Prevalence of oral lichen planus among a sample of the Egyptian population

An Evidence-Based Update on the Potential for Malignancy of Oral Lichen Planus and Related Conditions: A Systematic Review and Meta-Analysis

A systematic review and a meta-analysis is presented on published articles on the malignant transformation of oral lichen planus (OLP) and related conditions, which, based on current evidence, updates an earlier systematic review published by our research group that included publications until November 2018. In this updated study (Nov-2023) we searched MEDLINE, Embase, Web of Science, and Scopus. We evaluated the methodological quality of studies (QUIPS tool) and carried out meta-analyses. The inclusion criteria were met by 101 studies (38,083 patients), of which, 20 new primary-level studies (11,512 patients) were published in the last 5 years and were added to our updated study. The pooled malignant transformation ratio was 1.43% (95% CI = 1.09-1.80) for OLP; 1.38% (95% CI = 0.16-3.38) for oral lichenoid lesions; 1.20% (95% CI = 0.00-4.25) for lichenoid reactions; and 5.13% (95% CI = 1.90-9.43) for OLP with dysplasia. No significant differences were found between the OLL or LR groups and the OLP subgroup (p = 0.853 and p = 0.328, respectively), and the malignant transformation was significantly higher for the OLP with dysplasia group in comparison with the OLP group (p = 0.001). The factors that had a significant impact with a higher risk of malignant transformation were the presence of epithelial dysplasia, a higher methodological quality, the consumption of tobacco and alcohol, the location of lesions on the tongue, the presence of atrophic and erosive lesions, and infection by the hepatitis C virus. In conclusion, OLP behaves as an oral potentially malignant disorder (OPMD), whose malignancy ratio is probably underestimated as a consequence essentially of the use of inadequate diagnostic criteria and the low methodological quality of the studies on the subject.

Bidirectional Association between Lichen Planus and Hepatitis C-An Update Systematic Review and Meta-Analysis

Lichen planus (LP) is a chronic, inflammatory mucocutaneous disorder associated with systemic diseases such as hepatitis C (HCV). The objective of this study is to evaluate the association between LP and HCV bidirectionally through a systematic review and meta-analysis. A comprehensive search of studies published was performed in the databases of PubMed, Embase, and Web of Science. Out of 18,491 articles, 192 studies were included. The global prevalence of HCV positive (HCV+) in LP patients registered from 143 studies was 9.42% [95% confidence interval (CI), 7.27-11.58%], and from these, 84 studies showed HCV+ 4-fold more frequent in LP than a control group (OR, 4.48; 95% CI, 3.48-5.77). The global prevalence of LP in patients HCV+ recorded from 49 studies was 7.05% (95% CI, 4.85-9.26%), and from these, 15 registered a 3-fold more LP in HCV (OR, 3.65; 95% CI, 2.14-6.24). HCV+ in LP patients showed great geographic variability (OR, 2.7 to 8.57), and the predominantly cutaneous location was higher (OR, 5.95) than the oral location (OR, 3.49). LP in HCV+ patients was more frequent in the Eastern Mediterranean (OR, 5.51; 95% CI, 1.40-15.57). There is a higher prevalence of HCV+ in LP and vice versa than in the control group, especially in certain geographical areas that should be taken into consideration when doing screening in countries with an upper prevalence of HCV among the general population.

Rate of Malignant Transformation Differs Based on Diagnostic Criteria for Oral Lichenoid Conditions: A Systematic Review and Meta-Analysis of 24,277 Patients

OBJECTIVES

This systematic review and meta-analysis aims to evaluate the evidence on the malignant potential of oral lichenoid conditions (OLCs) including oral lichen planus (OLP), oral lichenoid lesions (OLL), and lichenoid mucositis dysplasia (LMD). In addition, it aims to compare the rate of malignant transformation (MT) in OLP patients diagnosed according to different diagnostic criteria, and to investigate the possible risk factors for OLP MT into OSCC.

MATERIALS AND METHODS

A standardized search strategy was applied across four databases (PubMed, Embase, Web of Science, and Scopus). Screening, identification and reporting followed the PRISMA framework. Data on MT were calculated as a pooled proportion (PP), subgroup analyses and possible risk factors for MT were pooled as odds ratios (ORs).

