Lichen Planus Research Articles

Retrospective Analysis of Blood Inflammatory Biomarkers in Patients with Oral Lichen Planus: Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio

Objectives: Oral lichen planus (OLP) is a potentially malignant disorder and a chronic inflammatory condition of an immune nature. The aim of this study was to investigate the association between immune-inflammatory biomarkers in patients with OLP and a control group. Materials and Methods: This was a retrospective study with 129 patients (62 with OLP and 67 controls) in which clinical and laboratory data were analyzed. The neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the mean platelet volume (MPV) index, and the parameter of systemic immune-inflammation index (SII) were assessed. Results: In patients with OLP, the average time of progression was significantly longer when the condition manifested in the atrophic–erosive form (4.3 ± 3.2 years) as opposed to the reticular form (1.8 ± 0.9 years) (p = 0.018). With regard to NLR, no differences were found in terms of age (p = 0.346 (r = 0.08)), tobacco use (p = 0.807), sex (p = 0.088), alcohol consumption (p = 0.281), clinical form of OLP (p = 0.55), time of progression of OLP (p = 0.309 (r = −0.13)), and number of sites (p = 0.217). The same was observed for the systemic immune-inflammation index. Conclusion: The lack of significant statistical associations between the biomarkers and parameters (NLR, PLR, MPV, and SII index) in patients with oral lichen planus makes such parameters of very limited use in clinical OLP practice.

Adalimumab Use in Severe Recalcitrant Vulval Lichen Sclerosus and Vulval Lichen Planus.

This case series aims to evaluate the demographic features, disease characteristics, and treatment outcomes of 8 patients receiving subcutaneous (SC) adalimumab for severe, refractory vulval lichen sclerosus (VLS) and/or vulval lichen planus (VLP). Both conditions are chronic inflammatory dermatoses that significantly impair quality of life, and although first-line treatment typically involves potent to ultrapotent topical corticosteroids, managing severe cases is challenging due to a lack of FDA-approved systemic therapies. Adalimumab, a TNF-α inhibitor, may offer a promising alternative by targeting the inflammatory cytokine implicated in the pathogenesis of both conditions. Eight patients received SC adalimumab for VLS and/or VLP at a tertiary referral vulvar disorders clinic from September 2020 to June 2024. Among the 8 patients, 4 had VLS/VLP clinical overlap, 2 had VLP, and 2 had VLS. Evaluation included patient-reported outcome measures (PROMs) namely the vulval life quality index (VLQI) and numerical rating scales for itch and pain, and objective clinical severity was assessed by a vulvar dermatologist based on cutaneous signs and architectural features. Adalimumab was well tolerated by 6 of 8 patients who received treatment for at least 9 months. Varying degrees of clinical improvement were observed in cutaneous signs and PROMs, including significant reductions in vulval life quality index scores for 6 patients. Architectural changes remained stable throughout treatment for all patients. This case series indicates that SC adalimumab may be a treatment option for patients with severe, refractory VLS and VLP, as demonstrated by significant improvements in PROMs. The observed clinical benefits suggest that adalimumab targets key inflammatory pathways in these conditions. Controlled trials are necessary to further validate these findings and define adalimumab's role in managing severe refractory VLS and VLP. Future research should also investigate long-term efficacy and safety, as well as potential predictors of treatment response, to optimize care for this challenging patient population.

Metformin Induced Lichenoïd Drug Eruption

Cutaneous lichenoid drug eruptions are rare adverse drug reactions reminiscent of lichen planus. The most frequently reported culprit drugs are Checkpoint inhibitors, tyrosine kinase inhibitors and TNF-α inhibitors, but other drugs can also be responsible. This case-report is about a 49-year-old woman with a history of type 2 diabetes. She started taking metformin 160 weeks before the onset of a pruritic lichenoid rash on the trunk and limbs, of which the histopathology was in favor of an adverse cutaneous lichenoid drug eruption caracterized by the presence of eosinophilic polynuclei in the perivascular infiltrate. The patient benefited from oral corticosteroids with discontinuation of metformin which resulted in the resumption of the lichenoid rash.

