Cases Of Oral Lichen Planus Research Articles

Guideline for the diagnosis and treatment of oral lichen planus (revision)

Oral lichen planus (OLP) is a chronic and inflammatory oral mucosal disease that commonly affects middle-aged females. Most OLP cases might exhibit such symptom as pain, roughness and other discomfort, and more severe forms may show a high risk of developing oral cancer. Active preventive measure, precise diagnosis and standard therapeutic approach play a vital role in the management and prevention of OLP. This guideline is a revision on the base of trial in 2012, which mainly covers the following 8 aspects: etiology and medical records, clinical manifestations, pathological manifestations, diagnosis, differential diagnosis, laboratory examination, disease treatment and prevention, aiming at providing scientific evidence and guidance for the dental clinicians in diagnose and treatment of OLP.

Onset of oral lichen planus following dental treatments: A nested case-control study.

The exposure to amalgam restorations has been reported to bring about altered immunity followed by inflammation and infection. This study aimed at identifying whether patients who received restorative or endodontic treatments, or tooth extraction, would have altered odds of developing oral lichen planus (OLP). In this population-based nested case-control study, 421 cases of OLP and 1,684 controls were included after propensity score matching. Logistic regression was used to estimate the adjusted odds ratio (aOR) of OLP in individuals who had received amalgam and composite resin restorations, root canal therapy, and tooth extraction over a follow-up duration of five years. There were no significantly different odds of OLP for those who underwent either amalgam (aOR = 0.948, 95% CI = 0.853-1.053, p = 0.3170) or resin restorations (aOR = 1.007, 95% CI = 0.978-1.037, p = 0.6557) in both anterior and posterior teeth in an observational period of five years after restorations. Root canal therapy was associated with significantly lower odds of OLP, with each additional root canal therapy attenuating the risk of OLP at an aOR of 0.771 (95% CI = 0.680-0.874, p = 0.0001) for both anterior (aOR = 0.786, 95% CI = 0.626-0.986, p = 0.0372) and posterior teeth (aOR = 0.762, 95% CI = 0.650-0.893, p = 0.0008). Likewise, each tooth extraction reduced the risk of OLP, with an aOR of 0.846 (95% CI = 0.772-0.927, p = 0.0003), especially for anterior teeth (aOR = 0.733, 95% CI = 0.595-0.904, p = 0.0037). We reported no significant association between dental restorations and consequent OLP, and significantly lower odds of OLP following both root canal therapy and tooth extraction.

Histopathology oforallichen planus andorallichenoid lesions: An exploratory cross-sectional study.

To better characterize the histopathology of oral lichen planus and oral lichenoid lesions and to highlight the differences between them in order to support the clinician in the diagnostic and therapeutic management of such conditions. Fifty-five patients, clinically diagnosed with oral lichen planus (n = 25) or oral lichenoid lesions (n = 30), were consecutively enrolled in the present study. Subsequently, one blind pathologist reviewed all the biopsy specimens of enrolled subjects following a specific protocol to provide a detailed histopathological description. Demographic, anamnestic, and clinical data were also recorded from all the participants. Patients' data were analysed and compared using the chi-squared test, to provide distinguishing features between the studied conditions. We found a higher and statistically significant number of eosinophils in the oral lichenoid lesions compared with the oral lichen planus group (p < 0.01), an equally promising result was seen regarding plasma cells, which were more represented (p = 0.05) in the oral lichenoid lesions than in the oral lichen planus cases. No statistically significant differences were detected in demographic, anamnestic and clinical data. A mixed lichenoid inflammatory infiltrate, consisting of eosinophils and plasma cells, could be used as reliable histological features for the diagnosis of oral lichenoid lesions, as long as compared with findings obtained from the patients' history and clinical examination.

