Criteria For Oral Lichen Planus Research Articles

A Clinicohistopathological Characterization of Oral Lichen Planus: A Cross-Sectional Study.

Based on the modified diagnostic criteria for oral lichen planus (OLP) proposed by Van der Meij and Van der Waal, the objective of the current investigation was to demonstrate a clinicohistopathological association in the diagnosis of OLP. Data were retrieved from 250 individuals who visited the Department of Oral Medicine and Radiology and were diagnosed with OLP between September 2018 and December 2021. Upon completion of the histopathological analysis, the precise diagnosis of OLP was made. Repeat biopsies were performed in the cases suspecting malignant transformation during the follow-up phase. The data were analyzed using SPSS software. The Fisher's exact test and chi-square test of association were used to establish the significant differences between the variables at a 5% significance level. Of the 250 patients, 48% and 52% were males and females, respectively. The two clinical manifestations observed were reticular (n=145, 58%) and erosive types (n=105, 42%). The most frequently impacted locations were the buccal mucosa (n=150, 60%) and labial mucosa (n=100, 40%). Fourteen individuals (two with reticular form and 12 with erosive form) later during follow-up showed dysplasia, with moderate (n=2) to mild (n=12) dysplastic alterations. Koilocytes were reported in 84 cases (34%), which included 35 (24%) reticular cases and 49 (47%) erosive lesions. The histopathological features such as acanthosis, epithelial atrophy, hyperkeratosis, presence of neutrophils, koilocytes, and epithelial dysplasia were shown to be statistically significant between the clinical forms (p<0.001). The results of the current study highlight the concordance of histopathological and clinical diagnoses, especially for early definitive diagnosis of OLP. More research studies are warranted to validate the trend of epithelial dysplasia in OLP associated with human papillomavirus (HPV) and to explore the course of the lesions that might be affected by this trait.

Development and chinization of diagnostic criteria for oral lichen planus

Oral lichen planus (OLP) is a common chronic inflammatory disease of oral mucosa. The diagnostic criteria of OLP is the cornerstone of clinical diagnosis and treatment and scientific research. However, there are various understandings of the diagnostic criteria in China. Thus several questions need to be answered, for example, how to combine the international diagnostic criteria with China's specific conditions, how to apply the criteria into clinical practice, and how to use the criteria guiding clinical work and scientific research in China. The authors of this article systematically introduced and discussed the development, content and difference of the international diagnostic criteria of OLP. We proposed "23 Princeples" for the selection of biopsy indications in OLP diagnosis based on authors' personal experiences in clinical and basic research and the actual conditions of Chinese clinicians. We also express our own views and suggestions about some other hot issues associated with OLP diagnosis.

Direct Immunofluorescence in Clinically Diagnosed Oral Lichen Planus

Purpose: Oral lichen planus (OLP) is relatively common mucosal disease in clinical dentistry. OLP is intractable and regarded having malignant potential. Until now, there is some debate on how far OLP can be malignant, and which characteristics can be a risk factor for malignant transformation. Clinician need to know some differences between OLP and lesions similar to OLP to manage properly and suppose prognosis correctly. Therefore, the aim of this study was to divide clinical OLP into two groups and to compare the results of direct immunofluorescence (DIF) between two groups. Methods: This study was conducted on outpatients who visited at the department of Oral Medicine in Chonbuk National University Hospital from January 2007 to November 2015. Patients with DIF result were retrospectively reviewed. The selected patients were classified ‘clinical typical of OLP’ (CTO) or ‘clinical compatible with OLP’ (CCW) by modified World Health Organization diagnostic criteria of OLP and oral lichenoid lesion. Results: DIF were classified by deposition intensity or pattern of anti-human antibody and fibrinogen. The classification of fluorescence pattern in each specimen was graded as positive, possibly positive or negative. Conclusions: Both CTO and CCW had positive and possibly positive pattern. Prevalence of positive pattern was 68.8% in CTO and 52.6% in CCW and that of possibly positive pattern was 9.4% in CTO and 5.3% in CCW. Prevalence of negative was 21.8% in CTO and 42.1% in CCW.

Clinico-pathological study to evaluate oral lichen planus for the establishment of clinical and histopathological diagnostic criteria.