RESULTS

Among 54 studies with 24,277 patients, the PP for OLCs MT was 1.07% (95% CI [0.82, 1.32]). The estimated MT rate for OLP, OLL and LMD was 0.94%, 1.95% and 6.31%, respectively. The PP OLP MT rate using the 2003 modified WHO criteria group was lower than that using the non-2003 criteria (0.86%; 95% CI [0.51, 1.22] versus 1.01%; 95% CI [0.67, 1.35]). A higher odds ratio of MT was observed for red OLP lesions (OR = 3.52; 95% CI [2.20, 5.64]), smokers (OR = 1.79; 95% CI [1.02, 3.03]), alcohol consumers (OR = 3.27, 95% CI [1.11, 9.64]) and those infected with HCV (OR = 2.55, 95% CI [1.58, 4.13]), compared to those without these risk factors.

CONCLUSIONS

OLP and OLL carry a low risk of developing OSCC. MT rates differed based on diagnostic criteria. A higher odds ratio of MT was observed among red OLP lesions, smokers, alcohol consumers, and HCV-positive patients. These findings have implications for practice and policies.

Spatial Evaluation of Oral Lichen Planus Patients Referred to Shiraz Dental School, Iran: a Medical Geography Approach

STATEMENT OF THE PROBLEM

Oral lichen planus (OLP) is an important inflammatory disease concerning its tendency to malignancy. The etiopathogenesis of this disease is still unknown. Medical geography uses geographic techniques to study factors related to location that cause uneven distribution of disease.

PURPOSE

This study was conducted to map OLP in patients referred to Shiraz Dental School with medical geography techniques and investigate any possible relationship between the number of dentists and health-centers in different regions of Fars province with the number of referrals.

MATERIALS AND METHOD

In this cross-sectional study, we evaluated the records of OLP patients referred to Shiraz Dental School from 2007 to 2018. Age, sex, place of residence, occupation, level of education, location of involvement, duration, and cutaneous involvement were recorded. The number of dentists and healthcare centers was obtained from the statistical records of Fars province. A Geographic Information System was used for the assessment of the spatial distribution of OLP. Ordinary least squares (OLS) and geographically weighted regression (GWR) indices were used for evaluating the relationship between the number of dentists and health centers with the number of referrals.

RESULTS

From 1006 records, 457 were studied, from which 71% were female (age range of 41-60). The regression coefficient was 0.937 for the number of dentists in each county compared to OLP referrals indicating a strong relationship. The regression coefficient was 0.983 for the number of health-centers. According to GWR analyses in Shiraz neighboring counties like Marvdasht, Sepidan, and Sarvestan, there is a positive relationship between the number of dentists and OLP patients.

CONCLUSION

The results revealed that dentists and health care centers had a good cognition of referring patients with OLP (as a premalignant lesion) for definite diagnosis in Fars counties. But both groups need more education in this matter. Moreover, referrals from settlements near Shiraz were more common because of their easier access.

Dysplasia in oral lichen planus: relevance, controversies and challenges. A position paper

Background

Patients with oral lichen planus (OLP) have an increased risk of oral cancer. For this reason, OLP is classified as an oral potentially malignant disorder. However, the precise personal (or individual) risk is unknown. Recent meta-analytical studies have reported that dysplastic OLP may transform to cancer in around 6% of cases, while the rate of transformation is lower (<1.5%) in non-dysplastic cases. The presence of epithelial dysplasia has emerged as the most powerful indicator for assessing cancer risk in oral potentially malignant disorders in routine practice. However, the general acceptance of epithelial dysplasia as an accompanying histologic feature in OLP is subject to great controversy. Many pathologists consider the presence of dysplasia as a criterion to exclude OLP when routinely reporting on this disease. This practice, widespread among oral pathology professionals, has resulted in the underestimation of the potential for malignancy of OLP.

Material and Methods

A review of the literature was carried out in order to critically analyze the relevance, controversies and challenges encountered across the diagnosis of epithelial dysplasia in OLP.

Results

12 studies have been published examining dysplastic changes in OLP, reporting Figures ranging from 0.54% to 25% of cases with dysplasia in the first diagnostic biopsy. The diagnosis of dysplasia in the OLP poses an additional difficulty due to the fact that the affected oral epithelium per se develops changes related to autoimmune aggression. Among the most frequent histological features of OLP that develops dysplasia are basal cell hyperplasia with basaloid appearance, loss of basal cells polarity, cellular and nuclear pleomorphism and irregular stratification.