Frequency of oral Lichen Planus among hypothyroid patients

Objective: Recent investigations have suggested a correlation between thyroid diseases, particularly hypothyroidism(HT), and oral lichen planus (OLP). Objective: This study aimed to assess the frequency of OLP in HT patients.Material and Methods: This analytical descriptive study evaluated 100 HT patients including 94 females and6 males, who were selected by convenience sampling. The subjects were clinically examined for OLP. The meanage of patients was 42.49±1.29 years. Also, 100 age- and sex-matched healthy controls were examined. Thedata were analyzed using chi-square test and Fisher’s exact test via SPSS. Results: Of all, 14 (14%) HT patients(12 females and 2 males) had OLP while only one case of OLP was found in the control group. The differencebetween the two groups in the frequency of OLP was significant (P=0.001). The odds ratio (OR) of developingOLP was calculated to be 16.11 in HT patients. Reticular form was the most common type of OLP in patients(50%). The buccal mucosa was the most common site of involvement (92.85%). The mean age of patients withOLP was 42.93±1.29 years with a median of 46±1.29 years in HT group. Conclusion: The frequency of OLPwas significantly higher in HT patients such that HT patients had higher odds of developing OLP by 16 folds.KEYWORDSHypothyroidism; Oral lichen planus; Frequency; Comparison.

Interest of periodontal maintenance in improving autoimmune diseases: about an oral lichen planus case report

Introduction: Oral lichen planus is an autoimmune inflammatory disease. These clinical manifestations can sometimes be confused and cumulated with clinical signs of periodontal disorders. The aim of this work is to illustrate the interest of a periodontal follow-up in the management of oral lichen planus by a clinical case report. Observation: A patient came for a consultation in dermatology for a persistent gingival erythema. The diagnosis of oral lichen planus was made and treatments were successively implemented. After six months of follow-up, an inflammatory gum was still present without showing improvement. A stage 3, grade B periodontitis associated with oral lichen planus was diagnosed and a periodontal treatment was initiated, combined with corticosteroids treatment as mouthwash. Four months after the beginning of this treatment, a marked decrease in gingival erythema was observed. Comments: There is often a close relationship between oral lichen planus and periodontal disease therefore a multidisciplinary approach can be very useful for optimal management.

Holistic Management F Holistic Management For Severe Oral Lichen Planus: A Case al Lichen Planus: A Case Report

Oral lichen planus (OLP) is an immunologically mediated mucocutaneous disease associated with various factors including systemic diseases, with a higher prevalence in females than males. The majority of OLP cases are accompanied by symptoms of discomfort and/or pain. Treatment of OLP can be challenging due to its unknown aetiology and involvement of multiple contributing factors. Objective: Our aim is to report a long-term follow-up case of oral lichen planus with holistic management approach. This report will provide some options to clinicians who are having difficulties in managing OLP cases especially with the medications. Case Report: This case report discusses a female patient who suffered OLP with no definitive treatment prior to referral to us. A thorough history of her problem including psychosocial factors and dietary pattern were obtained. Clinically, the oral mucosa presented characteristics similar to erosive oral lichen planus. Patient reluctance towards pharmacotherapy due to her comorbidities was a challenged in managing her OLP. Hence, a non-pharmacotherapeutic solution was offered by considering psychology and dietary pattern. Conclusion: A severe oral lichen planus with ulcerative background could be managed holistically and not just through a pharmacotherapeutic approach.

Matrix Metalloproteinases (MMPs) in skin and oral pathology - Premalignant Diseases, Spinocellular Carcinoma and Basocellular Carcinoma (markers).

Matrix Metalloproteinases (MMPs) in skin and oral pathology - Premalignant Diseases, Spinocellular Carcinoma and Basocellular Carcinoma (markers).

Comparative Analyses of Clinical Features, Histopathology, and CD123 Immunohistochemistry of Oral Lupus Erythematosus, Lichen Planus, and Other Lichenoid Lesions

