Oral mucosal lichen planus in children

Clinical Characteristics, Identification, and Treatment of Lichen Planus: A Case Report

Women are primarily affected by lichen planus, a chronic autoimmune skin and mucosal disorder in their 40s to 60s. Medication, systemic disorders, and mental stress are some of the factors that can cause it, though the precise cause is still unknown. Middle-aged females are the main victims of the disease; children are rarely affected. Oral lichen planus (OLP) is less common in atrophic and erosive forms. There is disagreement over whether OLP causes cancer; therefore physicians need to keep a close watch for any intraoral lichenoid lesions, and patients with OLP are advised to follow up regularly. This case report details a 52-year-old woman's right buccal mucosa and tongue affected by reticular lichen planus.

Childhood oral lichen planus: a case series with review of literature

BACKGROUND

Oral Lichen Planus (OLP) is a chronic autoimmune mucocutaneous condition, the exact etiology of which is still unknown. It is known to occur chiefly in adults and has a reported prevalence of 0.5-2% in general population and < 2-3% of total in pediatric population. OLP is considered as Oral Potentially Malignant Disorder with a malignant transformation rate of 1-2% in adults. Its occurrence in children is a rare finding with few cases reported in the literature. As a result, it gets misdiagnosed by the general practitioner and hence, there is a need to consider OLP in differential diagnosis of white lesions of oral cavity even in children. Therefore, in this paper, we present six cases of childhood OLP along with their management and follow-up.

CASE SERIES

We present here six patients aged between 11 and 13 years who presented either as incidental finding or as symptomatic lesions and were diagnosed with OLP. Symptomatic patients were treated with topical steroid ointment and both the symptomatic and asymptomatic patients were followed-up. We have also presented literature review of childhood OLP reported in PubMed, Medline and google scholar from 1980 till December 2020.

CONCLUSION

OLP is unusual in children and is often left untreated due to low awareness among the patients. Can be often misdiagnosed and should be considered in differential diagnosis of any white lesion of oral cavity. Any such lesions must be correctly diagnosed in time to institute appropriate management and follow-up.

Association of childhood vaccination with pediatric lichen planus: A systematic review

Lichen planus (LP) is a chronic T-cell-mediated mucocutaneous inflammatory disease, largely recognized in adults. It is uncommon in children, and the literature present still lacks comprehensive understanding mainly due to underreporting of such cases. LP shows atypical clinical features, when seen in children, mainly affecting the flexor aspect of the wrists, legs, and the oral and genital mucosae. It is largely considered an autoimmune response of the body with various etiologic factors. Its association with vaccination is still an interesting field for research. The focus of the present systematic review was to discover the link of vaccine in the pathogenesis of juvenile LP. An electronic search was carried out using MEDLINE by PubMed, Google Scholar, and Web of Science databases. Articles that reported LP in children with prior records for vaccination were selected for the present systematic review. Twenty-three published articles in the English language were included for the quantitative and qualitative syntheses. The demographic data, specific vaccine history, and clinical details of the lesions were recorded. The existing evidence supports that vaccines could play an important role in etiopathogenesis of pediatric LP.

Familial oral lichen planus in a 3-year-old boy: a case report with eight years of follow-up

BACKGROUND

Oral lichen planus (OLP) is a chronic mucocutaneous disease characterized by adult predominance and a prolonged course. However, it is rare in the pediatric population with familial aggregation.

CASE PRESENTATION

A 3-year-old boy presented with pain and irritation on the oral mucosa while contacting spicy food for 2 months. Oral examination showed widespread whitish reticular and papular lesions on the lips, the dorsum of the tongue, and bilateral buccal mucosa, with diffuse erosions covered with pseudomembrane on the buccal mucosa. The boy's parents were examined to exhibit white reticular and plaque-like lesions on their oral mucosa. The three patients were clinically diagnosed as affected by OLP and histopathologically confirmed. The boy underwent topical treatment with recombinant bovine basic fibroblast growth factor (rb-bFGF) gel, and oral lesions gradually resolved and healed. Neither of his parents received treatment. During the subsequent follow-ups, none of three patients underwent any medical treatment. Fortunately, their lesions had almost faded over 8 years.

CONCLUSIONS

Our case emphasizes that pediatric OLP should be recorded with family history. Besides, long-term periodic follow-up is recommended in pediatric patients with OLP for monitoring any changes in lesions.