Conclusions

Epithelial dysplasia should not be considered an exclusion criterion for OLP; its evaluation requires experienced pathologists in this field.

Key words:Oral lichen planus, epithelial dysplasia, oral cancer.

Global Prevalence and Incidence Estimates of Oral Lichen Planus: A Systematic Review and Meta-analysis

Importance

Integrated information on the global prevalence and incidence of oral lichen planus (OLP) is lacking.

Objective

To examine the global prevalence and incidence of OLP in a systematic review and meta-analysis.

Data Sources

A systematic review of population-based studies and clinic-based studies reporting the prevalence and incidence of OLP was performed using 3 electronic medical databases (Cochrane Database of Systematic Reviews, Embase, and MEDLINE) from their inception to March 2019. The search terms included "(lichen planus or LP) and (prevalence or incidence or epidemiology)." No language restriction was applied.

Study Selection

Observational descriptive studies investigating the prevalence and incidence of OLP were included.

Data Extraction and Synthesis

Data were extracted by continent, sex, and other characteristics. The risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal Instrument for Studies Reporting Prevalence Data using random-effects models to synthesize available evidence.

Main Outcomes and Measures

The primary outcome was the prevalence (with 95% CIs) of OLP among the overall population and among subgroups. Between-study heterogeneity was assessed using the I2 statistic.

Results

Among 46 studies, the overall pooled estimated prevalence of OLP was 0.89% (95% CI, 0.38%-2.05%) among the general population (n = 462 993) and 0.98% (95% CI, 0.67%-1.43%) among clinical patients (n = 191 963). Among the 15 population-based studies, the prevalence of OLP was 0.57% (95% CI, 0.15%-2.18%) in Asia, 1.68% (95% CI, 1.09%-2.58%) in Europe, and 1.39% (95% CI, 0.58%-3.28%) in South America. Among the 31 clinic-based studies, the prevalence was 1.43% (95% CI, 1.12%-1.83%) in Africa, 0.87% (95% CI, 0.61%-1.25%) in Asia, 1.03% (95% CI, 0.51%-2.09%) in Europe, 0.11% (95% CI, 0.07%-0.16%) in North America, and 3.18% (95% CI, 0.97%-9.95%) in South America. The pooled prevalence of OLP by sex was 1.55% (95% CI, 0.83%-2.89%) for women and 1.11% (95% CI, 0.57%-2.14%) for men in the population-based studies and 1.69% (95% CI, 1.05%-2.70%) for women and 1.09% (95% CI, 0.67%-1.77%) for men in the clinic-based studies. In 5 clinic-based studies providing the age distribution of patients with OLP, the prevalence by age was 0.62% (95% CI, 0.33%-1.13%) among patients younger than 40 years and 1.90% (95% CI, 1.16%-3.10%) among patients 40 years and older.

Conclusions and Relevance

This study identified the global prevalence and incidence of OLP in terms of its spatial, temporal, and population distribution. The overall estimated pooled prevalence of OLP was 0.89% among the general population and 0.98% among clinical patients. A higher prevalence of OLP was found in non-Asian countries, among women, and among people 40 years and older. The findings should be considered with caution because of the high heterogeneity of the included studies.

Comparative evaluation of effectiveness of autologous platelet rich plasma and intralesional corticosteroids in the management of erosive oral Lichen planus- a clinical study

Purpose

Oral Lichen planus is a potentially malignant autoimmune disorder, characterized by burning and pain in the affected mucosa which reduces the quality and comfort of patient's life. Various treatment modalities have been documented for OLP but due its malignant potential the alternative therapeutic approaches with least or no side effects are being in demand. One of such, yet unexplored treatment is Platelet rich plasma (PRP). This study aims to evaluate the effectiveness of intralesional PRP as compared to the Intralesional corticosteroids in the management of erosive OLP.

Materials and methods

The study sample consisted of 20 clinically and histopathologically confirmed patients of Erosive OLP among which 10 patients were given intralesional corticosteroids and 10 patients were administered intralesional PRP. All the patients were given weekly injections for 2 months and were followed up till 4 months for assessing the parameters such as pain/burning, erythema and size of the lesions.