Background: Oral lupus erythematosus (OLE) and oral lichen planus (OLP) are among the common causes of oral lichenoid lesions (OLLs). The differential diagnosis among causes of OLLs, particularly between OLE and OLP, is challenging as they have significant clinical and histopathological overlap. Objectives: To compare and summarize the clinical, histopathological, and direct immunofluorescence (DIF) findings between OLE, OLP, and other OLLs and to explore the diagnostic value of CD123 immunohistochemistry. Methods: A retrospective study on patients with OLE, OLP, and other OLLs was performed between January 2014 and December 2019. The baseline characteristics, the clinical, histopathological, and DIF features, as well as CD123 immunohistochemistry for plasmacytoid dendritic cells (PDCs) were statistically analyzed and compared between groups. Results: Of 70 patients, 12 had OLE, 39 had OLP, and 19 had other OLLs. Oral erosions/ulcers were the most common findings in all three groups. Red macules, telangiectases, and discoid plaques were more common in OLE patients, while OLP cases were typified by reticulated patches (p < 0.05). Additionally, white patches were found more often in other OLLs than in both OLE and OLP (p = 0.002). Histologically, mucosal atrophy, basal vacuolization, and perivascular infiltrate were observed in OLE, whereas OLP specimens possessed mucosal hyperplasia, hypergranulosis, and compact orthokeratosis (p < 0.05). Mucosal spongiosis was a histologic feature that favored other OLLs over OLE and OLP (p < 0.001). Data on DIF were nonspecific for all three conditions. For immunohistochemical staining, the median number of total CD123+ PDCs was observed to be higher in OLE than OLP in the mucosal-submucosal junction (MSJ) (p = 0.021), the superficial perivascular area (p = 0.026), and the superficial and deep perivascular areas (p = 0.001). Likewise, PDCs in clusters ≥2+ were seen in significantly higher numbers on OLE than OLP along the MSJ (p = 0.002), the superficial perivascular area (p < 0.001), as well as the superficial and deep perivascular areas (p = 0.011). CD123+ PDCs were found to be significantly more numerous in both OLE and OLP than other OLLs in all of the abovementioned areas (all p < 0.05). Conclusion: While there are some differences in the clinicopathological features between OLE, OLP, as well as other OLLs, a significant overlap remains. The quantity and distribution pattern of CD123 immunohistochemical staining has a diagnostic implication in differentiating OLE from OLP and other OLLs.

A machine-learning algorithm for the reliable identification of oral lichen planus.

Oral lichen planus (OLP) is a relatively common oral disorder which shares clinical and histopathological features with other lichenoid lesions, leading to considerable inter-observer disagreement. This negatively impacts understanding of the pathogenesis and malignant transformation potential of this condition. Artificial intelligence was employed to create a machine-learning artificial neural network to identify and quantify mononuclear cells and granulocytes within the inflammatory infiltrates in digitized hematoxylin and eosin microscopic slides. Twenty-four regions of interest were extracted from OLP cases for learning purposes and validated on a retrospective cohort of 130 cases. All cases were related to patients with confirmed diagnoses of OLP, oral lichenoid lesions (OLLs), or oral epithelial dysplasia (OED) with lichenoid host response. The number of inflammatory cells was statistically significantly higher in OLP compared to OLLs or OED with lichenoid host response (p<0.0005). The proposed machine-learning method was reliably capable of detecting OLP cases based on the number of inflammatory cells and the number of mononuclear cells with an area under the curve of 0.982 and 0.988, respectively. Identifying a cut-off point between OLP and other lichenoid conditions based on the number of mononuclear cells showed a sensitivity of 100% and an accuracy of 94.62%. Artificial intelligence has shown promising outcomes and provides a robust approach to enhance the accuracy of anatomical pathologists in accurately diagnosing OLP using features of disease pathogenesis.

Serum 8-isoprostane levels in patients with resistant oral lichen planus before and after treatment with lycopene: a randomized clinical trial