DEMOGRAPHIC PROFILE OF ORAL LICHEN PLANUS PATIENTS IN THE BULGARIAN POPULATION. CLINICOPATHOLOGICAL CORRELATION IN THE DIAGNOSIS OF THE DISEASE

Oral lichen planus (OLP) is a relatively common mucosal disease that mainly affects middle-aged women, yet the epidemiological characteristics of this condition in the Bulgarian population are poorly studied. OLP is considered a clinic-pathological diagnosis that is sometimes challenging to make. Aim. The aim of the present study was to determine the prevalence of OLP among the Bulgarian population and to evaluate the clinico-pathological correlation in the diagnosis of the disease. Materials and Methods. The files of the patients with diseases of the oral mucosa consulted in the Department of Periodontology and Oral Mucosa Diseases, Medical University of Plovdiv, between 2012-2016, were retrospectively reviewed. A comparison was also made of the clinical and histopathological diagnoses retrieved from the archived pathohistological records for the same cohort of patients. Results. Out of a total of 714 patients with mucosal diseases, 141 have been diagnosed with OLP, with the disease accounting for the largest proportion (20%) among the analyzed group. Male to female ratio was 1:4, and most patients were over 51 years of age. Histological confirmation of the clinical diagnosis OLP has been obtained in 84.1%, and there were additional 10.84% ​​cases with a histological diagnosis of OLP that were clinically misdiagnosed. Conclusion. OLP seems to be of great clinical importance in our country. There is a clinic-pathological discrepancy in the diagnostic evaluation of the disease in a relatively high percentage of cases. Therefore, stricter diagnostic criteria need to be introduced and followed to obtain a more reproducible diagnosis of OLP.

Direct Immunofluorescence in Oral Lichen Planus and Related Lesions: Sensitivity, Specificity, and Diagnostic Accuracy in a Single Diagnostic Center in Poland

Objectives: Our study aimed to establish the basic reliability parameters of direct immunofluorescence test results in patients with oral lichen planus. Methods: We conducted an evaluation of individual antibody classes in the DIF and ELISA (BP180 antigen), comparing these results with the classical histopathological (HP) examination in a group of patients treated within the standard healthcare in our clinic. Results: Among 66 participants with oral changes indicative of LP, only 50% received histopathological confirmation of the LP diagnosis. Among those with a DIF profile entirely typical for LP (C3+, F+), 57.1% had a positive HP result. Fibrinogen deposits were identified in 42.4% and 36.4% of individuals with positive HP results for F1 and F2, respectively; 78.8% of patients with negative HP and 57.6% with positive HP exhibited no fibrinogen deposits. Simultaneous positivity for F1 and F2 occurred in all cases where F1 was positive. HP confirmed positive DIF for C3 in 50% of cases. Fibrinogen deposits demonstrated the highest diagnostic accuracy (61%). Sensitivity and specificity for fibrinogen deposits were 36% and 42% for F1 and 79% and 82% for F2. The positive predictive values were 67% for F1 and 67% for F2, while the negative predictive values were 58% for F1 and 56% for F2. Overall diagnostic accuracy was reported at 61% for F1 and 59% for F2. Conclusions: Our data indicate the complementarity of HP and immunological test results and the necessity of using both methods together in cases of doubt.

Oral Lichen Planus: Clinical Presentation, Demographic Characteristics, and Risk Factors in a Retrospective Study of 186 Polish Patients

Background/Objectives: Lichen planus (LP) is a chronic, recurrent mucocutaneous inflammatory disease that develops due to a disturbed immunological response triggered by endogenous and exogenous factors. To evaluate clinical presentation, demographic characteristics, and risk factors in a cohort of Polish patients with oral lichen planus (OLP). Methods: Medical records of 186 patients with OLP referred to the student outpatient clinic in Poznań University of Medical Sciences from 2013 to 2023 were analyzed in order to establish clinical presentation, patient’s demographic characteristics, and risk factors for OLP. We considered data regarding age, sex, medical history, habits, subjective complaints, clinical type, localization, histology, and treatment. Results: Patients with OLP constituted 20.1% of 887 admitted patients. Of the 186 patients with OLP, 130 (69.9%) were females and 56 (30.1%) were males. The average age at the diagnosis was 60.7 years (range 15–95 years). Only 24.2% of patients reported smoking. The most common intraoral presentation of OLP was reticular form (61.8%), followed by mixed erosive-bullous type (15%), and atrophic (6.4%). Pathologic lesions were most commonly located on buccal mucosa (89.2%) and tongue (58.6%). Subjective complaints included pain (48.4%), burning sensation (46.2%), xerostomia (25.3%), bleeding (10.2%), taste disturbance (4.8%), and excessive saliva production (3.8%), while 22.6% of OLP patients were asymptomatic. Conclusions: The most common type of OLP in Polish patients was reticular, developing mostly on the buccal mucosa and tongue. It was found most often in non-smoking middle-aged women. Subjective complaints were reported by over 77% of patients.

