Emotional assessment of patients with oral lichen planus

What can we learn from treatments of oral lichen planus?

Oral lichen planus (OLP), a T-lymphocyte-mediated disease of the oral mucosa, has a complex pathogenesis that involves a number of factors. The disease is characterized by recurrent episodes and requires continuous follow up, and there is no curative treatment available. Erosive lichen planus, among others, has a risk of malignant transformation and requires standardized treatment to control its progression. Different clinical subtypes of oral lichen planus require appropriate treatment. Pharmacological treatments are the most widely available and have the greatest variety of options and a number of novel pharmacological treatments are presented as highlights, including JAK enzyme inhibitors. The second is photodynamic therapy, which is the leading physiological treatment. In addition, periodontal treatment and psychological treatment should not be neglected. In this review, we briefly discuss the most recent developments in therapies for oral lichen planus after summarizing the most widely used clinical treatments, aiming to provide different proposals for future clinical treatment.

Psychological Functioning of Women Diagnosed with Lichen Planus and Other Diseases of the Oral Cavity-Explorative Study

The role of psychosocial factors in the development of changes in lichen planus and other diseases of the oral cavity has been implicated, but is still understudied. Therefore, the aim of our study was to describe the specific profile of psychological functioning of patients with these diseases, including the role of temperamental traits, action-oriented personality components, and self-esteem. In total, 94 adult women participated in the study: (1) with lichen planus (LP; n = 46; M_age = 54.80, SD = 12.53), (2) with other oral conditions (n = 25; M_age = 34.76, SD = 16.03), (3) without chronic disease (n = 24; M_age = 40.96, SD = 13.33). The following questionnaires were used: ZKA-PQ/SF, Polish Adaptive and Maladaptive Perfectionism Questionnaire, ACS-90, PROCOS, and MSEI. Results indicated no significant differences in temperament dimensions between studied groups. However, women diagnosed with LP presented lower levels of maladaptive perfectionism and social support than healthy women. Furthermore, women with LP also obtained lower scores for social resourcefulness and higher scores for moral self-approval than healthy women. Summarizing, patients with LP often use compensatory mechanisms that negatively affect their social functioning; thus diagnostic/therapeutic programs directed towards those group should be holistic, including psychologists and psychiatrists who support patients' psychological well-being.

Quality of life in patients with oral potentially malignant disorders: oral lichen planus and oral epithelial dysplasia

OBJECTIVE

The aim of this study was to evaluate and compare quality of life (QoL) parameters in patients with oral potential malignant disorders (OPMDs), namely, oral lichen planus (OLP) and oral epithelial dysplasia (OED).

STUDY DESIGN

A cross-sectional study was completed at the oral maxillofacial surgery/oral medicine practices at University of Pennsylvania. Patients with clinical and histopathologic confirmation of OLP or OED from January to June 2021 were included in the study. The primary predictor variable was the OPMD type. The primary outcome variable was the score of 3 separate surveys: the Chronic Oral Mucosal Disease Questionnaire-26 (COMDQ-26), Oral Potential Malignant Disorder QoL Questionnaire (OPMDQoL), and Hospital Anxiety and Depression Scale. Multiple linear regression was used to determine independent predictors of increased/decreased questionnaire scores.

RESULTS

The final study sample consisted of 100 patients:53 patients had OLP (53.0%), 39 patients had OED (39.0%), and 8 patients had OLP with OED (8.0%). Relative to OED, OLP added 15.7 points to the COMDQ-26 survey score (P < .001). Relative to OED, OLP added 8.9 points to the OPMDQoL survey score (P = .003).

CONCLUSIONS

Oral lichen planus shows significantly poorer QoL specifically within the COMD-26 and OPMDQoL questionnaires, compared with OED. Additionally, patients with OPMDs aged 40 to 64 years were independently associated with higher COMD-26 scores compared with older patients (>65 years).

French guidelines for the management of oral lichen planus (excluding pharmacological therapy)

INTRODUCTION

Oral lichen is a chronic inflammatory disease for which diagnostic management and follow-up are heterogeneous given the absence of specific guidelines in France. Our objective was to develop French multidisciplinary guidelines for the management of oral lichen.

