Biopsy-proven Oral Lichen Planus Research Articles

Comparative Efficacy and Safety of Interventions for the Treatment of Oral Lichen Planus: A Systematic Review and Network Meta-Analysis.

This systematic review and network meta-analysis aimed to assess comparative efficacy and safety of interventions to treat symptomatic, biopsy-proven oral lichen planus (OLP). Search was conducted for trials published in Medline, Embase and Cochrane Central Register of Controlled Trials. Network meta-analysis was performed on data from randomized controlled trials that assessed efficacy and safety of interventions used in the treatment of OLP. Agents were ranked according to their effectiveness in treatment of OLP based on outcomes using surface under the cumulative ranking [SUCRA]. In total, 37 articles were included in the quantitative analysis. Purslane was clinically significant and ranked first in improving clinical symptoms [RR = 4.53; 95% CI: 1.45, 14.11], followed by aloe vera [RR = 1.53; 95% CI: 1.05, 2.24], topical calcineurin [RR = 1.38; 95% CI: 1.06, 1.81] and topical corticosteroid [RR = 1.35 95% CI: 1.05, 1.73]. Topical calcineurin demonstrated the highest incidence of adverse effects [RR, 3.25 [95% CI: 1.19, 8.86. Topical corticosteroids were significant in achieving clinical improvement of OLP with RR1.37 [95% CI: 1.03, 1.81]. PDT [MD = -5.91 [95% CI: -8.15, -3.68] and showed statistically significant improvement in the clinical score for OLP. Purslane, aloe vera and photodynamic therapy appear promising in treatment of OLP. More high-quality trials are recommended for strengthening the evidence. Although topical calcineurin is significantly efficacious in the treatment of OLP, significant adverse effects are a concern for clinical use. Based on the current evidence, topical corticosteroids are recommended for treatment of OLP owing to their predictable safety and efficacy.

Oral hairy leukoplakia in an immunocompetent patient treated with topical steroids for oral lichen planus

<h3>Objectives</h3> Oral Hairy Leukoplakia (OHL) is an Epstein-Barr Virus (EBV)-related lesion of the oral mucosa, most commonly affecting immunocompromised patients. Although HIV-infection appears to be the most frequent pre- disposing factor, OHL cases have been reported in patients with other causes of systemic or even local immuno- suppression. Herein, we present a case of OHL arising in an HIV-negative immunocompetent patient treated with topical steroids for Oral Lichen Planus (OLP). <h3>Findings</h3> A 62 years old male patient with biopsy-proven OLP presented for his regular follow-up. He was un- der treatment with topical steroids: fluocinonide (oral gel) and dexamethazone (oral solution). Clinical examina- tion revealed a white plaque of irregular surface involving the right lateral border of the tongue, which had not been noticed in the previous follow up appointment, 2 months ago. With a differential diagnosis of morsicatio linguarum, hypertrophic OLP and leukoplakia, an incisional biopsy was performed. Histopathologic examination revealed hyperkeratotic squamous epithelium with surface corrugations and the presence of "balloon cells" in the upper spinous layer, some of which exhibited nuclear beading in high power magnification. Immunohistochem- ical examination for EBV-LMP1 and in-situ hybridization for EBV were positive, establishing a diagnosis of OHL. Although no symptoms or signs of immunosuppression/HIV infection were present, the patient underwent blood examinations, including an HIV ELISA antibody test, which were within normal limits. In the absence of any in- dications of systemic causes, a diagnosis of OHL associated with local immunosuppression due to long-term use of topical corticosteroids was rendered. <h3>Conclusions</h3> OHL may be associated with different types of immunosuppression. In recent years, few cases of OHL developing in patients treated with topical steroids have been reported, the majority of which were linked to inhalers for pulmonary diseases. Topical steroid-induced immunosuppression in patients with oral mucocutaneous diseases should be considered as a possible, albeit unusual, cause of OHL.