Large-scale global retrospective study on the interaction between ancestry and risk of comorbid autoimmune diseases in patients with pemphigus

The pemphigus family of skin blistering diseases represents a rare yet potentially life-threatening condition characterized by multiple known genetic loci associated with other autoimmune disorders. While several studies have empirically indicated an increased risk of developing additional autoimmune diseases in individuals with pemphigus, the scarcity of data and the rarity of pemphigus have hindered efforts to establish and generalize these associations across diverse populations. In this study, we analyzed a dataset comprising 126 million patients, including 18,000 with pemphigus, to assess the likelihood of developing any of 74 autoimmune diseases following a diagnosis of pemphigus. For a subset of 26 diseases from this list with adequate patient numbers, we conducted further case-control retrospective analyses to quantify the odds and hazard ratios of developing comorbid conditions across various ethnicities. Our findings reveal highly significant and generalizable associations between pemphigus and pemphigoid diseases, discoid lupus erythematosus, lichen planus, and undifferentiated connective tissue disease, among others.

273 Ferroptosis accelerates inflammation in lichen planus and cutaneous lupus erythemathosus

273 Ferroptosis accelerates inflammation in lichen planus and cutaneous lupus erythemathosus

060 Single-cell profiling of lichen planus reveals type I interferon response triggering the interface dermatitis reaction

060 Single-cell profiling of lichen planus reveals type I interferon response triggering the interface dermatitis reaction

Impact of risk factors for oral candidiasis in patients with Sjögren's syndrome

Background: Sjogren's Syndrome (SS) is an autoimmune disease in which the body attacks the exocrine glands. The characteristics of this syndrome involve dysfunction and destruction of the exocrine glands, leading to oral manifestations. Patients with Sjogren's Syndrome are at a significantly higher risk of developing oral cavity diseases. Common oral manifestations found in Sjogren's Syndrome include sialadenitis, lichen planus, and salivary swelling. Material and Methods: The literature review was carried out in Pubmed, ScienceDirect, and Researchgate as well as various relevant sources with the keywords: “Oral Candidiasis", “Sjogren’s Syndrome", "Oral Cavity Lesions”, "Flow Saliva", and "Oral Health." Conclusion: In patients with Sjogren's Syndrome, the saliva flow tends to decrease, which can increase the risk of higher levels of Candida albicans bacteria, thereby raising the likelihood of developing Oral Candidiasis.

The Mechanism of Immune Intervention by Iguratimod in Oral Lichen Planus Patients: An InVitro Experimental Study.

Oral lichen planus (OLP) is a T cell-mediated immune disease. Iguratimod (IGU) is a novel immunomodulatory agent for rheumatoid arthritis. No studies have been reported on the mechanism of IGU in the treatment of OLP, which deserves investigation. Samples were collected from two batches of non-erosive OLP, erosive OLP (EOLP) patients and healthy control subjects. In the first batch, the effects of IGU or the same volume of dimethyl sulfoxide (DMSO) on proliferation, apoptosis and migration of peripheral blood T lymphocytes (PBL T) were examined by CCK-8, flow cytometry and transwell assay respectively. The levels of IL-6, IL-17, TNF-α, TGF-β and IL-10 were measured by enzyme-linked immunosorbent assay. In the second batch, the percentages of Th17 and Treg cells were determined by flow cytometry in peripheral blood mononuclear cells after IGU or DMSO stimulation. Compared with the control, IGU promoted apoptosis and inhibited migration, but had no significant effect on the proliferation of PBL T in OLP. IL-6, IL-17 and TNF-α were decreased in OLP. TGF-β and IL-10 showed an upward trend in the IGU-treated EOLP. IGU decreased Th17 in OLP and reduced Th17/Treg ratio in EOLP. The percentage of Treg cells showed an upregulated trend but the difference was not statistically significant. IGU may intervene in the immune response of OLP by affecting functions of PBL T, improving the balance of Th17/Treg and regulating related cytokines.

History of Breast Cancer in Patients with Oral Lichen Planus: A Case–Control Study