MATERIALS AND METHODS

Working groups from the Groupe d'Etude de la Muqueuse Buccale (GEMUB) formulated a list of research questions and the corresponding recommendations according to the "formal consensus" method for developing practice guidelines. These recommendations were submitted to a group of experts and the degree of agreement for each recommendation was assessed by a scoring group.

RESULTS

Twenty-two research questions, divided into 3 themes (nosological classification and initial assessment, induced oral lichenoid lesions, and follow-up) resulted in 22 recommendations. Initial biopsy for histology is recommended in the absence of reticulated lesions. Biopsy for direct immunofluorescence is recommended for ulcerated, erosive, bullous types and for diffuse erythematous gingivitis. Management should include a periodontal and dental check-up, and investigation for extra-oral lesions. Hepatitis C testing is recommended only if risk factors are present. Definitions, triggering factors and the management of "induced oral lichenoid lesions" were clarified. Oral lichen must be monitored by a practitioner familiar with the disease at least once a year, using objective tools.

CONCLUSION

This formalised consensus of multidisciplinary experts provides clinical practice guidelines on the management and monitoring of oral lichen.

Risk of anxiety and depression in patients with lichen planus: A nationwide population-based study

BACKGROUND

This study aims to determine the risk of developing anxiety and/or depression among patients with lichen planus.

METHODS

Based on the Longitudinal Health Insurance Database of Taiwan National Health Insurance Research Database, a total of 4012 patients with lichen planus and 16,048 matched controls (1:4) were enrolled between January 1, 2000, and December 31, 2015. After controlling for the risk variables, multivariate Cox proportional hazard regression and the log-rank test with Kaplan-Meier method were performed to assess the influence of anxiety/depression among individuals with lichen planus under a maximum follow-up period of 16 years.

RESULTS

The subsequent anxiety or depression incidence of the lichen planus group and the comparisons was 19.67% (1962.70 per 10⁵ person-years) and 10.11% (982.23 per 10⁵person-years), respectively. Additionally, after adjustment of the risk variables, the hazard ratios for anxiety, depression, anxiety without depression, depression without anxiety, anxiety or depression, and both anxiety and depression combined were 1.779 (95%CI: 1.289-2.477, p < 0.001), 2.010 (95%CI: 1.454-2.790, p < 0.001), 2.015 (95%CI: 1.463-2.799, p < 0.001), 2.356 (95%CI: 1.705-3.286, p < 0.001), 2.011 (95%CI: 1.457-2.793, p < 0.001), and 1.515 (95%CI: 1.100-2.134, p < 0.001), respectively.

LIMITATIONS

Individuals with lichen planus were unable to be classified into oral subtype and cutaneous subtype based on the ICD-9-CM. Moreover, the results of our study could not demonstrate the mechanism between lichen planus and anxiety and/or depression.

CONCLUSION

Patients with lichen planus was positively associated with developing anxiety or depression. Physicians should to be aware of the signs of anxiety and/or depression while facing the patients with lichen planus during the clinical practices.

Analysis of the psychopathological profile, quality of life, and cost-effectiveness of oral lichen planus patients treated with photobiomodulation

OBJECTIVES

To evaluate the effect of PBM on the psychological profile and quality of life of patients with oral lichen planus (OLP) in comparison to corticoid and to investigate the cost-effectiveness of both treatments.

MATERIALS AND METHODS

Patients were randomized into two groups: Control (clobetasol propionate 0.05%) and Photobiomodulation (660 nm, 100mW, 177 J/cm², 5 s, 0.5 J) twice a week for 30 days. The Hospital Anxiety and Depression Scale (HADS) and OHIP-14 were used in different treatment time points and at follow-up. The cost-effectiveness was calculated using the improvement in OHIP-14 after treatment.

RESULTS

OLP patients showed detected levels of anxiety, depression, and poor quality of life at baseline. No improvement in anxiety and depression was noticed after treatments. However, PBM and corticoid significantly improved the quality of life of OLP patients, considering the OHIP-14-T and the physical pain domain. The treatment with corticoid was more cost-effective than PBM.