BackgroundOral lichen planus is an autoimmune disease in which topical steroids are the first line of treatment. The adverse effects of systemic corticosteroids prescribed for resistant oral lichen planus cases advocate alternative modalities. Lycopene is an antioxidant with a wide range of beneficial properties. This trial aimed to evaluate the effect of pure lycopene as compared to systemic corticosteroids (Prednisolone) on the symptoms, signs and oxidative stress in patients with erosive oral lichen planus recalcitrant to topical steroids.MethodsTwenty patients were randomly divided into the test (lycopene) and control (corticosteroids) groups. Numeric rating scale and Escudier et al. (Br J Dermatol 4:765–770, 2007. https://doi.org/10.1111/j.1365-2133.2007.08106.x) lesion scores were assessed at baseline and weeks 4 and 8 from baseline. Serum levels of 8-isoprostane were measured in all patients at baseline and at the end of treatment (week 8).ResultsThere was a significant reduction in signs and symptoms after the end of treatment in each group. However, no significant difference was found between the lycopene and the corticosteroids group. Moreover, a significant reduction in 8-isoprostane levels was observed in the lycopene group from baseline and as compared to the control group.ConclusionsBased on the study results, lycopene is a safe and effective therapeutic modality for resistant oral lichen planus. 8-isoprostane is a biomarker of lipid peroxidation that can be reduced by lycopene.Trial registration ID: PACTR202003484099670. 'Retrospectively registered on 11/3/2020'.

Topical triamcinolone acetonide, oral methotrexate, and a combination of topical triamcinolone acetonide and oral methotrexate in the management of oral lichen planus- A comparative study

This paper aims to compare 0.1% topical triamcinolone acetonide, oral methotrexate, and a combination of 0.1% topical triamcinolone acetonide and oral methotrexate in the management of oral lichen planus. 60 histologically confirmed cases of oral lichen planus were divided into 3 groups. Group T was given 0.1% topical triamcinolone acetonide, group M was given topical methotrexate and group C was given combination of both 0.1% topical triamcinolone acetonide and oral methotrexate. Clinical severity score and VAS was compared. The mean CSS at baseline was 5.4 in group T, 4.2 in group M and 4.1 in group C and at 4 months was 2.6 in group T, 2.1 in group M and 0.82 in group C. Baseline VAS was 6.5 in group T, 6.2 in group M and 7.1 in group C and at 4 months was 2.5 in group T, 1.3 in group M and 0.25 in group C. Group T had 3.2 years, group M had 3.1 years and group C had 3.3 years of duration of symptoms. It is concluded that the combination of triamcinolone and methotrexate exhibited maximum relieve of symptoms in patients with oral lichen planus.

HUMAN PAPILLOMA VIRUS INFECTION AND CORRELATION WITH EXPRESSION OF P16 GENE IN ORAL POTENTIALLY MALIGNANT DISORDERS AND ORAL CANCER

<h3>Background</h3> Human papilloma virus (HPV) infection has been increasingly recognized as a major etiologic factor for a subset of oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMDs). The <i>p16^INK4A</i> gene is usually inactivated in many cancers. HPV leads to an increase in p16^INK4a levels. <h3>Objective</h3> To investigate the presence of E7 and E6 oncogenes of HPV and the expression of p16^INK4a in OSCC and OPMDs. <h3>Methods</h3> Twelve OSCC, 71 OPMD, and 30 normal oral mucosal tissues were used. Of the OPMD samples there were 24 cases of oral submucous fibrosis (OSF), 26 cases of oral lichen planus (OLP), and 21 cases of oral leukoplakia (OL). Expression of p16 was investigated by immunohistochemistry. E7 and E6 oncogenes were detected using polymerase chain reaction. <h3>Results</h3> Twenty-two cases were positive for p16 gene expression (26.5%). Expression of p16 in OLP was observed in 7 cases (8.4%), followed by 10 cases of OSF (12.1%) and 4 cases of OL (4.8%). One OSCC case was positive for p16 (1.2%), and HPV E7 was detected in same specimen (8.4%). Of OSF cases, 1 was positive for HPV (4.2%) and the same specimen was positive for P16. For HPV E7 overall positivity was 2.4% and HPV E6 was negative for all cases. All positive HPV cases were among male patients and positive for p16 gene expression. <h3>Conclusions</h3> A significant correlation between HPV gene positivity and p16 gene expression was observed in OSCC and OPMD. The findings also suggest that inactivation of p16 occurs at the early stage of multistep carcinogenesis before the acquisition of an invasive phenotype.

High Prevalence of Human Papillomavirus Type 18 in Oral Potentially Malignant Disorders in Thailand.

