Oral lichen planus in childhood: a report of three cases

A Novel Approach to Differentiating Erosive and Reticular Lichen Planus Based on the Percentage of Dental Surfaces With Metal Restorations

Introduction Oral lichen planus (OLP) and oral lichenoid reaction (OLR) constitute clinical entities with strong but unclear etiologic relation to dental materials. The aim of this study was to evaluate a correlation between the clinical form of OLP/OLR and the number of dental metal restorations in the oral cavity thus utilizing an exposure to metal (EM) index.  Material and methods The study type is experimental, and the study design is characterized as semiquantitative research that belongs to the branch of experimental research. Twenty-nine patients were chosen based on clinical (either reticular or erosive clinical forms) and histologic findings suggestive of OLP/OLR. The files of patients were retrieved from the archives of the Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Greece, during the period 2009-2019. The medical history of the patients did not include any disorder or medication associated with lichenoid lesions and the measurements took place concurrently with the establishment of the diagnosis, thus no treatment for the lichen planus had been administered prior to the measurements. Quantitative measurement of the percentage of dental surfaces restored through metal restorations and correlation with the clinical and histologic findings of OLP/OLR was evaluated. The EM index was evaluated on a scale of 1-3, which corresponds to the percentage of dental surfaces restored through metal restorations. The statistical analysis was performed with the Pearson chi-square test and the significance level was set at p≤0.05. Results The EM index was measured by dividing each tooth into five surfaces (occlusal, mesial, distal, buccal, lingual), subsequently multiplying the number of available teeth with the number 5 to calculate the total number of surfaces, and then counting the number of surfaces with metal restorations - both fillings and crowns (in case of metal-ceramic crowns, the respective dental surface is taken into account only in case of macroscopically exposed metal), dividing the number of surfaces with metal restorations with the total number of surfaces and multiply by 100 so that the results take the form of percentages (%) and finally classifying the percentages into three groups: 1: 0% metal restorations, 2: 1-25% metal restorations, 3: >26% metal restorations). The percentage in female patients ranged from 0% to 100%, whereas it ranged from 0% to 60% in male patients. According to the clinical form of the lichenoid lesion, the percentage ranged from 0% to 60% in reticular lichen planus cases and from 0% to 100% in erosive lichen planus cases. There was no statistical difference between lichen planus cases, in total, and in normal oral epithelium. However, the levels of EM were marginally similar between the reticular lichen planus and the erosive lichen planus (Fisher's exact test, p = 0.056). Therefore, it may be the case that the EM index is higher in erosive lichenoid lesions. Conclusion In our study, the EM index was higher in female patients and in erosive lichenoid lesions. These findings should be tested and supported by larger samples of patients since the aforementioned Fisher's Exact Test, p = 0.056 could fall below the threshold of 0.05 if more patients were included. This is the first attempt to establish a novel approach to differentiating erosive and reticular lichen planus based on the percentage of dental surfaces with metal restorations.

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.

Evaluation of salivary oxidative stress in oral lichen planus using malonaldehyde

Background:

Oral lichen planus is a chronic, mucocutaneous, inflammatory disease, with an unknown etiology. Reactive oxygen species and oxidative damage to the tissues might be the cause. Malonaldehyde (MDA), a low molecular weight end product of lipid peroxidation reaction is a suitable biomarker of endogenous DNA damage. monitoring the oxidant-antioxidant status of saliva may serve as an efficient marker of disease development in oral lichen planus patients.

Aim and Objectives:

To evaluate salivary oxidative stress in oral lichen planus subject using MDA and compare it with control subjects. Furthermore, to compare MDA levels in erosive and hypertrophic lichen planus.

Materials and Methods:

The current study is case–control study. Unstimulated salivary samples in the morning hours were taken from oral lichen planus subjects (n = 25) and controls subjects without any oral disease (n = 25). The saliva was centrifuged at 900 g for 10 min at a temperature of 4°C. Then, the entire filtrate was transferred to Eppendorf test tubes and frozen at–80°C until analysis. Salivary MDA was done through thiobarbituric acid reactive substance assay as per the protocol laid down by the manufacturer (Sigma Aldrich Lipid Peroxidation Assay Kit).

Results:

The data were expressed as the mean ± standard deviation and the statistical analysis was done using Student's t-test using SPSS version 21 IBM software. The salivary level of MDA was significantly higher than that of controls (P < 0.05).

Conclusion:

The higher level of MDA in patients with oral lichen planus suggests that free radicals and the resulting oxidative damage may be important in the pathogenesis of oral lichen planus lesions.

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.

Pediatric lichen planus: a systematic review of 985 published cases

BACKGROUND

Lichen planus (LP) is a chronic inflammatory disorder usually occurring in middle-aged adults. Data are scarce in the pediatric population.

OBJECTIVE

To describe the patients' characteristics, clinical presentation, and management of pediatric LP.

METHODS

A systematic literature review of pediatric LP was performed in the Medline and Cochrane databases up to February 1, 2020. Demographic and clinical data were extracted for analysis, in addition to laboratory and histology findings, treatments used, and response to treatment. LP pemphigoides (LPP) was further pooled for a subcategory analysis.