Objectives: The purpose of this study was to determine the association between oral lichen planus (OLP) and the history of cancer outside of oral cavity and the predominance of its location. Methods: This case–control study included 600 OLP patients and 600 control subjects evaluated in the same section, matched for age and sex to the OLP patients. OLP patients were diagnosed clinically and histologically. Initially, the prevalence of the most frequent types of cancers was described. A Pearson chi-squared test model was used to determine the association of cancer history and OLP. It was considered statistically significant whether p value was ≤0.05. The final multivariate regression model was built after applying a backward selection method to the complete multivariate model considering the odds ratio (OR) with a 95% confidence interval (CI). Results: The history of cancer was significantly associated with OLP regardless of age, sex, tobacco and or alcohol use in both univariate [OR = 2.26 (95%CI: 1.26–4.24); p = 0.008] and multivariate analyses [OR = 2.21 (95%CI: 1.21–4.19); p = 0.012]. According to the location of cancer, there was an association between OLP and history of breast cancer [OR = 3.71 (95%CI = 1.03–13.38); p = 0.032]. Conclusions: This case–control study suggests a higher frequency of cancer, particularly breast cancer, among patients with OLP compared to the control group. Due to the study’s design and sample limitations, these findings should be interpreted cautiously. Future longitudinal, multi-institutional studies with rigorous control for cancer history and other confounding factors are essential to further explore the association between OLP and cancer, particularly breast cancer.

Correlations between lichen planus and autoimmune diseases: a Mendelian randomization study.

Previous observational studies have found that lichen planus (LP) is associated with autoimmune diseases. To determine the association between LP and 15 autoimmune diseases, we applied the Mendelian randomization (MR) approach, which uses genetic variants as a tool to improve causal inference. We performed a two-sample MR with the genetic instruments identified for 15 autoimmune diseases. Genome-wide association study (GWAS) data was sourced from the IEU Open GWAS database. The instrumental variables (IVs) for LP (1865 cases and 212,242 non-cases) were genetic variations highly associated (P < 5 × 10-6) with LP in the European population. To calculate causal effects, odds ratios (ORs) with 95% confidence intervals (CIs) are employed. MR showed that the genetic risk of psoriasis was positively associated with atopic dermatitis (OR [95%CI] = 0.964[0.936, 0.992], PIVW = 0.013), ankylosing spondylitis (OR [95%CI] = 0.879[0.774, 0.999], PIVW = 0.047) and Type 1 diabetes (OR [95%CI] = 1.074[1.008, 1.145], PIVW = 0.027). These results didn't exhibit horizontal pleiotropy, and "leave-one-out" analysis demonstrated result stability. The MR study indicates a causal relationship between atopic dermatitis, ankylosing spondylitis and Type 1 diabetes in Europe. Further research is necessary to clarify the biological mechanisms that underlie these associations.

Oncological Outcomes of Patients With Oral Potentially Malignant Disorders

Understanding the clinical course and malignant transformation rate of oral potentially malignant disorders (OPMDs)-including oral leukoplakia, oral erythroplakia, oral submucous fibrosis, and oral lichen planus-is crucial for early detection and improved survival rates in patients with oral cancer. To evaluate the progression of oral cancer from OPMDs using a large US electronic medical database. This retrospective cohort study used data from the University of California, San Francisco's PatientExploreR database between January 1973 and March 2024. Patients with oral leukoplakia, oral erythroplakia, oral submucous fibrosis, and oral lichen planus were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes and keywords. Demographics, tobacco and alcohol use, HIV status, and other known risk factors for oral cancer were recorded to identify factors associated with malignant transformation. Logistic regression and descriptive analyses were used. Diagnosis of oral leukoplakia, oral erythroplakia, oral submucous fibrosis, or oral lichen planus. Incidence of oral cancer, malignant transformation rate, median time to progression, and associations between demographics and risk factors and the development of oral cancer. Among 4 225 251 individuals in the database, 4371 were diagnosed with oral cancer (median [IQR] age, 63 [53-71] years; 2610 [59.9%] male; 0.1% of the cohort), and 110 (2.5%) had a preceding OPMD. Oral leukoplakia was found in 1124 patients, with 94 (8.4%) undergoing malignant transformation (median [IQR] time to progression, 25 [7-129] months). HIV-positive patients with oral leukoplakia were more likely to develop oral cancer (odds ratio, 3.80; 95% CI, 1.35-10.70). Of 22 patients with oral erythroplakia, 11 (50.0%) developed oral cancer (median [IQR] time to progression, 3.7 [0.2-334] months). Those who smoked tobacco with oral erythroplakia showed a higher malignant transformation rate (odds ratio, 3.75; 95% CI, 0.54-26.05). Of the 78 patients with oral submucous fibrosis, 4 (5.1%) underwent malignant transformation (median [IQR] time to progression, 36 [36-48] months). Only 1 patient with oral lichen planus developed oral cancer after 5 years. This cohort study showed that OPMDs have notable but varying propensities to progress to oral cancer. Early detection and monitoring of OPMDs are crucial for improving patient outcomes. However, the risk, etiopathogenesis, and clinical presentation vary for each OPMD and should, therefore, be considered distinct diseases.