Objectives:The main objectives of this study were to investigate the detection rate of high-risk human papillomavirus types 16 and 18 (high-risk HPV16/18) in oral potentially malignant disorders (OPMDs) including oral leukoplakia (OL) and oral lichen planus (OLP) in a Thai population and their associations with demographic, risk habits, and clinicopathologic features. Methods:Paraffin-embedded formalin-fixed specimens from 101 OL and 59 OLP patients with patients’ demographic, risk habits, and clinicopathologic data were collected. Conventional qualitative polymerase chain reaction was used to detect high-risk HPV16/18 DNA. Associations between high-risk HPV type 16/18 and demographic, clinicopathologic, risk factors (tobacco and alcohol uses) of OPMDs were analysed by Chi-square or Fisher’s exact test. The results with p value less than 0.05 were considered statistically significant. Results:HPV16/18 DNA was found in both OL and OLP groups with the detection rate of 19.8% and 18.6%, respectively. Approximately 90% of high-risk HPV were HPV18 subtype. Additionally, in OL group, high-risk HPV was found more frequently in patients with moderate/severe dysplasia than that in mild dysplasia. Interestingly, in OLP group, high-risk HPV was only detected in atrophic/ulcerative subtypes. None of risk factors was associated with high-risk HPV. Conclusions:Approximately 19% of OPMDs were HPV16/18-positive. HPV18 DNA was predominantly detected in both OL and OLP patients (90%). Additionally, the detection rate of high-risk HPV was higher in more severe dysplastic cases of OL and more clinically severe cases of OLP.

Correlation of Mast Cell and Angiogenesis in Oral Lichen Planus, Dysplasia (Leukoplakia), and Oral Squamous Cell Carcinoma.

ObjectiveThe aim of this study was to compare and correlate mast cell density (MCD) and microvessel density (MVD) between normal oral mucosa, oral lichen planus, various grades of dysplasia, and oral squamous cell carcinoma (OSCC).Materials and MethodsThe study comprised a total of 75 samples, of which 65 were archival tissue blocks of histopathologically confirmed cases, which included 10 cases of oral lichen planus, 25 cases of dysplasia (mild [n=10], moderate [n=10], and severe [n=5]), and 30 cases of OSCC (well differentiated [n=10], moderately differentiated [n=10], and poorly differentiated [n=10]), and 10 samples of normal oral mucosa. All the sections were immunohistochemically stained with anti-CD34 and counterstained with toluidine blue stain. Mean MCD and MVD were determined and analyzed using ANOVA test and compared between the lesions using Tukey HSD test. Pearson’s correlation coefficient test was used to correlate these two factors between various lesions.ResultsMean MCD and mean MVD were found to be increased in all the lesions compared to normal oral mucosa, and the values were statically significant. Overall, MCD and MVD showed a significant positive correlation (r=0.640).ConclusionIncrease of MCD and MVD and their positive correlation in all the lesions have emphasized their role in the pathogenesis and disease progression.

EXFOLIATIVE CYTOLOGICAL FINDINGS IN ORAL POTENTIALLY MALIGNANT DISORDERSMALIGNANT DISORDERS

Objective: Patients with oral potentially malignant disorders (OPMDs) are at risk for development of malignancy and tobacco use contributes in its transformation. This study was designed to assess exfoliative cytological findings in OPMD cases using tobacco and healthy controls with no history of tobacco use. The aim was to screen OPMD cases for biopsy with the help of brush cytology.&#x0D; Materials and Methods: This comparative cross-sectional study was conducted at Histopathology Laboratory of Peshawar Medical College, Peshawar for which samples were collected from two dental hospitals and private dental clinics of Peshawar. The study included 20 cases of clinically diagnosed Oral Potentially Malignant Disorders (OPMDs) with history of tobacco use; including 10 cases of leukoplakia and 10 cases of oral lichen planus (OLP), and 20 age and gender matched healthy controls with no history of tobacco use, after observing a strict inclusion and exclusion criteria. A pre-designed proforma was used to collect the data, which was later analyzed in SPSS version 21.&#x0D; Results: A total of 40 participants had a mean age of 48.25±10.01 years with gender distribution of 32(80%) males and 8(20%) females, giving a male to female ratio of 4:1. The duration of tobacco use in cases had a mean of 22.95 ± 9.17 years, while duration of lesion had a mean of 2.3±4.4 years. As per Oral Bethesda Criteria, 18 (90%) OPMD cases were Negative for Intraepithelial Lesion/Malignancy (NILM). Buccal mucosa 12(60%) was the most common site of lesions. On Oral Exfoliative Cytology (OEC), OPMDs showed mild to moderate cytological changes as compared to healthy controls.&#x0D; Conclusion: This study concluded that most of the OPMD cases show mild to moderate cytological changes as compared to healthy controls. Dysplastic changes were seen only in 10% of OPMD cases that needed further assessment through biopsy.

