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Campana F, Lan R, Girard C, Rochefort J, Le Pelletier F, Leroux-Villet C, Mares S, Millot S, Zlowodzki AS, Sibaud V, Tessier MH, Vaillant L, Fricain JC, Samimi M. French guidelines for the management of oral lichen planus (excluding pharmacological therapy). Ann Dermatol Venereol 2022; 149:14-27. [PMID: 34238586 DOI: 10.1016/j.annder.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/16/2021] [Accepted: 04/01/2021] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- F Campana
- Aix Marseille Univ, APHM, INSERM, MMG, Hôpital de la Timone, Unité de chirurgie orale, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - R Lan
- Aix Marseille Univ, APHM, CNRS, EFS, ADES, Hôpital de la Timone, Unité de chirurgie orale, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - C Girard
- Dermatologie, CHU de Montpellier, 34295 Montpellier cedex, France
| | - J Rochefort
- Odontologie, Hôpital La Pitié Salpetrière - Université Paris Diderot, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - F Le Pelletier
- Anatomie Pathologique, Hôpital La Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - C Leroux-Villet
- Dermatologie, Hôpital Avicenne, 125 Rue de Stalingrad, 93000 Bobigny, France
| | - S Mares
- Chirurgie Maxillo-faciale, Hôpital La Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - S Millot
- Chirurgie Orale, CHU de Montpellier, 34295 Montpellier cedex, France
| | | | - V Sibaud
- Dermatologie, IUCT Oncopôle, 31000 Toulouse, France
| | - M-H Tessier
- Dermatologie, CHU de Nantes, 44000 Nantes, France
| | - L Vaillant
- Dermatologie, CHU de Tours, Université de Tours, 37000 Tours, France
| | - J-C Fricain
- Université de Bordeaux, INSERM U1026, service de chirurgie orale, CHU Bordeaux, 33000 Bordeaux, France
| | - M Samimi
- Dermatologie, CHU de Tours, Université de Tours, 37000 Tours, France.
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Li W, Huang Z, Tan B, Chen G, Li X, Xiong K, Zhu R, Li R, Li S, Ye H, Liang Z, Dong X, Zhou S, Chen S, Xi H, Cheng H, Xu R, Tu S, Chen Z, Qi L, Song J, Xiao R, Liu H, Nan Q, Yu H, Cui H, Shen Y, Wang C, Lin N, Zhang Y, Chen W. General recommendation for assessment and management on the risk of glucocorticoid-induced osteonecrosis in patients with COVID-19. J Orthop Translat 2021; 31:1-9. [PMID: 34692412 PMCID: PMC8526281 DOI: 10.1016/j.jot.2021.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/OBJECTIVE Coronavirus disease 2019 (COVID-19) is a disaster in human medical history and glucocorticoids remain the most promising therapy. Osteonecrosis is a disease caused by reduced intraosseous blood flow to bones in the joints, which will rapidly induce joint destruction. Approximately one-third patients with severe acute respiratory syndrome (SARS) who received high cumulative doses and long treatment durations of glucocorticoids occurred osteonecrosis. Considering the similarity of SARS and COVID-19 on their pathogen, clinical characteristics, and therapeutic strategies, it is particularly desirable to investigate whether osteonecrosis will become a common sequela among convalescent COVID-19 patients. METHODS This multi-strategy study was designed by integrating different research methods, such as meta-analysis, systematic review, and cross-sectional investigations to address above study objectives. At first, two meta-analyses were performed on the osteonecrosis incidence among SARS patients and the clinical data of glucocorticoid exposure among COVID-19 patients. Then, a systematic review of low-dosage glucocorticoid associated osteonecrosis and a cross-sectional investigation of glucocorticoid exposure of COVID-19 patients in Wuhan city of China were also conducted. Moreover, the pathogenesis, diagnosis, prevention, and treatment options for osteonecrosis patients with COVID-19 infection were further presented and discussed. RESULTS Our meta-analysis showed that 32% of SARS patients had developed osteonecrosis after receiving glucocorticoid treatment with high dose, and our system review supported that low level glucocorticoid exposure might also lead to the occurrence of osteonecrosis. Similarly, 40% of COVID-19 patients had undergone glucocorticoid treatment according to our meta-analysis. The cross-sectional investigation in Wuhan city of China found that the average of cumulative glucocorticoid exposure level was 504 mg calculated by the dosage of methylprednisolone. Notably, a confirmed osteonecrosis case was identified from 1406 patients with COVID-19 during our cross-sectional investigation, implying that preventive management of osteonecrosis should be better started with regular clinical follow-up observation. CONCLUSION Growing evidence of the glucocorticoid therapy for COVID-19 patients prompts us to establish risk-classification-based early screening and to introduce early prevention protocol of its associated osteonecrosis that will be of clinical significance in favor of improved prognosis of this disease. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE To establish risk-classification-based early screening and to introduce early prevention protocol of glucocorticoid-induced osteonecrosis will be of clinical significance in favor of improved prognosis of COVID-19.
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Affiliation(s)
- Wenlong Li
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Zeqing Huang
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, PR China
| | - Biao Tan
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, PR China
| | - Gang Chen
- Hubei College of Chinese Medicine, Jingzhou, 434020, PR China
- Hubei University of Chinese Medicine, Wuhan, 430065, PR China
| | - Xugui Li
- Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, 430079, PR China
| | - Kan Xiong
- Wuhan Jiangxia District Hospital of Traditional Chinese Medicine, Wuhan, 430200, PR China
| | - Ruizheng Zhu
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Ruihan Li
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Shuwen Li
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Hengli Ye
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
- Guizhou University of Traditional Chinese Medicine, Guiyang, 550025, PR China
| | - Zhi Liang
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Xiaojun Dong
- Wuhan Hospital of Traditional Chinese Medicine, Wuhan, 430014, PR China
| | - Shijing Zhou
- Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, 430079, PR China
| | - Song Chen
- Hubei University of Chinese Medicine, Wuhan, 430065, PR China
| | - Haixiang Xi
- Wuhan Hospital of Traditional Chinese Medicine, Wuhan, 430014, PR China
| | - Hao Cheng
- Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, 430079, PR China
| | - Rongpeng Xu
- Hubei College of Chinese Medicine, Jingzhou, 434020, PR China
| | - Shenghao Tu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Zhe Chen
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Lihua Qi
- Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, 430061, PR China
| | - Jiandong Song
- Hubei Integrated Traditional Chinese and Western Medicine Hospital, Wuhan, 430015, PR China
| | - Ruoran Xiao
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Huilan Liu
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Qian Nan
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Huiyong Yu
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Hongsheng Cui
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Yanguang Shen
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Chengxiang Wang
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Na Lin
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Yanqiong Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Weiheng Chen
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
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