Oral lichen planus following mRNA COVID-19 vaccination

Oral Lichen Planus: An Updated Review of Etiopathogenesis, Clinical Presentation, and Management

Lichen planus (LP) is a chronic idiopathic immune-mediated inflammatory condition. LP is a heterogeneous disease with varied clinical presentations having different natural history, prognosis, sequelae, and outcomes. It can affect skin, hair, nails, and mucosae. Mucosal LP (including oral LP) tends to be persistent and resistant to treatment, compared to cutaneous LP. Oral LP (OLP) is broadly divided into two main categories: hyperkeratotic (usually asymptomatic) and erosive (commonly symptomatic). It can present with symptoms including odynophagia, dysphagia, dysgeusia, and sensitivity to hot spicy foods. Apart from the superficial epidermal changes, which vary with the type of clinical presentation, histopathologically oral LP shows a unifying similar and consistent feature of a lichenoid interface dermatitis. Recently, researchers have highlighted the critical role played by IL-17 in the pathogenesis of OLP. World Health Organization has categorized oral LP as one of the oral potentially malignant disorders (OPMD), albeit with a low risk of malignant transformation. Also, in the last couple of years there have been various reports on the usage of newer drugs like anti-IL17, anti-IL12/23, anti-IL 23, PDE4 inhibitors, and JAK inhibitors in the management of refractory OLP. The principal aim of treatment still remains to resolve the symptoms, prolong the symptoms free period, and reduce the risk of potential malignant transformation. We have described many new revelations made in recent times regarding the etiopathogenesis, associated conditions as well as management of OLP. Thus, the objective of this review is to present a comprehensive up-to-date knowledge including the recent advances made regarding OLP.

Neurological complications following mRNA COVID-19 vaccination: Oral and lower limb paresthesia. A case discussion and literature review

Vaccines used in the coronavirus pandemic have reported some minor side effects such as pain at the injection site, headache, myalgia and fever. Also major neurological side effects have been experienced by some patients. We present the clinical case of a healthy woman who two weeks after being vaccinated with the third dose of Moderna COVID-19 Vaccine, began to feel numbness in mouth, both feet, legs, interscapular space, and hands. She was diagnosed with distal sensory polyneuropathy caused by the vaccine. Progressive improvement was seen. The patient did not require corticosteroid medication. We reviewed the literature to assess the frequency of this type of complication. Key words:COVID-19, SARS-CoV-2, vaccine, vaccination, peripheral axonal neuropathy, transverse myelitis, oral manifestations.

Systematic review of the oral manifestations produced by the SARS-CoV-2 vaccine

Background

To combat the coronavirus pandemic different vaccines have been developed. However, diverse adverse effects have been reported due to their use, including oral manifestations. Our objective is to review the existing bibliography to analyze what complications these vaccines have caused in the oral cavity.

Material and Methods

A bibliographic search was conducted by two independent reviewers (TS and CL), in parallel in 6 electronic databases (PubMed, Scopus, Cochrane, Google Scholar, LILACS, BioMed Central). A total of 22 articles were analyzed.

Results

The most frequent adverse effect was oral lichen planus, with a higher prevalence in women and after the Pfizer mRNA BNT162b2 vaccine.

Conclusions

These complications are minor and resolve with treatment, so the benefit of the use of vaccines outweigh the potential risks associated with these. Key words:Covid-19 vaccine, oral lesions, oral manifestations, SARS-CoV-2 vaccine, oral symptoms.

Lichen planus after COVID-19 infection and vaccination

Lichen planus (LP) is an inflammatory disorder believed to result from CD8 + cytotoxic T-cell (CTL)-mediated autoimmune reactions against basal keratinocytes. We present a review of LP following COVID-19 infection and vaccination. Literature searches were conducted on PubMed and Google Scholar from 2019 to 7/2022. 36 articles were selected based on subject relevance, and references within articles were also screened. 39 cases of post-vaccination LP and 6 cases of post-infection LP were found among case reports and case series. 152 cases of post-vaccination LP and 12 cases of post-infection LP were found in retrospective and prospective studies. LP is a rare complication of COVID-19 infection and vaccination that may be mediated by overstimulation of T-cell responses and proinflammatory cytokine production. However, it does not represent a limitation against COVID-19 vaccination, and the benefits of vaccination considerably outweigh the risks.

Oral Adverse Events Following COVID-19 Vaccination: Analysis of VAERS Reports

Background

Oral adverse events (AEs) following COVID-19 vaccination have been sporadically reported during the previous months, warranting further investigation for their prevalence and suspected relationship with vaccine-elicited immune response.

Methods

A retrospective analysis using the Vaccine Adverse Event Reporting System (VAERS) data was conducted to evaluate AEs within the oral cavity (mucosa, tongue, lips, palate, dentition, salivary glands) and AEs involving taste and other sensations. Oral AEs reported after receiving COVID-19 vaccination (test group) and seasonal influenza vaccination (control group) were extracted and cross-tabulated to assess their relative prevalence.

Results

Among the 128 solicited (suspected) oral AEs, oral paresthesia (0.872%) was most reported after receiving COVID-19 vaccines, followed by the swelling of lips (0.844%), ageusia (0.722%), oral hypoesthesia (0.648%), swollen tongue (0.628%), and dysgeusia (0.617%). The reported prevalence of oral AEs was higher in the COVID-19 vaccine group than in the seasonal influenza group. The distribution pattern of the most reported oral AEs was similar for both COVID-19 and seasonal influenza vaccines. Female sex, older age (>39 years old), primer doses, and mRNA-based COVID-19 vaccines exhibited a higher reported prevalence of oral AEs.

Conclusion

Within the limitations of this study, COVID-19 vaccines were found to be associated with rare oral AEs that are predominantly similar to those emerging following seasonal influenza vaccines. The most commonly reported oral AEs were oral paraesthesia (mouth-tingling), lip swelling, and ageusia, representing various pathophysiologic pathways that remain unclear. Taste-related AEs should be acknowledged in the context of the COVID-19 pandemic and the public should be adequately informed about a potential taste dysfunction after receiving the COVID-19 vaccination. Dentists and dental teams need to be aware of the prevalence, severity, and prognosis of oral AEs to inform their patients and increase public confidence in vaccines.

Suggested risk factor for oral lichen planus arising after mRNA COVID ‐19 vaccination

A single dose of BNT162b2 vaccine is suggested for COVID‐19‐infected individuals to reduce side effects due to release of inflammatory mediators such as oral lichen planus (OLP).