Results

The patients in both the groups showed a statistically significant reduction in all the assessed parameters of erosive lichen planus from baseline till 4 months of treatment and follow up. However, on comparison of the pain reduction, size of lesion and erythema scores between the two groups, the difference was found to be statistically insignificant.

Conclusion

The intralesional PRP was found to be of comparative effectiveness with respect to intralesional triamcinolone acetonide in the management of erosive OLP and with an added advantage of having less recurrence and no adverse effects.

Diagnostic accuracy of colposcopic examination in patients with oral dysplastic lesions

OBJECTIVE

Colposcopy is a direct microscopic method and is the gold standard tool to detect early cervical dysplastic lesions. In the past, many attempts have been made to use gynecologic methods to examine the oral mucosa. The aim of this study was to detect the diagnostic accuracy of oral colposcopy in diagnosing oral dysplastic lesions in comparison with microscopic evaluation based on biopsy and compare Reid's Colposcopic Index (RCI) and the Swede scoring system in diagnosing oral dysplastic lesions.

STUDY DESIGN

Twenty-five patients who presented for diagnosis of oral leukoplakia to the Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University (Cairo, Egypt) and met the selection criteria were recruited in this study. Each patient was subjected to colposcopic examination, followed by biopsy to confirm the results of colposcopy. The sensitivity and specificity of oral colposcopy were calculated after colposcopic assessment by using the Swede scoring system and the RCI.

RESULTS

The diagnostic accuracy of oral colposcopy with use of the Swede scoring system was superior to that of oral colposcopy with the use of the RCI.

CONCLUSIONS

Colposcopic examination using the Swede scoring system is very specific for diagnosing oral epithelial dysplasia and for using the "see-and-treat" method, whereas the RCI is a very sensitive screening method for the diagnosis of oral epithelial dysplasia in oral potentially malignant disorders.

Malignant transformation risk of oral lichen planus: A systematic review and comprehensive meta-analysis

OBJECTIVES

To evaluate current evidence on the malignant transformation of oral lichen planus (OLP), oral lichenoid lesions (OLLs), and oral lichenoid reactions (LRs) and to determine the variables with greatest influence on cancer development.

MATERIAL AND METHODS

We searched PubMed, Embase, Web of Science, and Scopus for studies published before November 2018. We evaluated the quality of studies (QUIPS tool). We carried out meta-analyses to fulfill our objectives. We examined the between-study heterogeneity and small-study effects, and conducted sensitivity studies and subgroup analyses.

RESULTS

Inclusion criteria were met by 82 studies (26,742 patients. The combined malignant transformation rate was 1.14% for OLP (95% CI = 0.84-1.49), 1.88% for OLLs (95% CI = 0.15-4.95) and 1.71% for LRs (95% CI = 0.00-5.46). Subgroup analysis revealed a higher malignant transformation rate in studies when the presence of epithelial dysplasia was not an exclusion criterion (p = 0.001), when both clinical and histopathological criteria were used for diagnosis (p < 0.001), when the follow-up was at least 12 months (p = 0.048), and when there was lower risk of potential bias (p = 0.002). Malignant transformation risk factors were: tongue localization (RR = 1.82, 95% CI = 1.21-2.74, p = 0.004), presence of atrophic-erosive lesions (RR = 4.09, 95% CI = 2.40-6.98, p < 0.001), tobacco use (RR = 1.98, 95% CI = 1.28-3.05, p = 0.002), alcohol consumption (RR = 2.28, 95% CI = 1.14-4.56, p = 0.02), and hepatitis C virus infection (RR = 4.46, 95% CI = 0.98-20.22, p = 0.053).

CONCLUSIONS

The malignant transformation rates of OLP, OLLs and LRs are underestimated due essentially to restrictive diagnostic criteria, inadequate follow-up periods, and/or low quality of studies.

The immunopathogenesis of oral lichen planus-Is there a role for mucosal associated invariant T cells?

