was evidenced highlighting CUS is an entity too often misdiagnosed. Histopathology found lichenoid features (46%) and non-specific inflammation (54%). Extra-oral involvement was reported in 21%, especially as LP (69%). Of DIF, 97% were positive; 3% negative, compensated by positive IIF, permitting diagnosis. Of patients on steroids, only 12% reported therapeutic success; most steroid-non-responsive patients passed to antimalarials, with 91.66% success when used alone, 100% success in combination therapy. CONCLUSION Dermatologists should suspect CUS in chronic steroid-unresponsive erosive/ulcerative stomatitis. In these cases, to diagnose CUS, the presence of stratified epithelium-specific antinuclear antibodies (SES-ANA) should be investigated through immunofluorescence. Once diagnosed, CUS can be treated with antimalarials, which are an effective treatment contrarily to corticosteroids.
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Affiliation(s)
- Astrid Herzum
- DISSAL, Section of Dermatology, 9246Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Martina Burlando
- DISSAL, Section of Dermatology, 9246Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Emanuele Cozzani
- DISSAL, Section of Dermatology, 9246Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Aurora Parodi
- DISSAL, Section of Dermatology, 9246Ospedale Policlinico San Martino IRCCS, Genova, Italy
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Carrozzo M, Porter S, Mercadante V, Fedele S. Oral lichen planus: A disease or a spectrum of tissue reactions? Types, causes, diagnostic algorhythms, prognosis, management strategies. Periodontol 2000 2019; 80:105-125. [PMID: 31090143 DOI: 10.1111/prd.12260] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Oral lichen planus and lichenoid lesions comprise a group of disorders of the oral mucosa that likely represent a common reaction pattern to 1 or more unknown antigens. The coexistence of hyperkeratotic striation/reticulation, varying degrees of mucosal inflammation from mild erythema to severe widespread ulceration, and a band-like infiltrate of mononuclear inflammatory cells including activated T lymphocytes, macrophages, and dendritic cells, are considered suggestive of oral lichen planus and lichenoid lesions. Several classification systems of oral lichen planus and lichenoid lesions have been attempted, although none seem to be comprehensive. In this paper, we present a classification of oral lichen planus and lichenoid lesions that includes oral lichen planus, oral lichenoid contact lesions, oral lichenoid drug reactions, oral lichenoid lesions of graft vs. host disease, discoid lupus erythematosus, and systemic lupus erythematosus, lichen planus-like variant of paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome, chronic ulcerative stomatitis, lichen planus pemphigoides, solitary fixed drug eruptions, and lichen sclerosus. We present the clinical and diagnostic aspects of oral lichen planus and lichenoid lesions, and discuss related treatment options.
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Affiliation(s)
- Marco Carrozzo
- Centre for Oral Health Research, Oral Medicine Department, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Porter
- UCL Eastman Dental Institute, University College London, London, UK
| | | | - Stefano Fedele
- UCL Eastman Dental Institute, University College London, London, UK.,NIHR University College London Hospitals Biomedical Research Centre, London, UK
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Ferrisse TM, Travassos DC, Rocha AF, Massucato EM, Bufalino A. Chronic ulcerative stomatitis: A systematic review of the clinical and microscopic features. Med Oral Patol Oral Cir Bucal 2019; 24:e698-e703. [PMID: 31655827 PMCID: PMC6901147 DOI: 10.4317/medoral.22213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 05/01/2018] [Indexed: 11/12/2022] Open
Abstract
Background the purpose of this study was to perform a systematic review regarding clinical and histopathological characteristics, immunopathological findings, and treatment for chronic ulcerative stomatitis (CUS).
Material and Methods articles in English, published from January 1962 up to November 2017, assessing clinical and immunological features, treatment, and follow-up of patientes with CUS, were retrieved from three databases (PubMed, Cochrane Library and SCOPUS). A manual literature search was also conducted. A total of 12 studies met inclusion criteria, therefore, were analyzed in this review.
Results CUS shares similiar clinical and microscopic features to those found in oral lichen planus (OLP) and oral lichenoid lesions (OLL). Hence, direct immunofluorescence (DIF) is indispensable to define a final diagnosis. Due to the poor sample availability in the current literature, it is not possible to accurately confirm the prevalence and features of CUS.