Lichen planus and lichenoid lesions affecting the oral cavity show similar clinico-pathological features creating a diagnostic dilemma. Hence, the aim of the present study was to establish a clinical and histopathological correlation in the diagnosis of oral lichen planus, based on the modified WHO diagnostic criteria of oral lichen planus and oral lichenoid lesions proposed by Van der Meij and Van der Waal in 2003. In the present study, 100 cases of oral lichen planus were clinically and histopathologically analyzed. Out of the 100 cases, 50 were prospective and 50 were retrospective cases. Prospective cases were collected based on the clinical diagnosis of oral lichen planus and oral lichenoid lesion. Retrospective cases were collected based on the histopathological diagnosis of oral lichen planus. Both the clinical and histopathological analyses were performed based on a proposal for a set of modified diagnostic criteria of oral lichen planus and oral lichenoid lesion. A final diagnosis of oral lichen planus was made only after the correlation of the clinical diagnosis with the histopathological diagnosis. The interobserver agreement among three observers for both prospective and retrospective cases in the final diagnosis of oral lichen planus was found to be "good" to "very good" indicating high reproducibility. However, the final diagnoses of true oral lichen planus after clinico-pathological correlation in prospective and retrospective study groups appeared to be 38.0% and 54.0% respectively. The results of the present study revealed mild to moderate clinico-pathological correlation in the final diagnosis of oral lichen planus for the prospective and retrospective study groups respectively.

A retrospective clinicopathologic study of lichen planus and lichenoid lesions in the oral cavity

Lichen planus is a common oral disorder which may represent the manifestation of varies clinical presentation and microscopic findings. In this retrospective study of 86, cases of oral lichen planus (OLP) were compared with 73 cases of oral lichenoid lesions (OLL). Various clinicohistopathological features were studied. The object of this study was to compare clinical and microscopic findings in order to present evidence that supports the position of true lichen planus. Biopsy specimens were obtained from every patient. The biopsy specimens were fixed in 10 percent formalin, embedded in paraffin, sectioned at 4 microns and stained by means of routine hemotoxylin and eosin procedures. The histologic specimens were examined and evaluated without knowledge of clinical findings. The mean age at presentation of patients with OLP was 42.5 years as compared to 47.0 years for OLL. There was no significant difference between the ethnic groups, site of lesions and the distribution of the clinical presentation. Compare to histopathologic findings, there were only 55% clinical and histological agreement in this study, this because of using strict criteria for oral lichen planus there could be an over diagnosis lesions. This study showed that there were no reliable clinical and histopathological features which could differentiate OLL from OLP. The features in the OLL group were non specific. The patient’s medical history, oral habits or psychological status appeared to be able to alter the classical clinicopathological findings.

Biopsy of the buccal mucosa in oral lichen planus: The traditional method versus the use of a new pressure forceps

The authors designed a pressure forceps, called the "B forceps," for use in performing biopsies. They compared biopsy specimens taken with and without the aid of the B forceps from buccal mucosa of 84 patients divided equally into two groups, all of whom satisfied the World Health Organization's diagnostic criteria for oral lichen planus. They analyzed the advantages and disadvantages of using this instrument. The 42 patients in group A underwent a conventional biopsy (29 with a scalpel and 13 with a punch). The 42 patients in group B underwent a biopsy performed with the B forceps and a punch. The authors studied artifacts of fragmentation, pseudocysts, crushing, fissures and hemorrhages histologically in both groups. There were no significant differences within group A between the subjects who had undergone either the scalpel or the punch biopsy. There were, however, significant differences between groups A and B. Group B experienced less fragmentation (P = .021), fewer fissures (P = .001) and fewer hemorrhages (P = .001). The new B forceps was a useful aid in the performance of biopsies. It improved visibility and reduced the time needed for the procedure. Biopsy specimens taken with the B forceps also had histologically fewer artifacts than did those taken without the B forceps. This technique using the B forceps has several advantages, including speed, because the ischemia produced by the clamp stabilizes the tissue and increases visibility, facilitating dissection. The time needed for surgical removal thus is shortened.