Oral lichen planus (OLP) is a chronic, T-cell-mediated, immune condition of unknown cause. OLP may present with painful symptoms requiring treatment, as well as lesions outside the oral cavity. It is likely that what initiates the OLP disease process is a complex interaction of host susceptibility and environmental triggers. While it is possible that OLP represents a true autoimmune condition against an epithelial autoantigen, the mechanisms that lead to this immune dysregulation are still poorly understood. In this review article, we discuss current concepts relating to the immunopathogenesis of OLP, as well as the potential contributory roles the oral microbiota and mucosal-associated invariant T (MAIT) cells.

Lichen planus and diabetes mellitus: Systematic review and meta-analysis

OBJECTIVE

The aim of this study was to perform a systematic review and meta-analysis answering the following questions: (a) "What is the prevalence and risk of oral lichen planus among patients with diabetes mellitus?" and (b) "What is the prevalence and risk of diabetes mellitus among patients with oral lichen planus?".

MATERIAL AND METHODS

A bibliographic search was conducted in PubMed/Medline and Scopus database from 1966 to March 2018, using the following terms: "Lichen planus" AND "Diabetes mellitus" AND "Prevalence" AND "Oral mucosal lesions".

RESULTS

Twenty-two studies were included in this review. Twelve studies assessed the prevalence of diabetes mellitus among patients with lichen planus. The prevalence reported ranges from 1.6% to 37.7% with a relative risk of 2.432. Ten studies assessed the prevalence of lichen planus among patients with diabetes mellitus which showed a prevalence of lichen planus ranging from 0.5% to 6.1% with a relative risk of 1.4.

CONCLUSIONS

Contradictory results were found when analyzing the relationship between lichen planus and diabetes mellitus. Diverse factors should be considered when studying this association for a correct interpretation of results. Diabetes mellitus has high prevalence and morbidity, which is why new case-control studies are needed to further investigate this association.

Evaluation of Combined Topical Ozone and Steroid Therapy in Management of Oral Lichen Planus

AIM:

The present study aims to assess the therapeutic effect of the combination of topical ozone and steroid therapy in comparison to topical ozone alone versus topical steroid as a control in the management of atrophic - erosive oral lichen planus (OLP).

METHODS:

Sixty-six patients are having atrophic-erosive OLP were included in the study. They were randomly divided into three equal groups to be treated with topical corticosteroids alone (steroid group) as control, topical ozone alone (ozone group) or combination of topical steroids and ozone (combined group). Assessment of pain and sign scores was done before and after each treatment modality.

RESULTS:

The results revealed that the greatest significant percentage of change and subsequent improvement in pain and sign scores were recorded in the combined group.

CONCLUSION:

Reported data in this study using the combination of ozone and steroid therapy could provide a new promising safe and effective adjunct therapy for management of OLP.

The effect of diode laser and topical steroid on serum level of TNF-alpha in oral lichen planus patients

Background

Oral lichen planus (OLP) is a common chronic inflammatory mucosal disease with a multifactorial etiology. It is a T-cell mediated autoimmune disease in which the cytotoxic CD8+T cells trigger apoptosis of the basal cells of oral epithelium. Various treatment regimens have been employed for management of symptomatic OLP. This study was carried out to evaluate the effect of topical steroids as well as laser on the clinical signs and symptoms detected by reticular, atrophic, erosive score (RAE score) and tumor necrosis factor- α (TNF-α) level in the serum of patients with symptomatic OLP.

Material and Methods

The study was conducted on twenty-four patients (18 females and 6 males) with symptomatic OLP that were allocated into two groups. Each included twelve patients. The first group treated either with diode laser (970nm SIROLaser Advance class IIIb, SIRONA The Dental Company, Germany) twice weekly with maximum of ten sessions while the second group were treated with topical corticosteroids (0.1% triamcinolone acetonide orabase, Kenacort-A Orabase Pomad, DEVA HOLDING A.Ș, Istanbul, Turkey) for four weeks.

Results

Corticosteroids group showed less clinical signs and symptoms of reticular, atrophic, erosive RAE score (p=0.02) and TNF-α serum level (p=0.028) than diode laser group with no reported therapy side effects or complications in any of the treated patients.

Conclusions

Topical steroids reduce pain, reticular, atrophic, erosive RAE score and TNF-α serum level more than laser treatment. Moreover, laser treatment can be used as an alternative treatment when steroids are contraindicated for the treatment of symptomatic OLP.

Key words:Oral lichen planus, diode laser, topical steroid, RAE score, TNF-α.