Conclusions in order to better evaluate this condition’s findings, further studies with a greater amount of similar immune-mediated diseases should be performed. Key words:Chronic ulcerative stomatitis, immune-mediated diseases, immunofluorescence, lichen planus.
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Affiliation(s)
- T-M Ferrisse
- Department of Diagnosis and Surgery Univ Estadual Paulista (UNESP) CEP 14801-903, Araraquara, Sao Paulo, Brazil
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Tikkhanarak K, Wangboo D, Sookviboonpol N, Thongprasom K. Correlation of clinicopathological characteristics and direct immunofluorescence studies in oral lichenoid lesion in Thai patients. ACTA ACUST UNITED AC 2019; 10:e12433. [PMID: 31219241 DOI: 10.1111/jicd.12433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/03/2019] [Accepted: 05/25/2019] [Indexed: 01/20/2023]
Abstract
AIM To investigate the correlation between the clinicopathological characteristics, serum antinuclear antibody (ANA) and direct immunofluorescence (DIF) findings in oral lichen planus (OLP) and oral lichenoid lesion (OLL). METHODS Fifty three Thai patients with red and white lesions were divided into 3 groups: 17 cases of OLP, 19 cases of OLL and 17 cases of oral lichenoid drug reaction (OLDR), respectively. The medical records, photographs, histopathological evaluation and laboratory ANA and DIF results were analyzed. RESULTS Atrophic pattern was the most commonly found pattern in the OLDR, OLP and OLL groups. In the OLP group, the DIF interpretation confirmed only 41.2% of cases as OLP, with 23.5% each as lichen planus (LP)/lupus erythematosus (LE) or negative findings. In the OLL group, the most common DIF interpretation (31.6% each) was LP/LE or non-specific finding. In the OLDR group, DIF interpretation was OLP or LP/LE (23.5% each), with 5.9% each of immune complex-mediated disease, compatible with OLP, and mixed connective tissue disease. Interestingly, 1 case in the OLDR group demonstrated mild to moderate dysplasia. There were no significant differences in ANA positivity or patterns between the 3 groups. CONCLUSION An OLP-like lesion could be diagnosed as OLP, OLP/LE, chronic ulcerative-like lesion, immune-mediated disease or dysplasia.
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Affiliation(s)
| | - Daras Wangboo
- Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | | | - Kobkan Thongprasom
- Oral Medicine Department, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Azzi L, Cerati M, Lombardo M, Pellilli M, Croveri F, Maurino V, Tagliabue A, Tettamanti L, Olszewska M. Chronic ulcerative stomatitis: A comprehensive review and proposal for diagnostic criteria. Oral Dis 2019; 25:1465-1491. [PMID: 30457193 DOI: 10.1111/odi.13001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/23/2018] [Accepted: 10/11/2018] [Indexed: 11/29/2022]
Abstract
Chronic ulcerative stomatitis (CUS) is an immune-mediated disorder characterized by oral erosions and ulcers usually refractory to conventional treatments. The disease often involves middle-aged and older women with painful lesions sometimes resembling those of erosive oral lichen planus (OLP). The most affected sites are the buccal mucosa, the gingiva and the tongue, but the skin is involved in 22.5% of cases. Histopathologic features in CUS are non-specific and indistinguishable from those of OLP, with the exception of the presence of a mixed infiltrate composed of lymphocytes and plasma cells. Direct immunofluorescence (DIF) analysis reveals the presence of stratified epithelium-specific antinuclear antibodies (SES-ANA) in the lower third of the epithelium. The IgG antibodies detected on DIF are directed against the ∆Np63α isoform of p63 expressed in the nuclei of the epithelial basal cells. A distinguishing feature of CUS is the low response to conventional corticosteroid therapy and the good outcome with hydroxychloroquine at the dosage of 200 mg/day or higher dosages. This paper presents a comprehensive review of CUS and is accompanied by a new case report (the 73rd case) and a proposal for updated diagnostic criteria.