CONCLUSIONS

Psychological distress was not improved after both treatments and PBM is as effective as corticoids in promoting a better quality of life in OLP patients, despite its higher cost.

CLINICAL RELEVANCE

This study highlights the need for additional therapeutic interventions in OLP patients, to early recognize and to manage the alterations in their psychological profile. Moreover, PBM is an effective therapy in OLP patient's quality of live and although it was a more expensive, the advantage of being a minimally invasive therapy associated with no side effects must be considered in clinical practice, especially in those patients with refractory disease.

TRIAL REGISTRATION

This study is registered at ClinicalTrials.gov; the registration number is NCT03320460, registered in 17/10/2017.

Psychological profile and unexpected pain in oral lichen planus: A case-control multicenter SIPMO studya

OBJECTIVES

To analyze psychological profiles, pain, and oral symptoms in patients with oral lichen planus (OLP).

MATERIALS AND METHODS

300 patients with keratotic OLP (K-OLP; reticular, papular, plaque-like subtypes), 300 patients with predominant non-keratotic OLP (nK-OLP; erythematosus atrophic, erosive, ulcerative, bullous subtypes), and 300 controls were recruited in 15 universities. The number of oral sites involved and oral symptoms were recorded. The Numeric Rating Scale (NRS), Total Pain Rating Index (T-PRI), Hamilton Rating Scales for Depression and for Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) were administered.

RESULTS

The OLP patients, especially the nK-OLP, showed higher scores in the NRS, T-PRI, HAM-D, HAM-A and PSQI compared with the controls (p-value < .001** ). A positive correlation between the NRS, T-PRI, HAM-A, HAM-D, and PSQI was found with the number of oral symptoms and number of oral sites involved. Pain was reported in 67.3% of nK-OLP and 49.7% of K-OLP cases with poor correspondence between the site of lesions and the site of the symptoms.

CONCLUSIONS

Mood disorders are frequently associated with OLP with an unexpected symptomatology correlated with the number of oral symptoms and with the extension of disease suggesting a peripheral neuropathy.

Association between Clinical Signs of Oral Lichen Planus and Oral Health-Related Quality of Life: A Preliminary Study

Subjective patient’s symptoms and Oral Health-Related Quality of Life (OHRQoL) are recommended to be involved in oral lichen planus (OLP) studies. This study aims to assess the OHRQoL of OLP patients, and their associations with pain and OLP in Thai patients. Sixty-nine patients were interviewed using the Numeric Rating Scale (NRS) for pain perception and Oral Impacts on Daily Performance (OIDP) index. OLP signs examined included localization, types, number of affected sides and clinical severity using the Thongprasom sign scoring system. There were significant associations (r_s = 0.490, p < 0.001) between clinical severity and the intensity of oral impacts as well as pain (r_s = 0.298, p = 0.013). The intensity of oral impacts and pain increased according to the increasing OLP clinical severity, except for the white striae lesions (Thongprasom sign score 1). The erosive/ulcerative OLP lesions (Thongprasom sign scores 4 and 5) were the most painful symptom and had the highest degree of oral impacts (p < 0.001). No significant associations were found between the number of affected lesion sides and OHRQoL (p = 0.316) and pain (p = 0.284). OHRQoL was associated with OLP type and clinical severity but not with the number of affected sides.

Anxiety and oral lichen planus

OBJECTIVES

To investigate the association between oral lichen planu(OLP) and anxiety.

SUBJECTS AND METHODS

This study included 174 OLP patients and 174 healthy controls. We assessed anxiety by Self-rating Anxiety Scale (SAS) and recorded OLP lesion type and severity. t test and analysis of variance were applied for continuous variants and chi-square test was performed for categorical variants. Multiple linear regression and logistic regression analysis were used for multi-variable analysis.