VERRUCIFORM XANTHOMA: CASE SERIES OF AN UNUSUAL, COMMONLY MISDIAGNOSED LESION

Introduction Verruciform Xanthoma (VX) is a benign condition occurring primarily in the oral cavity with some lesions also found on the genital mucosa or skin. VX occurs primarily in the fifth decade of life and shows a slight male predilection. This lesion generally presents as a papillary or rough-surfaced, painless, well-demarcated lesion, ranging from white, yellow-white, to orange in color. The etiology of VX is still largely unknown and definitive diagnosis is made based on histology. This lesion is thought to correlate with localized trauma or chronic inflammatory conditions such as lichen planus, lupus, epithelial dysplasia, pemphigus vulgaris, and mucous membrane pemphigoid. We report a series of three cases from our institution in which we examine the demographics associated with verruciform xanthoma as well as its connection to known inflammatory conditions. Patient Cases Our case series includes two males and one female patient ranging in age from 45-76 years old. The lesions were found in 3 different sites: gingival mucosa, ventral tongue, and buccal mucosa. Two of the patients had biopsy-proven oral lichen planus. The social and medical histories of each patient will be examined and compared for overlapping factors that may be of assistance in further clarifying demographic and etiological factors. Conclusion Clinicians should be familiar with verruciform xanthoma as it is often misdiagnosed as the more commonly occurring viral papilloma. Patients may be concerned they have contracted a viral disease and thus this lesion should be biopsied to rule out HPV infection.

Efficacy of photodynamic therapy or low level laser therapy against steroid therapy in the treatment of erosive-atrophic oral lichen planus.

The efficacy of photodynamic therapy (PDT) or low level laser therapy (LLLT) in the treatment of oral lichen planus (OLP) is debatable. The aim of this study was to compare the effects of PDT, LLLT or topical corticosteroid application in the treatment of erosive-atrophic OLP. Forty-five adult patients with erosive-atrophic biopsy-proven OLP on the tongue or buccal mucosa (size ≤3 cm) were randomly divided into three groups. Group-1: patients receiving PDT topical application of 50 μl toluidine blue (1 mg/ml) with micropipette and after 10 min treated by laser irradiation using GaAlAs laser (630 nm, 10 mW/cm2, continuous wave, spot size: 1 cm2); Group-2: patients receiving LLLT using diode laser (630 nm, 10 mW, continuous wave, spot size: 1 cm2); and Group-3: patients receiving topical corticosteroid applications consisting of dexamethasone (0.5 mg in 5 ml water) mouthwash for 5 min. Demographic data, type, and severity of the lesions and pain were recorded before and after treatment and then at the 1 year follow-up. There was a significant difference in sign score changes before and after the treatment in the PDT group (p = 0.03), LLLT group (p = 0.04) and in the control group (p = 0.02). There was a statistically significant difference between group-1 (p = 0.001) and group-2 (p = 0.001) against group-3 before and after treatment. Mean amount of improvement in pain was significantly greater in the control group in comparison with the PDT and LLLT groups (p < 0.001). The efficacy index of the PDT group improved significantly more than the LLLT (p = 0.001) and corticosteroid groups (p = 0.001). Within the limits of the present RCT, it is indicated that PDT and LLLT are effective in the treatment of erosive-atrophic forms of OLP in adult patients. However, further comparative clinical trials are needed to obtain strong conclusions in this regard.

Retrospective Analysis of Medication Use and Systemic Conditions In 155 Patients With Biopsy Proven Oral Lichen Planus and Oral Lichenoid Mucositis

Retrospective Analysis of Medication Use and Systemic Conditions In 155 Patients With Biopsy Proven Oral Lichen Planus and Oral Lichenoid Mucositis

Comparison of Low-Level Laser Therapy versus Ozone Therapy in the Treatment of Oral Lichen Planus.

BackgroundThe treatment options for oral lichen planus (OLP) are numerous and include topical and systemic agents. Intralesional and systemic corticosteroids are used; however, the therapeutic results are often disappointing.ObjectiveTo compare the influence of ozone, laser, and topical corticosteroid therapies in the treatment of OLP.MethodsOne hundred twenty adult patients with ≤3 cm atrophic-erosive biopsy-proven OLPs in the tongue or buccal mucosa were recruited into the study. They were randomly assigned, by preoperative envelope drawing, to be treated with low-level laser therapy (LLLT group), ozone therapy (ozonated group), and topical corticosteroid therapy (positive control group). A placebo treatment containing base ointment without the active corticosteroid component was administered to patients in the negative control group. Response rate scores were determined on the basis of changes in the appearance score and pain score of the lesions between baseline and after each treatment.ResultsThe study subjects consisted of 56 male and 64 female OLP patients with a combined mean age of 42.6±8.3 years (range, 28~55 years). No statistically significant difference was detected in clinical severity among the groups. The sign scores decreased in almost all scoring groups; however, statistically significant improvement was found in the ozonated and corticosteroid-treated groups. Symptom improvement was achieved after treatment with LLLT, ozone, and corticosteroid (p<0.05). The efficacy indices were significantly higher in the ozonated and corticosteroid-treated groups.ConclusionOzone and corticosteroid therapies were more effective than 808-nm LLLT in the treatment of OLP.