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Affiliation(s)
- Lorenzo Azzi
- Unit of Oral Pathology, Dental Clinic, ASST Sette Laghi, Ospedale di Circolo, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Michele Cerati
- Unit of Anatomical Pathology, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Maurizio Lombardo
- Unit of Dermatological Diseases, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Maria Pellilli
- Unit of Anatomical Pathology, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Fabio Croveri
- Unit of Oral Pathology, Dental Clinic, ASST Sette Laghi, Ospedale di Circolo, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Vittorio Maurino
- Unit of Oral Pathology, Dental Clinic, ASST Sette Laghi, Ospedale di Circolo, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Angelo Tagliabue
- Unit of Oral Pathology, Dental Clinic, ASST Sette Laghi, Ospedale di Circolo, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Lucia Tettamanti
- Unit of Oral Pathology, Dental Clinic, ASST Sette Laghi, Ospedale di Circolo, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Seventeen New Cases of Chronic Ulcerative Stomatitis with Literature Review. Head Neck Pathol 2018; 13:386-396. [PMID: 30374883 PMCID: PMC6684677 DOI: 10.1007/s12105-018-0982-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/26/2018] [Indexed: 10/28/2022]
Abstract
Chronic ulcerative stomatitis (CUS) is a poorly understood disease with clinical and histologic overlap with lichen planus (LP). Unlike classic LP, direct immunofluorescence (DIF) studies in cases of CUS exhibit a granular pattern of IgG in nuclei of basal and parabasal cells. This study assesses the demographic, clinical, histologic, and DIF features of CUS. It is important to differentiate CUS from LP and other vesiculobullous diseases (VBD) because lesions of CUS are resistant to steroid therapy, which is typically used to control LP and VBD. A literature review and IRB-approved retrospective search of CUS was performed within the archives of the University of Florida (UF) Oral Pathology Biopsy Service from 2007 to 2017. Fifty-two cases were identified from the literature and seventeen new cases were identified in our series. All UF patients were female and the median age was 64-years. The majority of patients were Caucasian and the most common location was buccal mucosa. Frequent clinical presentations were pain, erythema, leukoplakia, and ulcerations. Histologic features included epithelial separation, atrophic epithelium, and a chronic inflammatory infiltrate. All cases were confirmed with DIF testing that showed a speckled pattern of IgG staining in basal and parabasal cell nuclei. Fibrinogen was present in eleven cases and two cases were positive for C3. The results of our series are in accordance with the literature. Since CUS has overlapping features with LP and VBD, clinicians and pathologists should consider this entity and confirm diagnosis with DIF testing when recalcitrant oral ulcerative diseases are encountered.
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9
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Ko EM, Danciu TE, Fullen DR, Chan MP. Chronic ulcerative stomatitis: Case series of an under-recognized entity. J Cutan Pathol 2018; 45:927-932. [DOI: 10.1111/cup.13347] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/14/2018] [Accepted: 08/28/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Eugene M. Ko
- Department of Periodontics and Oral Medicine, School of Dentistry; University of Michigan; Ann Arbor Michigan
- Department of Oral Medicine, School of Dental Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| | - Theodora E. Danciu
- Department of Periodontics and Oral Medicine, School of Dentistry; University of Michigan; Ann Arbor Michigan
| | - Douglas R. Fullen
- Department of Pathology; University of Michigan; Ann Arbor Michigan
- Department of Dermatology; University of Michigan; Ann Arbor Michigan
| | - May P. Chan
- Department of Pathology; University of Michigan; Ann Arbor Michigan
- Department of Dermatology; University of Michigan; Ann Arbor Michigan
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10
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Clinicopathologic significance of in vivo antinuclear autoantibodies in oral mucosal biopsies. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:475-482. [PMID: 28939244 DOI: 10.1016/j.oooo.2017.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022]
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Feller L, Khammissa RAG, Lemmer J. Is chronic ulcerative stomatitis a variant of lichen planus, or a distinct disease? J Oral Pathol Med 2017; 46:859-863. [PMID: 28186659 DOI: 10.1111/jop.12561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 12/31/2022]
Abstract
Chronic ulcerative stomatitis is an immune-mediated mucocutaneous disorder characterized clinically by erosions or ulcers. Most cases are limited to the mouth. The histopathological features are non-specific or mimic those of oral lichen planus, and studies by immunofluorescent microscopy are essential for definitive diagnosis. The defining immunopathogenic mechanism is the binding of IgG to the nuclear protein deltaNp63alpha of keratinocytes in the basal and parabasal cell layers of the oral stratified epithelium. DeltaNp63alpha functions as a regulator of epithelial stem cell activity and as an antiapoptotic agent and regulates the expression of cell-to-cell and cell-to-basement membrane adhesion molecules. The autoimmune IgG-deltaNp63alpha interaction is thought to result in damage to the structural attachment of keratinocytes to one another and to the epithelial basement membrane zone and in dysregulation of the cell cycle and apoptosis of basal keratinocytes with the development of erosions or ulcers. The aims of treatment are to suppress the pathogenic immunoinflammatory responses, to prevent local infection and to promote healing. The purpose of this article is to provide a succinct review of the diagnostic, clinical and etiopathogenic features of, and treatment guidelines for chronic ulcerative stomatitis, and to argue that this disease should be regarded as a variant of oral lichen planus, rather than as a distinct entity.