Chronic Hepatitis C and Its Dermatological Impact: Focus on Lichen Planus

Chronic Hepatitis C and Its Dermatological Impact: Focus on Lichen Planus

Exploring the Intersection of Dentistry and Dermatology: Oral Manifestations in Dermatological Conditions and Implications for Diagnosis and Treatment

Dermatological conditions frequently present with oral symptoms, making the collaboration between dermatology and dentistry crucial. Oral manifestations are often an early sign of systemic dermatological conditions, necessitating the involvement of dentists in both diagnosis and management. This article explores the intersection of dermatology and dentistry, focusing on recent advancements in the treatment of oral lesions associated with dermatological diseases, including dermatitis and autoimmune conditions. A variety of dermatological diseases, such as lichen planus, pemphigus vulgaris, and systemic lupus erythematosus, present oral manifestations. These conditions can significantly impact a patient’s oral health and overall quality of life, often requiring a combined dermatological and dental approach to care.

Lichenoid paraneoplastic pemphigus in a patient presenting with follicular lymphoma: a review of the literature.

Paraneoplastic pemphigus (PNP) is a rare, autoimmune, mucocutaneous blistering disease that is almost always associated with a confirmed or occult neoplasm. PNP often presents with characteristic features of intractable stomatitis and polymorphous cutaneous eruptions, including blisters and lichenoid dermatitis caused by humoral and cell-mediated autoimmune reactions. We present the following case of a patient with follicular lymphoma (FL) who developed lichenoid PNP involving the buccal mucosa and lateral tongue. We also summarize the literature, discussing current proposed mechanisms, guidelines, and treatment of this unique disease. While patients can achieve complete remission from their underlying neoplasm, most patients with PNP do not have a good survival time with a 5-year survival rate of only 38%. This case sheds light on an uncommon occurrence, highlights the need for further studies around PNP as it relates to FL, and suggests that T cell immunosuppressive therapy may be effective in treating FL patients with PNP.

Lichenoid dermatitis induced by abemaciclib in a patient with HR+/HER2- breast cancer

Cyclin-dependent kinase (CDK) 4/6 inhibitors, such as palbociclib, ribociclib, and abemaciclib, are widely used in combination with endocrine therapy for the treatment of hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) breast cancer. Despite their efficacy, these drugs are associated with a range of adverse events, including dermatologic toxicities. This case report presents a rare instance of lichenoid dermatitis in a 48-year-old woman following treatment with abemaciclib. The patient developed erythematous, edematous plaques and papules on her hands and forearms, which resolved after discontinuation of the drug and treatment with topical corticosteroids. This report highlights the need for awareness of cutaneous side effects associated with CDK4/6 inhibitors, particularly abemaciclib.

Artificial Intelligence Diagnosing of Oral Lichen Planus: A Comparative Study.

Early diagnosis of oral lichen planus (OLP) is challenging, which traditionally is dependent on clinical experience and subjective interpretation. Artificial intelligence (AI) technology has been widely applied in objective and rapid diagnoses. In this study, we aim to investigate the potential of AI diagnosis in OLP and evaluate its effectiveness in improving diagnostic accuracy and accelerating clinical decision making. A total of 128 confirmed OLP patients were included, and lesion images from various anatomical sites were collected. The diagnosis was performed using AI platforms, including ChatGPT-4O, ChatGPT (Diagram-Date extension), and Claude Opus, for AI directly identification and AI pre-training identification. After OLP feature training, the diagnostic accuracy of the AI platforms significantly improved, with the overall recognition rates of ChatGPT-4O, ChatGPT (Diagram-Date extension), and Claude Opus increasing from 59%, 68%, and 15% to 77%, 80%, and 50%, respectively. Additionally, the pre-training recognition rates for buccal mucosa reached 94%, 93%, and 56%, respectively. However, the AI platforms performed less effectively when recognizing lesions in less common sites and complex cases; for instance, the pre-training recognition rates for the gums were only 60%, 60%, and 20%, demonstrating significant limitations. The study highlights the strengths and limitations of different AI technologies and provides a reference for future AI applications in oral medicine.

Carpal Tunnel Corticosteroid Injection Treatment of Nail Lichen Planus

Treatment for nail lichen planus (NLP) typically involves the use of intralesional or systemic corticosteroids. However, both modalities have distinct considerations. Systemic options are typically reserved for severe cases due to potential adverse effects while intralesional injections are limited due to patient discomfort. Here we present a case in which a corticosteroid injection for carpal tunnel syndrome led to incidental bilateral improvement in a patient’s nail lichen planus. Carpal tunnel injection may be an alternative to more traditional treatments and is a potential area for further research.