RESULTS

he SAS score of OLP patients was higher than that of healthy individuals. There was no significant difference in SAS score between the OLP subgroups, obtained according to age, type, and severity, respectively. Multiple linear regression analysis showed gender was the only factor that affected the SAS score of OLP patients. Compared with weakly anxiety-related groups, the SAS score and female ratio of highly anxiety-related group were obviously higher. Logistic regression analysis demonstrated that males were less exposed to highly anxiety-related types than females.

CONCLUSIONS

OLP patients tend to be more anxious compared with healthy individuals, and female patients are more anxious than male patients. There might be two types of OLP patients: weakly anxiety-related or highly anxiety-related. These results highlight the significance of psychological counseling in OLP disease management.

Serological and psychological assessment of patients with oral lichen planus using serum cortisol levels and hads questionnaire-a case control study

BACKGROUND

Oral lichen planus (OLP) is a T cell-mediated chronic autoimmune disorder directed against antigens secreted by the basal cell layer, with an incidence of 0.02-0.22% in Indian population and showing female predilection. Stress is considered one of the etiological factors in the causation, progression, and recurrence of this disease.

OBJECTIVES

To evaluate the levels of serum cortisol, anxiety, and depression in patients with symptomatic OLP and to correlate the levels of serum cortisol with anxiety and depression.

METHODS

Sixty subjects were categorized into two groups. Group A: 30 adults with no history of OLP and no psychological history of anxiety and depression. Group B: 30 patients with clinically and histopathologically diagnosed symptomatic OLP. The subjects in both groups were evaluated for anxiety and depression levels using the Hospital Anxiety and Depression Scale (HADS) questionnaire and serum cortisol levels (8-9 am sample) using the chemiluminiscence method.

RESULTS

Higher depression and anxiety levels were significantly associated with group B with significant P values (P < 0.0001 and <0.0002 respectively) when compared with group A; higher mean serum cortisol levels were seen in group B compared with group A, with P < 0.0001. In group A, a positive correlation was found between depression, anxiety, and serum cortisol levels with non-significant P-value. In group B, a positive correlation was found between depression, anxiety, and serum cortisol levels with a significant P value (P < 0.0001).

CONCLUSION

Increased levels of depression and anxiety with increased serum cortisol levels were observed in subjects with OLP.

Clinicopathologic data of individuals with oral lichen planus: A Brazilian case series

Background

The aim of the present series was to analyze the sociodemographic characteristics, clinicopathologic features, and oral health-related quality of life of 41 individuals with oral lichen planus (OLP).

Material and Methods

In a retrospective analysis (1998-2018), individuals with a clinical diagnosis of OLP from a referral service of Oral Medicine of Brazil were invited for follow-up. The individuals were assessed using the Oral Health Impact Profile-14 (OHIP-14) form. Histopathological data were reviewed according to the latest criteria proposed by the American Academy of Oral and Maxillofacial Pathology (AAOMP/2016).

Results

This series mainly consisted of females (70.7%) in their forties (31.7%). The buccal mucosa (68.2%) was the most commonly affected site. Reticular (56.1%) and erosive (34.3%) appearances were the most frequent. According to OHIP-14, individuals with OLP at multiple sites in the oral cavity showed worse values in the handicap domain and those who did not respond to corticosteroids showed a higher score on the psychological discomfort domain.

Conclusions

The findings of the present study, using the AAOMP/2016 criteria, agree with case series and retrospective studies reported in the literature. Besides, OLP in its more severe clinical forms had an influence on patient quality of life.

Key words:Diagnosis, epidemiology, oral lichen planus, oral mucosa, quality of life.