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Affiliation(s)
- Liviu Feller
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Razia A G Khammissa
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Johan Lemmer
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Qari H, Villasante C, Richert J, Rees T, Kessler H. The diagnostic challenges of separating chronic ulcerative stomatitis from oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:622-7. [DOI: 10.1016/j.oooo.2015.07.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 07/03/2015] [Accepted: 07/13/2015] [Indexed: 11/16/2022]
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Mustafa MB, Porter SR, Smoller BR, Sitaru C. Oral mucosal manifestations of autoimmune skin diseases. Autoimmun Rev 2015; 14:930-51. [PMID: 26117595 DOI: 10.1016/j.autrev.2015.06.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023]
Abstract
A group of autoimmune diseases is characterised by autoantibodies against epithelial adhesion structures and/or tissue-tropic lymphocytes driving inflammatory processes resulting in specific pathology at the mucosal surfaces and the skin. The most frequent site of mucosal involvement in autoimmune diseases is the oral cavity. Broadly, these diseases include conditions affecting the cell-cell adhesion causing intra-epithelial blistering and those where autoantibodies or infiltration lymphocytes cause a loss of cell-matrix adhesion or interface inflammation. Clinically, patients present with blistering, erosions and ulcers that may affect the skin as well as further mucosal surfaces of the eyes, nose and genitalia. While the autoimmune disease may be suspected based on clinical manifestations, demonstration of tissue-bound and circulating autoantibodies, or lymphocytic infiltrates, by various methods including histological examination, direct and indirect immunofluorescence microscopy, immunoblotting and quantitative immunoassay is a prerequisite for definitive diagnosis. Given the frequency of oral involvement and the fact that oral mucosa is the initially affected site in many cases, the informed practitioner should be well acquainted with diagnostic and therapeutic aspects of autoimmune dermatosis with oral involvement. This paper reviews the pathogenesis and clinical presentation of these conditions in the oral cavity with a specific emphasis on their differential diagnosis and current management approaches.
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Affiliation(s)
- Mayson B Mustafa
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; Oral medicine section, Department of Oral and Maxillofacial Surgery, University of Khartoum, Faculty of Dentistry, Khartoum, Sudan
| | | | - Bruce R Smoller
- Department of Pathology, University of Rochester, School of Medicine and Dentistry, USA
| | - Cassian Sitaru
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; BIOSS Centre for Biological Signalling Studies, Signalhaus Freiburg, Schänzlestr. 18, 79104 Freiburg, Germany.