RESULTS

One hundred and sixty-four articles were included representing 985 patients. The most common country of origin was India. The most common clinical signs were flat-topped papules (51%); the linear variant was present in 9%. Oral involvement was present in 22%. The most commonly used treatment was topical corticosteroids followed by systemic corticosteroids. The mean duration of treatment was 124.4 days. LPP patients had a short disease duration before diagnosis (4.1 months, P < 0.001) and failed previous treatment more frequently (P < 0.001). Systemic corticosteroids were more often prescribed in this subgroup (75%, P < 0.001) with more recurrence after treatment (31%, P = 0.048).

LIMITATIONS

Lack of randomized controlled studies, in addition to publication bias.

CONCLUSION

In children, LP had a wide polymorphous clinical presentation, and the reported cases were mostly from India. The linear variant was more common and the oral mucosa was less affected in children. LPP, a rare subtype in children, was treated with systemic corticosteroids and recurred more frequently.

Micronutrients Profile in Oral Lichen Planus: a Review Literature

Oral lichen planus (OLP) is a relatively common chronic inflammatory disease. The micronutrients are critical factors in health of oral mucous and proper function of immune system. There have not been any review articles for evaluating trace element levels before and after standard treatments of OLP. The purpose of this study is to provide complete review of the association of micronutrients with OLP. Databases including PubMed, Google Scholar, Scopus, and Embase (Ovid) with keywords of oral lichen planus, OLP, oral disorder, micronutrients, trace element, nutrient element, antioxidant, oxidative stress, malnutrition, and essential trace elements, without time limitation (1900-2019) were searched to collect data on related articles. Total number of 58 original articles including 12 randomized clinical trials, 41 case-control, 4 case reports, and 1 cell line research were reviewed in this study. Lower levels of iron and its associated markers, such as hemoglobin and ferritin, increased levels of TIBC; reduced levels of zinc, calcium, vitamin D, vitamin B12, folic acid, and antioxidants such as vitamins C and E; and increased levels of oxidants and homocysteine, have been reported in OLP patients.

Oral lichen planus in an 8-year-old child: A case report with a brief literature review

Lichen planus (LP) is a chronic autoimmune condition of uncertain etiopathogenesis and usually affects the skin, oro-genital mucosa, nail and scalp appendages. LP is primarily seen in middle-aged individuals, and oral lesions of LP in children are relatively uncommon. Herewith, we report a case of oral LP in an 8-year-old boy, which regressed well with the treatment modality.

Oral mucosa lesions and gingival bleeding can indicate the progression of liver disease in children and adolescents aged two to 18 years

AIM

This study assessed correlations between systemic disturbances of paediatric chronic liver diseases (CLD) and oral symptoms in subjects aged 2-18 years.

METHODS

It was carried out during outpatient appointments at the Children's Memorial Health Institute, Warsaw, Poland, from 2010 to 2015 and comprised 52 CLD patients with a mean age of 12.3 ± 4.6. We also recruited 54 generally healthy controls with a mean age of 12.0 ± 3.7 from the Department of Paediatric Dentistry at the Medical University of Warsaw. The study used various measures, including the Child-Pugh score, which assesses CLD prognosis. We also assessed the causes of liver disease and the medication taken by the patients with CLD.

RESULTS

A total of 24 patients received a Child-Pugh score of seven or more points, while 28 patients were awarded five or six points. More severe cases of gingivitis and a greater prevalence of oral lesions were evident in patients suffering from liver disease. Oral candidiasis, telangiectasia, bald tongue, cracked strawberry lip, yellowish-brown gum discoloration, petechiae and gingival bleeding all correlated with the severity of liver dysfunction, coagulopathy, protein, bilirubin and creatinine levels and portal hypertension.

CONCLUSION

This study found that oral lesions and gingival bleeding may indicate the progression of liver failure.

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.

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.

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: clinical features, etiology, treatment and management; a review of literature

Lichen planus is a chronic inflammatory mucocutaneous disease. Mucosal lesions are classified into six clinical forms and there is malignant potential for two forms of OLP; therefore, follow-up should be considered. There are many un-established etiological factors for OLP and some different treatment modalities are based on etiology. The aims of current OLP therapy are to eliminate mucosal erythema and ulceration, alleviate symptoms and reduce the risk of oral cancer. We have used review papers, case reports, cohort studies, and case-and-control studies published from 1985 to 2010 to prepare this review of literature.

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.

Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation

Lichen planus, a chronic autoimmune, mucocutaneous disease affects the oral mucosa (oral lichen planus or OLP) besides the skin, genital mucosa, scalp and nails. An immune mediated pathogenesis is recognized in lichen planus although the exact etiology is unknown. The disease most commonly affects middle-aged females. Oral lichenoid reactions (OLR) which are considered variants of OLP, may be regarded as a disease by itself or as an exacerbation of an existing OLP, by the presence of medication (lichenoid drug reactions) or dental materials (contact hypersensitivity). OLP usually presents as white striations (Wickham's striae), white papules, white plaque, erythema, erosions or blisters. Diagnosis of OLP is established either by clinical examination only or by clinical examination with histopathologic confirmation. Direct immunofluorescence examination is only used as an adjunct to the above method of diagnosis and to rule out specific autoimmune diseases such as pemphigus and pemphigoid. Histopathologic features of OLP and OLR are similar with suggestions of certain discriminatory features by some authors. Topical corticosteroids are the treatment of choice for OLP although several other medications have been studied including retinoids, tacrolimus, cyclosporine and photodynamic therapy. Certain OLP undergo malignant transformation and the exact incidence and mechanisms are still controversial. In this paper, etiopathogenesis, diagnosis, management and malignant transformation of OLP and OLR have been reviewed.