Increased number of Langerhans cells in oral lichen planus and oral lichenoid lesions

The aim of this study was to quantify the presence of Langerhans cells (LC) in oral lichen planus (OLP) and oral lichenoid lesions (OLL), comparing them with normal epithelium. Thirty-six patients with biopsy-proven OLP or OLL were selected for the study, as well as 23 control subjects free of inflammatory conditions. Immunohistochemical reactions were performed using the streptavidin-biotin peroxidase complex method with CD1a and CD83 primary antibodies. Densities were compared between groups and correlated with microscopic findings. Patients with lichenoid conditions (OLP + OLL) presented higher densities of CD1a(+) cells than the control subjects (P = .03). Higher densities of CD1a were associated with a thinner layer of inflammatory cells (P = .02). This study indicates that OLP and OLL are characterized by the recruitment of LC, which may play a significant role on its pathogenesis.

Oral lichen planus treated with 13-cis-retinoic acid (isotretinoin): effects on the apoptotic process

The aim of the present study is to verify the efficacy of isotretinoin in oral lichen planus (OLP). In a double-blind study, ten patients with biopsy-proven OLP were treated for 4 months with 0.1% isotretinoin gel and another ten patients with placebo. At the end of the first period of observation, the patients who had been given the placebo were given isotretinoin for a further 4 months. A complete response was defined as the disappearance of the lesions as assessed by inspection, whereas a partial response was defined as a 50% or more reduction in the size of the lesions. All patients treated with isotretinoin showed a significant improvement of the oral lesions, whereas in the patients who were given the placebo, the size of the lesions remained the same. The patients who were given isotretinoin after the placebo showed a reduction in lesions. In total, there were ten complete and ten partial responses. Lesions were analysed histologically and immunohistochemically with antibodies against bcl-2 and Ki-67. Ki-67 and bcl-2 have statistical significant increased values from before to after treatment, whereas apoptotic bodies decreased one. All these facts could have contributed to the partial or complete regression of OLP lesions. The increase in Ki-67 positive cells show that the epithelium requires for enhanced proliferation and healing. The present results revealed a disturbed cell death programme in OLP that could underline an abnormal epithelial differentiation. The results of this pilot study show that the topical use of isotretinoin is effective in treating OLP.

A randomized controlled trial to compare steroid with cyclosporine for the topical treatment of oral lichen planus

To compare the effectiveness of cyclosporine solution versus triamcinolone acetonide in orabase in the treatment of oral lichen planus (OLP) in reducing signs and symptoms. One hundred thirty-nine biopsy-proven OLP patients were randomly assigned to cyclosporine (68) or steroid (71) applied onto the target lesion and affected areas. Assessments were at weeks 0, 2, 4, 8 by clinical scoring and grid measurement of the target lesion (reticulation, erythema, ulceration). Patients ranked severity of pain and burning sensation using visual analog scales. Although clinical response, pain, burning sensation, area of reticulation, erythema, and ulceration at week 4 were all worse in patients receiving cyclosporine than in those receiving steroid, the differences were not statistically significant. Large patient-to-patient variability was evident over the observation period, with little evidence of marked changes in levels over time in both treatment groups. Topical cyclosporine appears no more effective than steroid in the treatment of oral lichen planus.

The clinical features, malignant potential, and systemic associations of oral lichen planus: A study of 723 patients

Background: Although oral lichen planus (OLP) is a relatively common disorder, reports comprising large numbers of patients with the disease are lacking in the dermatology literature. Objective and Methods: The purpose of this investigation was to describe the clinical characteristics of 723 patients with biopsy-proven OLP who were followed up from 6 months to 8 years (mean, 4.5 years). Results: Of the 723 patients, 75% were women and 25% men. The erosive form of the disease was the predominant type in 40% of patients at initial presentation, and symptoms were present in the majority of patients with all forms of the disease. Isolated gingival lichen planus was observed in 8.6% of patients. Precipitating factors that resulted in an exacerbation of the disease were frequently noted and included stress, foods, dental procedures, systemic illness, and poor oral hygiene. In 195 patients prospectively screened, no liver abnormalities or antibodies to hepatitis B or C were detected. Oral squamous cell carcinoma developed in 6 patients (0.8%) at sites previously diagnosed by clinical examination as erosive or erythematous lichen planus. Conclusions: Patients with OLP usually display lesions with distinctive clinical morphology and characteristic distribution but may also present with a confusing array of forms and patterns mimicking other diseases. Because patients with OLP may be at an increased risk for the development of squamous cell carcinoma, periodic follow-up is mandatory to detect malignant transformation. Routine screening of American patients with OLP for hepatitis C and other liver abnormalities does not appear to be warranted as in Italian and Japanese patients with OLP. (J Am Acad Dermatol 2002;46:207-14.)