Oral Lichen Planus in a 7-year-old Child: A Rare Case Report

Lichen planus is a chronic inflammatory mucocutaneous disease reported most frequently in adults and relatively rare in children with the prevalence being 0.03%. This article reports a case of oral lichen planus (OLP) in a 7-year-old girl without any attendant skin lesions, diagnostic workup, and management protocol for the same. This article also emphasizes the need to consider OLP as a differential diagnosis for white lesions of oral mucosa in children.

How to cite this article: Chinnasamy NK, Venugopal DC, Sankarapandian S, et al. Oral Lichen Planus in a 7-year-old Child: A Rare Case Report. Int J Clin Pediatr Dent 2020;13(1):91–93.

Salivary Level of Trace Element in Oral Lichen Planus, A Premalignant Condition

Background:

Oral Lichen Planus (OLP) is a common inflammatory disease of unknown cause that knows also as a premalignant condition. Recent studies contributed nutritional factors to the pathogenesis of many autoimmune disorders. Objective: The aim of present study was to investigate the salivary levels of Magnesium (Mg), Calcium (Ca), Iron (Fe), Zinc (Zn) and Copper (Cu) in this disorder.

Materials and Methods:

In this observational case-control study, the unstimulated saliva of 40 patients with OLP and 40 age and sex matched healthy control subjects were collected. The salivary levels of Mg, Ca, Fe, Zn and Cu were determined using ICP-AES.

Results:

Mg levels were significantly lower in OLP patients than in healthy controls, although it didn’t differ significantly between erosive and non-erosive types of Lichen Planus. Also there was no meaningful relationship between the levels of Ca, Fe, Zn and Cu in case and control groups.

Conclusion:

Trace elements such as Mg may have a role in ethiopathogenesis of OLP.

Prevalence of oral lichen planus in Iranian children and adolescents: a 12-year retrospective study

AIM

To investigate the prevalence of oral lichen planus in patients younger than 18 years, referred to a dermatology centre in Iran during 2002-2014. Lichen planus is a chronic inflammatory, immune-mediated disease that could affect the oral mucosa and is a pre-cancerous condition. The disease usually develops in middle age with female predominance and is rare in children.

METHODS

In this retrospective study, cases with definitive histopathologic diagnosis of lichen planus, over a 12-year period from 2002 to 2014 from a dermatologic hospital archive were evaluated. The prevalence of both cutaneous and oral lichen planus, the male:female ratio and site of involvement were calculated using SPSS version 21.

RESULTS

Thirty-six of 564 patients younger than 18 years old diagnosed with lichen planus. Two females (0.4%) had oral lichen planus. One patient had erosive, and one had bullous, oral lichen planus.

CONCLUSION

Oral lichen planus had a very low frequency in Iranian population younger than 18 years old, identifying these patients is recommended for long-term follow-up.

Oral lichen planus in childhood: a case series

BACKGROUND

Although the exact incidence of pediatric oral lichen planus (OLP) is unknown, the oral mucosa seems to be less commonly involved, and the clinical presentation is often atypical. The aim of the study is to present a case series of OLP in childhood.

METHODS

From our database, we retrospectively selected and analyzed the clinical data of OLP patients under the age of 18 where the diagnosis had been confirmed by histopathological analysis.

RESULTS

The case series from our database shows eight patients, four males and four females. The mean (±SD) age at the time of diagnosis of the disease was 13.5 (±2.73) years, ranging in age from 9 to 17. Clinically, a reticular pattern was present in six patients (75%), and the tongue was the most commonly involved oral site (six cases, 75%). We also report the first case of OLP in a 9-year-old girl affected by autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy.

CONCLUSIONS

We report the largest case series of pediatric OLP published in literature thus far. Differences in the disease between adults and pediatric patients have been detected, but further investigation and a larger case series are needed to establish any detailed differences in clinical outcomes.

Molecular markers in oral lichen planus: A systematic review

Oral lichen planus (OLP) is a chronic inflammatory mucosal disease that is usually detected in 0.5–2.2% of the human population. Among these, only 0.5–2.9% of the lesions progress to carcinoma. However, there are no prognostic markers available presently to recognize the increased risk in malignant transformation of the lesions. Selected markers for cell proliferation, adhesion, apoptosis and lymphocytic infiltration were analyzed by immunohistochemistry in addition to static cytometry for DNA content. The concept linking OLP and oral squamous cell carcinoma states that chronic inflammation results in crucial DNA damage, which further progresses to development of carcinoma. Even though in the past decade, enormous information has been accumulated on malignant potential of OLP, its transformation still remains unclear. Hence, the purpose of this article was to review cellular and molecular markers to understand the pathogenesis of OLP and its progression toward malignancy.