The Assessment of Angiogenesis by Microvessel Density in Patients With Atrophic/Erosive or Reticular Oral Lichen Planus

The role of angiogenesis in the development of chronic inflammatory diseases, including oral lichen planus (OLP), is of great concern. The most representative method for the assessment of angiogenesis is the semi-quantification of microvessel density (MVD) using specific markers such as CD105. We aimed to assess the MVD in patients with OLP and find its clinical significance to differentiate the atrophic/erosive forms from reticular ones. This cross-sectional study was conducted on 82 patients with clinically and histopathologically proven cases of OLP, including reticular (n=52) or atrophic/erosive (n=30) lesions. The control group comprised 82 age- and sex-matched subjects without any oral disease. To assess the MVD using CD105, tissue blocks were sliced, and the immunoexpression of CD105 was measured by the standard immunohistochemical staining procedure. The mean value of MVD in OLP patients was significantly higher than that in the controls (14.61±12.48 vs. 8.67±1.76, P&lt;0.0001). Furthermore, there was a significant difference in the mean MVD value between reticular and atrophic/erosive lesions (8.19±7.13 vs. 25.73±12.06, P=0.001). However, no significant difference was observed between the reticular lesions and normal tissues (P=0.58). An increased level of CD105 in OLP patients can improve our knowledge about the causes and mechanisms of the disease. The CD105-MVD assessment might be a useful method for semiquantitative measurement of angiogenesis in OLP patients as well as differentiating its clinical forms; therefore, it can open new vistas for formulating strategies based on antiangiogenic treatments for the management of OLP and other precancerous lesions.

The role of CD68+ and CD163+ macrophages in immunopathogenesis of oral lichen planus and oral lichenoid lesions

Macrophages are phagocytic cells with essential participation in immunological events of the oral cavity. However, the role of these cells in oral lichen planus (OLP) and oral lichenoid lesions (OLL) remains unclear. The present study aimed to evaluate the density of macrophages in OLP and OLL, and to compare it with that of oral inflammatory fibrous hyperplasia (OIFH) (control group). 14 cases of OLP, 14 cases of OLL and 14 cases of OIFH were selected for immunohistochemical analysis of CD68+ (M1) and CD163+ (M2) macrophage expression. CD68+ and CD163+ macrophages densities were measured in the intraepithelial and subepithelial areas. The statistical tests used were multivariate analysis of variance, as well as a correlation and linear regression. OLP has more CD68+ macrophages when comparing with OLL (p = 0.001) and OIFH (p = 0.045). There is a very strong relationship between the macrophages types (p < 0.0001) in OLP and OLL. The linear regression showed that to OLL development (p < 0.0001/R2′ = 0.9584), the presence of different types of macrophages are more essential than to OLP (p < 0.0001/R2′ = 0.8983). However, in the OLP these dependencies are also largely. CD68+ macrophages may be associated with immunopathogenesis of OLP, indicating a pro-inflammatory activity and regulatory role in the type of T-cell response. Besides, CD68+ macrophages can cooperate in the diagnosis of OLP. These results are essential to future studies that seek a therapeutic target for OLP and OLL.