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Khudhur AS, Di Zenzo G, Carrozzo M. Oral lichenoid tissue reactions: diagnosis and classification. Expert Rev Mol Diagn 2014; 14:169-84. [DOI: 10.1586/14737159.2014.888953] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Bhattacharyya I, Kramer JM. Clinical pathologic conference case 5: Unusual severe glossitis. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:e46-9. [PMID: 23738346 DOI: 10.1016/j.oooo.2013.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Suresh L, Neiders ME. Definitive and Differential Diagnosis of Desquamative Gingivitis Through Direct Immunofluorescence Studies. J Periodontol 2012; 83:1270-8. [DOI: 10.1902/jop.2012.110627] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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17
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Ahmed Haji Omar A, Hietanen J, Kero M, Lukinmaa PL, Hagström J. Oral lichen planus and chronic junctional stomatitis: differences in lymphocyte subpopulations. Acta Odontol Scand 2012; 67:366-9. [PMID: 19626466 DOI: 10.1080/00016350903136605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Oral lichen planus (OLP) is an oral counterpart or oral manifestation of the common skin disease lichen planus. Chronic junctional stomatitis (CJS) is a relatively unknown condition characterized by a stromal lymphocyte infiltrate, which is also a diagnostic feature of OLP. The differential diagnosis of OLP and CJS is unclear and they have been suggested to represent variants of the same disease. MATERIAL AND METHODS To investigate possible differences in lymphocyte (sub)populations between these two conditions, we immunostained 10 OLP and 10 CJS specimens for CD1-a, and the lymphocyte markers, CD3, CD4, CD5, CD8, and CD20. We scored the staining results by a four-step grading system and used the Fisher exact test to analyze them statistically. RESULTS The proportional amount of (CD20 positive) B lymphocytes was higher in CJS than in OLP and the predominance of CD4 positive T lymphocytes over CD8 positive T lymphocytes was stronger in OLP than in CJS. The differences were statistically significant. CONCLUSION The results reflect differences in the lymphatic infiltrate between OLP and CJS. Their significance needs further investigation.
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18
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Woo SB. Diseases of the oral mucosa. MCKEE'S PATHOLOGY OF THE SKIN 2012:362-436. [DOI: 10.1016/b978-1-4160-5649-2.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Carlson MW, Garlick JA, Solomon LW. Chronic ulcerative stomatitis: evidence of autoimmune pathogenesis. ACTA ACUST UNITED AC 2011; 111:742-8. [DOI: 10.1016/j.tripleo.2010.12.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 12/02/2010] [Accepted: 12/29/2010] [Indexed: 11/29/2022]
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20
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Binmadi NO, Jham BC, Meiller TF, Scheper MA. A case of a deeply fissured tongue. ACTA ACUST UNITED AC 2010; 109:659-63. [PMID: 20416535 DOI: 10.1016/j.tripleo.2010.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 01/26/2010] [Accepted: 01/26/2010] [Indexed: 01/15/2023]
Affiliation(s)
- Nada O Binmadi
- Department of Oncology and Diagnostic Sciences, Dental School, University of Maryland, Baltimore, Baltimore MD, USA.
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21
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Edwards PC, Hess S, Saini T, Norton N. Twenty-eight-year-old woman with recent onset of painful oral erosions. J Oral Maxillofac Surg 2010; 68:1890-5. [PMID: 20417592 DOI: 10.1016/j.joms.2009.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Accepted: 06/30/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Paul C Edwards
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA.
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Solomon LW, Stark PC, Winter L, Kumar V, Sinha S. ELISA test for p63 antibodies in chronic ulcerative stomatitis. Oral Dis 2010; 16:151-5. [DOI: 10.1111/j.1601-0825.2009.01606.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lo Russo L, Fedele S, Guiglia R, Ciavarella D, Lo Muzio L, Gallo P, Di Liberto C, Campisi G. Diagnostic Pathways and Clinical Significance of Desquamative Gingivitis. J Periodontol 2008; 79:4-24. [PMID: 18166088 DOI: 10.1902/jop.2008.070231] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Solomon LW, Neiders ME, Zwick MG, Kirkwood KL, Kumar V. Autoimmunity to deltaNp63alpha in chronic ulcerative stomatitis. J Dent Res 2007; 86:826-31. [PMID: 17720849 DOI: 10.1177/154405910708600904] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic ulcerative stomatitis (CUS) is a recently described mucocutaneous condition in which patients experience chronic, painful, ulcerative lesions of the oral mucosa. CUS is diagnosed by immunofluorescence studies that demonstrate antinuclear antibodies. These autoantibodies are specific for a protein, deltaNp63alpha, which is normally expressed in basal cell nuclei of stratified squamous epithelia. The purpose of this study was to characterize the autoimmune response in CUS. Protein antigens were produced by in vitro transcription/translation of polymerase chain-reaction (PCR)-amplified cDNAs. We used immunoblotting and immunoprecipitation experiments with serum from CUS patients to examine the (1) antibody isotype, (2) immunogenic functional domains of the deltaNp63alpha antigen, and (3) cross-reactivity with homologous p53, p73, and p63 proteins. Results demonstrate CUS patient antibodies to deltaNp63alpha, and 52% of cases have circulating IgA isotype antibodies. The N-terminal and DNA-binding domains are the immunodominant regions, and antibody cross-reactivity with p53, p63, and p73 isoforms is limited.