Evaluation of depression, anxiety and stress levels in patients with oral lichen planus

The pathogenesis of oral lichen planus (OLP) remains to be fully elucidated; however, certain psychoneurological factors may influence the onset and exacerbation of OLP. The aim of the present study is to evaluate the intensity of negative emotions in patients with OLP. A cross-sectional, questionnaire-based study was performed. The sample consisted of 52 subjects, comprising 26 patients with OLP (OLP group) and 26 controls (CTRL group). The Depression Anxiety Stress Scale 21 (DASS-21) was used for psychometric evaluation. The patients were also asked about their attitude toward the disease, treatment, and interference of the disease on daily life. The mean level of depression was 12.54 ± 6.6 in the OLP group and 7.69 ± 5.22 in the CTRL group (P = 0.006). The mean level of anxiety was 11.15 ± 7.95 in the OLP group and 6.62 ± 4.86 in the CTRL group (P = 0.018). The mean stress levels were 8.69 ± 7.06 and 3.85 ± 3.18 in the OLP and CTRL groups, respectively (P = 0.003). Severe and very severe scores of depression and very severe scores of anxiety and stress were present in the OLP group, whereas these emotions were normal in the majority of controls. Depression, stress, and anxiety may be involved in the pathogenesis and course of OLP.

Severity of oral lichen planus and oral lichenoid lesions is associated with anxiety

OBJECTIVES

Oral lichen planus (OLP) and oral lichenoid lesions (OLL) are chronic inflammatory diseases whose symptoms can impair patient's quality of life (QoL). Psychological factors seem to play an important role in these diseases. This study aimed to determine the impact of oral health and anxiety levels on the QoL of patients with OLP and OLL.

PATIENTS AND METHODS

This was a cross-sectional study composed of OLP and OLL patients and a control group matched by age and sex with no autoimmune/inflammatory or malignant oral lesions. Anxiety levels and oral health impact on QoL were assessed using the Hamilton Anxiety Scale (HAM-A) and the Oral Health Impact Profile-14 (OHIP-14), respectively. The instruments were filled through personal interview before starting the treatment for oral lesions.

RESULTS

A total of 87 patients diagnosed with OLP (n = 45) and OLL (n = 42), and 87 controls were included in the study. Statistical differences were observed for the psychic and somatic anxiety dimensions between severities of diseases. Patients with OLP or OLL had higher scores for the OHIP-14 dimensions physiological discomfort and social limitation compared with controls. In addition, higher scores for physical pain, physical disability, social disability, and handicap were detected among patients with greater severity.

CONCLUSION

Greater severity of OLP and OLL seems to be associated with increased levels of anxiety, higher scores of oral health impact profile, and decreased QoL.

CLINICAL RELEVANCE

Patients with severe OLP/OLL may benefit from additional therapeutic treatments, such as psychological and/or psychiatric management, concomitant to treatment specific to oral lesions.

Black pepper and its bioactive constituent piperine: promising therapeutic strategies for oral lichen planus

Oral lichen planus (OLP) is a common T cell-mediated chronic inflammatory disease with malignant potential and unclear etiology. The present study suggests that antigen-specific mechanisms in which dentritic cells, T lymphocytes and NF-κB signaling pathway play critical roles, are involved in the pathogenesis of OLP. Additionally, it has been indicated that altered expression of cyclooxygenase 2 (COX-2) and imbalanced oxidant-antioxidant status as well as psychological issue may act as promoters to the development of OLP. Therapies for OLP are primarily aimed to control symptoms and a specific cure is not yet available. Black pepper and its principle bioactive compound piperine have been reported to possess remarkable pharmacological activities. Not only has piperine been evidenced to exhibit repressive effects on the maturation of dentritic cells, the proliferation, activation and function of T lymphocytes as well as the NF-κB signaling pathway, but also to suppress the overproduction of COX-2 and weaken the oxidative stress. Furthermore, piperine might be a possible agent for alleviating psychological disorders and preventing carcinogenesis. Given all these into consideration, piperine may be a novel and effective therapeutic strategy for OLP.

Psychological disorders and oral lichen planus: A systematic review

The aim of the present study was to identify and analyze scientific evidence available in the literature to answer the following question: Are psychological disorders associated with the development of oral lichen planus (OLP)? Using scientific databases (PubMed, LILACS, and Science Direct), a literature search was conducted between December 2016 and January 2017, using previously selected keywords. Two independent reviewers critically assessed the results in three stages, strictly obeying the inclusion and exclusion criteria defined in the study protocol. We assessed paper quality based on STROBE (Strengthening The Reporting of Observational studies in Epidemiology). After analysis, we selected 14 papers, of which 10 showed evidence of association between psychological disorders (in particular, stress, anxiety, and depression) and the development of OLP. The paper-quality assessment by means of STROBE showed that 13 papers presented intermediate quality and one paper presented high quality. In the present systematic review, we found an association between psychological disorders and the development of OLP.