Photodynamic therapy in treatment of oral lichen planus

Oral lichen planus (OLP) is a relatively common chronic immunologic mucocutaneous disorder. Although there are many presenting treatments, some of them proved its failure. Recently, the use of photodynamic therapy (PDT) has been expanding due to its numerous advantages, as it is safe, convenient, and non-invasive and has toxic effect towards selective tissues. This article provides comprehensive review on OLP, its etiology, clinical features and recent non-pharmacological treatments. We also describe the topical PDT and its mechanisms. Our purpose was to evaluate the efficacy of PDT in treatment of OLP through collecting the data of the related clinical studies. We searched in PubMed website for the clinical studies that were reported from 2000 to 2014 using specific keywords: "photodynamic therapy" and "treatment of oral lichen planus". Inclusion criteria were English publications only were concerned. In the selected studies of photodynamic treatment, adult patients (more than 20 years) were conducted and the OLP lesions were clinically and histologically confirmed. Exclusion criteria were classical and pharmacological treatments of OLP were excluded and also the using of PDT on skin lesions of lichen planus. We established five clinical studies in this review where all of them reported improvement and effectiveness of PDT in treatment of OLP lesions. The main outcome of comparing the related clinical studies is that the photodynamic is considered as a safe, effective and promising treatment modality for OLP.

Ulcerative lichen planus in childhood

Lichen planus (LP) is a chronic inflammatory mucocutaneous condition which is relatively common in adults but rarely affects children. The present study is a report on an unusual case of ulcerative oral LP involving the dorsum of tongue in a 12-year-old boy. Patient complained of painful oral lesion on the tongue which was burning in nature and obstructing talking and eating spicy foods. On intraoral examination, a white ulcerative lesion on the dorsum of tongue was observed. Diagnosis was made based on clinical examination and histopathological features. We instituted local treatment and patient responded well to the treatment. Although rarely reported in childhood, lichen planus should be considered in a differential diagnosis of hyperkeratotic, reticular, and ulcerative lesions of the oral mucosa in children.

Demographic and clinical profile of oral lichen planus: A retrospective study

Introduction:

Oral lichen planus (OLP) is a relatively common inflammatory mucocutaneous disorder that frequently involves the oral mucosa. The clinical presentation of OLP ranges from mild painless white keratotic lesions to painful erosions and ulcerations. An important complication of OLP is the development of oral squamous cell carcinoma, which led the World Health Organization (WHO) to classify OLP as a potentially malignant disorder. The demographic and clinical characteristics of OLP have been well-described in several relatively large series from developed countries, whereas such series from developing countries are rare.

Objective:

The objective of this retrospective study was to investigate the epidemiological and clinical characteristics of 128 OLP patients in rural population of India.

Materials and Methods:

In this study, the diagnostic criteria proposed by van der Meij et al. in 2003 based on the WHO definition of OLP were used to identify cases.

Results:

In 128 patients, M:F ratio was 1.61:1. The buccal mucosa was the most common site (88.20%). White lichen was seen in 83.59% and red lichen in 16.40% cases. Reticular type of OLP was the most common form (83.5%) followed by erosive (15.6%) and atrophic OLP (0.78%). The incidence of systemic diseases included hypertension (11%), diabetes mellitus (2.4%), and hypothyroidism (0.78%). Histopathologically epithelial dysplasia was present in 4 cases.

Conclusion:

Most of the characteristics are consistent with previous studies with differences in few. Lichen planus is a chronic disease where treatment is directed to control of symptoms. Long-term follow-up is essential to monitor for symptomatic flare ups and possible malignant transformation.

Oral lichen planus in a young Indian child

Lichen planus (LP) is one of the most distinct mucocutaneous diseases. It is common with the middle aged and elderly population but has rarely been described in children. Incidences of oral LP in children is most commonly reported amongst Asians. We present a 10-year-old Indian girl with the documented clinical aspects and histopathological studies.

Oral lichen planus and dental hygiene: a case report

BACKGROUND

The presence of atrophic-erosive lesions among gingival tissues makes oral hygiene procedures difficult for several reasons. Plaque control and rigorous oral hygiene are a fundamental requisite for the treatment of any oromucosal disease.

CASE REPORT

A patient suffering from a mixed atrophic-erosive form of oral lichen planus (OLP), with serious gingival involvement, was also treated with the topical application of clobetasol propionate 0.05% using gingival trays. The highest hygiene standards of both patient and trays were of fundamental importance.

DISCUSSION

The management of the patient suffering from gingival atrophic-erosive OLP requires the synergic treatment of both dentist and dental hygienist, whose contribution supports the corticosteroid and/or immunosuppressive treatment.