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Affiliation(s)
- L W Solomon
- Department of Oral and Maxillofacial Pathology, School of Dental Medicine, Tufts University, Boston, MA 02111-1527, USA.
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Rinaggio J, Crossland DM, Zeid MY. A Determination of the Range of Oral Conditions Submitted for Microscopic and Direct Immunofluorescence Analysis. J Periodontol 2007; 78:1904-10. [DOI: 10.1902/jop.2007.070095] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Islam MN, Cohen DM, Ojha J, Stewart CM, Katz J, Bhattacharyya I. Chronic ulcerative stomatitis: Diagnostic and management challenges—four new cases and review of literature. ACTA ACUST UNITED AC 2007; 104:194-203. [PMID: 17560144 DOI: 10.1016/j.tripleo.2007.02.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 02/12/2007] [Accepted: 02/23/2007] [Indexed: 01/20/2023]
Abstract
Chronic ulcerative stomatitis (CUS) is a recently described mucocutaneous disease characterized by involvement of mucosal surfaces and skin. The disease usually presents in the form of painful oral ulcers and has been seen predominantly among older women. Clinically, CUS patients may exhibit erosive or ulcerative lesions of oral mucosa resembling erosive lichen planus and/or other vesiculobullous lesions. Routine histology may exhibit features of lichenoid mucositis and is often nondiagnostic. Direct immunofluorescence studies of mucosal or skin biopsies usually reveal a unique pattern of IgG bound to nuclei of keratinocytes of the basal and parabasal cell layers. Chronic ulcerative stomatitis exhibits a unique resistance to standard treatments available, including topical and systemic corticosteroids and immunomodulatory medications. However, long-lasting favorable clinical responses may be achieved with hydroxychloroquine pharmacotherapy. We present the clinicoimmunopathologic findings of four cases of CUS and discuss the varied clinical, microscopic spectrum, and treatment for this chronic, debilitating, and often recalcitrant condition. A systematic review of the literature, including 35 previously reported cases, is presented.
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Affiliation(s)
- M N Islam
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL 32610, USA
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Ebrahimi M, Wahlin YB, Coates PJ, Wiik A, Roos G, Nylander K. Detection of antibodies against p63 and p73 isoforms in sera from patients diagnosed with oral lichen planus. J Oral Pathol Med 2007; 36:93-8. [PMID: 17238971 DOI: 10.1111/j.1600-0714.2007.00504.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Oral lichen planus (OLP) is a chronic inflammatory disease of oral mucosa. Despite numerous publications and intense research, the etiology of OLP is still unknown, however, autoimmunity as a possible causative factor has been discussed. METHODS In the present study sera from 20 patients clinically and histologically diagnosed with OLP were analyzed for antibodies directed toward p53, p63, and p73 using Western blot. RESULTS Sera from two patients reacted with all six p63 isoforms, and one also with p73. The strongest reaction was noted against the TAp63beta protein, which is the most potent transactivator of all p63 proteins and is implicated in the differentiation of stratified epithelia. CONCLUSIONS This is the first demonstration of antibodies directed against all p63 and some p73 isoforms in sera from patients diagnosed with OLP.
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Affiliation(s)
- Majid Ebrahimi
- Department of Odontology, Umeå University, Umeå, Sweden.
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