Time trend in the prevalence of oral lichen planus based on Taiwanese National Health Insurance Research Database 1996-2013

BACKGROUND/PURPOSE

Oral lichen planus (OLP) is a common chronic inflammatory disease characterized by a T cell-mediated immune response against epithelial cells. The epidemiological survey of OLP in Taiwanese population was scarce. In this study, we investigated the time trend of prevalence stratified by gender, age, urbanization, and income of OLP based on National Health Insurance Research Database (NHIRD).

MATERIALS AND METHODS

We studied the claims data of Taiwanese population from NHIRD 1996 to 2013. Patients with the diagnosis of OLP based on the International Classification of Diseases, Ninth Clinical Modification (ICD-9-CM) code: 697.0 were recruited in this study. Demographic characteristics were analyzed by multi-variate Poisson regression.

RESULTS

The prevalence of OLP increased significantly from 1.3 (per 105) in 1996 to 12.8 (per 105) in 2013 (p for trend < 0.001). The prevalence was higher among female than male (RR: 2.13; 95% CI: 2.07-2.18, p < 0.001). The subjects living in suburban area had a lower risk of OLP than those living in urban area (RR: 0.80; 95% CI: 0.78-0.82, p < 0.001). The higher income group had higher risk of OLP compared with the lower income group (RR, 2.27; 95% CI, 2.17-2.36, p < 0.001).

CONCLUSION

The prevalence of OLP in Taiwan significantly increased over the past 18 years. The mean age with OLP was shown in an increased pattern. In addition, OLP occurs more frequently in women than in men.

Impact of oral potentially malignant disorders on quality of life: a systematic review

Although oral potentially malignant disorders (OPMDs) are relatively common and potentially debilitating, literature on quality of life (QoL) in these patients is scanty. The purpose of this paper is to systematically review the literature on QoL in patients with OPMDs. A total of 210 titles were retrieved from electronic and manual databases searched from 1960 until September 2017. Out of these, 25 met our strict inclusion criteria as per the preferred reporting items for systematic reviews and meta-analyses guidelines. Most studies have assessed QoL in patients with oral lichen planus, reports of which cannot be generalized to all patients with OPMD. The findings of the studies differ but, overall, do not provide evidence that OPMD patients have a poorer QoL than healthy subjects.

Psychological disorders and oral lichen planus: matched case-control study and literature review

OBJECTIVE

Oral lichen planus (OLP) may be linked to psychological disorders. This study investigated psychological factors associated with OLP.

METHODS

A case-control study with incident OLP case patients and age-gender-socio-economic status-matched controls, recruited from among relatives, accompanying persons, and departmental staff, investigated psychological traits using the Psychological General Well-Being Index-Short form. Common factor analysis was used to generate a set of psychological dimensions. The association between these dimensions and OLP adjusted for confounders (education, number of lifetime sexual partners, drinking-smoking) and interactions was assessed through conditional logistic regression and odds ratios (OR) were estimated.

RESULTS

A total of 67 case-control pairs were recruited. Psychological dimensions generated were: dimension-1 (anxiety, low vitality), dimension-2 (negative well-being, low vitality), dimension-3 (depressed mood, low self-control). The ORs for OLP were, dimension-1, 1.0 (95% confidence interval -95CI, 0.3-2.6); dimension-2, 0.5 (95CI, 0.2-1.2); dimension-3, 4.8 (95CI, 1.8-12.9). Dimension-3 was highly associated with mild, but not associated with severe, OLP. Literature searching provided 21 studies, with anxiety and depression principally associated with OLP.

CONCLUSIONS

Depressed mood and low self-control were highly associated with OLP, particularly the reticular-papular forms. These traits could have a causative role in OLP development-progression, but further investigations are necessary.