New oral cytodiagnostic criteria predict change to oral epithelial dysplasia (OED) and cancerization

AbstractObjectivesThe purpose of this retrospective observational study was to evaluate the specificity of the new oral cytodiagnostic criteria and whether the new criteria predict change to oral epithelial dysplasia (OED) and cancerization for leukoplakia and oral lichen planus (OLP).Study designFifty‐three cases of leukoplakia without OED and 126 cases of OLP were included in this study. Liquid‐based cytology (LBC) was performed just before biopsy. We evaluated the specificity of the new oral cytodiagnostic criteria and the rates of change to OED and cancerization for each cytodiagnosis in leukoplakia and OLP.ResultsOne hundred and seventy patients were negative for intraepithelial lesion or malignancy (NILM), seven had low‐grade squamous intraepithelial lesions (LSILs), and two were indefinite for neoplasia (IFN). The specificity was 95% and the rates of OED change and cancerization in the observation period were 3.4% and 1.7%. In leukoplakia, there was a significant difference in the rates of change to OED and cancerization between negative for intraepithelial lesion or malignancy (NILM) and LSIL (odds ratio: 12.9; 95% CI: 1.72‐96.73).ConclusionsThe new oral cytodiagnostic criteria have high specificity for oral mucosal lesions. And, it was suggested that the cases diagnosed with LSIL using new criteria have a high possibility of change to OED or cancerization in leukoplakia.

Extended Erosive Oral Lichen Planus Treated with a very Low-Level Laser Therapy: A Case Report

Background: Oral lichen planus is a chronic idiopathic inflammatory disease that affects the skin and mucous membrane and involves about 1-2% of the population. The management of this pathology aims to control symptoms. Clinically, it can appear as a plaque, in reticular form, or an erythematous/atrophic form. The treatment options include different classes of drugs and non-drug therapies such as a laser. In addition, most drug treatments include numerous side effects. Objective: The aim of this work is to evaluate the clinical effectiveness of a particular type of very Low-Level-Laser Therapy for the management of an erosive oral lichen planus case. Methods: An extensive form of erosive Oral Lichen Planus was treated using a Low-Level Laser Therapy with a 660 nm diode laser. The treatment was performed once per week for two sessions of five minutes each. Different outcome variables were examined: the size of lesions, evolution of pain symptoms, and presence of side effects and stability of the therapeutic results in the follow-up period. Results: After a week, the lesion appeared more homogenous, and the erythematous areas underwent a reduction with a simultaneous decrease in symptoms. After two weeks, the lesion seemed completely healed with the disappearance of pain. The follow-up continued for the other four months, and no relapse was reported. No adverse effects were observed during the study. Conclusion: This study suggests that Low-Level Laser Therapy with very low power parameters could be a safe and successful treatment for extended oral erosive lichen planus lesions.

The relationship between lichen planus and metabolic syndrome.

Lichen planus (LP) is an idiopathic, chronic inflammatory disease. Chronic inflammatory diseases can cause metabolic complications. In the literature, data related to the relationship between lichen planus and metabolic syndrome (MS) are limited. We aimed to evaluate the relationship between MS and lichen planus with disease activity. The patients diagnosed with lichen planus at the dermatology outpatient clinic between January 2018 and January 2020 were retrospectively analyzed. 98 lichen planus cases, age- and sex-matched 99 controls, 197 cases in total were included in the study. Of the 98 lichen planus cases included in the study, 60 (61%) were women. The mean age of the patients was 49.3±14.4, and the average disease duration was 33.5±31.4months. 55 (55%) of the patients in the control group were female, and the mean age of the control group was 50±13.2. The body mass index of LP cases was 29.5±5.8, in the control group was 25.8±3.7. Metabolic syndrome was found in 47 (48%) of 98 cases with lichen planus and 32.3% in the control group. MS in the lichen planus group was significantly higher than the control group (P=.025). Metabolic syndrome was detected in the oral lichen planus at the rate of 60% (12 cases). Although the incidence of MS was more common in the oral lichen planus, it was not statistically significant (P=.29). While no significant relationship was found between oral disease severity and metabolic syndrome (P=.19), a significant correlation was found between cutaneous disease severity and metabolic syndrome (P=.023). The risk of mucosal malignancy that can occur when following LP cases has been known for a long time. According to our results, caution should be taken in terms of metabolic complications in the follow-up of LP cases, especially oral LP cases.