Oral lichenoid drug eruption: a report of a pediatric case and review of the literature

Lichenoid drug eruptions are seen most frequently on the skin and seldomly affect the mucosal surfaces. Oral involvement-known as oral lichenoid drug eruption-is more common in the adult population and has been associated with numerous medications. Pediatric-onset oral lichenoid drug eruption is an exceptionally rare finding with only isolated cases published in the literature. The nonspecific appearance and latent presentation of pediatric oral lichenoid drug eruption can cause confusion in diagnosis and treatment. We report a case of oral lichenoid drug eruption occurring in a 15-year-old and explore challenges in the clinical and histologic recognition of this condition.

Oral lichen planus in children

Oral lichen planus which is one of the most common oral mucosal diseases in adults, it has been rarely described in children. There are very reports in the literature regarding oral lichen planus in children, here we report a case of intraoral lesions of lichen planus. Lichen planus should be considered in the differential diagnosis of hyperkeratotic or erosive lesions of the oral mucosa in children.

Number V Oral lichen planus: clinical features and management

Oral lichen planus (OLP) is a relatively common chronic inflammatory disorder affecting stratified squamous epithelia. Whereas in the majority of instances, cutaneous lesions of lichen planus (LP) are self-limiting and cause itching, oral lesions in OLP are chronic, rarely undergo spontaneous remission, are potentially premalignant and are often a source of morbidity. Current data suggest that OLP is a T cell-mediated autoimmune disease in which auto-cytotoxic CD8+ T cells trigger apoptosis of oral epithelial cells. The characteristic clinical aspects of OLP may be sufficient to make a correct diagnosis if there are classic skin lesions present. An oral biopsy with histopathologic study is recommended to confirm the clinical diagnosis and mainly to exclude dysplasia and malignancy. The most commonly employed and useful agents for the treatment of lichen planus (LP) are topical corticosteroids but other newer agents are available.

Oral lichen planus in childhood

Oral lichen planus is rare in childhood, and only a few reports on this subject have appeared in the literature. Our objective was to report individual cases of oral lichen planus in childhood from our practice and to review the literature on this subject. We recruited patients younger than 18 years with oral lichen planus and documented several clinical aspects, the histopathology, patch tests, and blood examination findings. Three patients from about 10,000 dermatology patients younger than 18 years seen from 1994 to 2003 were included. Of these three, an Asian girl aged 11 years had an asymptomatic, hyperkeratotic variant of oral lichen planus, which disappeared without any treatment after 1 year. An Asian boy aged 16 years had an erosive oral lichen planus with severe pain, which healed after intensive local and systemic treatment in 2 years. A Caucasian girl aged 14 years had a hyperkeratotic variant with a little soreness, which disappeared with local treatment after 3 months. Our findings indicated that oral lichen planus in childhood is rare and therefore at present it is not possible to draw firm conclusions considering its nature and etiology. Oral lichen planus in childhood seems to occur preferentially in those of Asian race. The clinical features resemble those of oral lichen planus in adults. However, generally the prognosis of oral lichen planus in childhood seems to be more favorable than in adults.

Oral lichen planus in childhood: a report of three cases

Lichen planus is a common mucocutaneous condition in which the occurrence of oral lesions has been cited as between 0.5 and 1.9% of the adult population. It is rare in childhood. Here we report three cases of children with intra oral lesions of lichen planus. Lichen planus, although reportedly rare in childhood, should be considered in the diagnosis of hyperkeratotic or erosive lesions of the oral mucosa in children.

Position Paper: Oral Features of Mucocutaneous Disorders

Part of periodontology involves the diagnosis and treatment of a variety of non-plaque-related diseases of the periodontium. The International Workshop for a Classification of Periodontal Diseases and Conditions noted that the periodontist may be called upon to manage non-plaque-related mucocutaneous disorders either alone, or as part of a treatment team consisting of physicians, dentists or other allied health care professionals. This informational paper will review the etiology, clinical manifestations, diagnosis, and treatment of the most common chronic mucocutaneous diseases, including those that may present as desquamative gingivitis or intraoral vesiculobullous lesions. This paper is intended for the use of periodontists and other members of the dental profession.

The clinical manifestations and treatment of oral lichen planus

The progress in research on OLP and other autoimmune diseases has been significant. Coupled with a growing recognition of the clinical features and treatment options by dentists and physicians and fueled by the advances in immunosuppressive therapies, research will undoubtedly provide new insights into this complex disorder. It is likely that what is learned will enhance the understanding not only of OLP but also of many other mucocutaneous diseases.