Malignant transformation of oral lichen planus

The malignant transformation rate of oral lichen planus is a much debated issue. In a recent review, Mattsson et al. make an admirable effort to summarise and discuss data from two prospective and nine retrospective studies, in which ‘‘uniform and accurate information is available’’ and in which ‘‘the diagnostic criteria of oral lichen planus (OLP) have been defined’’. Based on data retrieved from these 11 papers, the authors conclude that there is an increased although low incidence of oral cancer in OLP patients. They therefore state that it is justified to regard OLP as a premalignant condition. Mainly for economic reasons, the authors further suggest that the malignant transformation rate (0.5—2% in the majority of studies) is too low to justify an extensive and costly recall program of OLP cases. These arguments are well taken by the authors. However, they also remark extensively on the diagnostic dilemma of OLP, in the sense that lichenoid contact reactions (LCR) may have been included in some previous studies, hence reported erroneously as OLP. This may have distorted the true prevalence figure of OLP. As the only example, the authors refer to a Swedish study by Axell showing an OLP prevalence figure of 1.86% but remark that at that time ‘‘LCR was not recognised as a disease entity’’, therefore casting doubts about this figure. Notably, there is an extensive microscopical overlap between OLP and LCR, even though LCR cases may exhibit a more variable histopathologic pattern than classic OLP. It may also be of some historical interest to mention, that when we suggested to our Scandinavian Oral Pathology group in the late 1970s that the histopathology of OLP was in fact ‘‘lichenoid’’, it met with much opposition. Nowadays, this is a widely recognised concept and there is a more widely accepted tendency to regard ‘‘oral lichen planus’’ (OLP) or ‘‘lichenoid contact reactions’’ (LCR) as subtypes of ’’oral lichenoid reactions’’ (e.g. Bratel et al.). Mattsson et al. conclude that their selected 11 studies ‘‘fulfilled explicitly defined diagnostic criteria’’ of OLP, indirectly suggesting that the 11 studies were also undisputable on the particular point of clearly defining and excluding cases of LCR. They further state, that LCR lesions ‘‘are not known to be associated with malignant transformation’’. We fully agree with Mattsson et al. that data are non-existent on malignant transformation of LCR. However, since inclusion or not of LCR in malignant transformation studies of OLP would seem to be a critically significant point of their review, we have somewhat at our surprise found that a majority of their 11 selected papers fail to explicitly mention or even comment upon LCR, thereby being no different from Axell’s study. Briefly, our own analysis of the 11 papers showed the following. In all the studies, OLP was diagnosed by a biopsy. Possible inclusion of LCR type lesions is suggested in only a single study but explicit mentioning of exclusion of such lesions is hard to find. In fact, there is no mentioning of LCR at all in Holmstrup and Pindborg, Silverman et al., Holmstrup et al., Salem, Silverman et al., Barnard et al. and Lo Muzio et al. In the discussion by Duffey et al., ‘‘dental amalgams’’ but not LCR was mentioned only in general terms. In the study by Rajentheran et al., their 832 cases had a histologically proven diagnosis of OLP ‘‘or lichenoid reaction’’ but no further mentioning of any possible association with dental restorations, i.e. of

Oral lichenoid reactions associated with amalgam: improvement after amalgam removal.

The pathogenetic relationship between oral lichenoid reactions (OLR) and dental amalgam fillings is still a matter of controversy. To determine the diagnostic value of patch tests with amalgam and inorganic mercury (INM) and the effect of amalgam removal in OLR associated with amalgam fillings. In 134 consecutive patients 467 OLR were classified according to clinical criteria. One hundred and fifty-nine biopsies from OLR lesions were histologically diagnosed according to the World Health Organization criteria for oral lichen planus (OLP) and compared with 47 OLP lesions from edentulous patients without amalgam exposure. One hundred and nineteen patients were patch tested with an amalgam series. In 105 patients (357 of 467 lesions) the amalgam fillings were removed regardless of the patch test results and OLR were re-examined within a follow-up period of about 3 years. Twenty-nine patients refused amalgam removal and were taken as a control group. Eleven patients with OLR (8.2%) had skin lesions of lichen planus (LP). Histologically, the lesions in the OLR group could not be distinguished from those seen in the OLP group. Thirty-three patients (27.7%) showed a positive patch test to INM or amalgam. Amalgam removal led to benefit in 102 of 105 patients (97.1%), of whom 31 (29.5%) were cured completely. Of 357 lesions, 213 (59.7%) cleared after removal of amalgam, whereas 65 (18.2%) did not improve. In the control group without amalgam removal (n = 29) only two patients (6.9%) showed an improvement (P < 0.05). Amalgam removal had the strongest impact on lesions of the tongue compared with lesions at other sites (P < 0.05), but had very little impact on intraoral lesions in patients with cutaneous LP compared with patients without cutaneous lesions (P < 0.05). Patients with a positive patch test reaction to amalgam showed complete healing more frequently than the amalgam-negative group (P < 0.05). After an initial cure following amalgam removal, 13 lesions (3.6%) in eight patients (7.6%) recurred after a mean of 14.6 months. Of all patients with OLR associated with dental amalgam fillings, 97.1% benefited from amalgam removal regardless of patch test results with amalgam or INM. We suggest that the removal of amalgam fillings can be recommended in all patients with symptomatic OLR associated with amalgam fillings if no cutaneous LP is present.

Candida in patients with oral lichen planus

The presence of yeasts in oral lichen planus (OLP) lesions was studied in cultivations from 41 OLP patients and by histological examination in 39 of these cases. The histological features of OLP were also recorded. The cultivation results were compared with those of a randomly selected, age- and sex-matched control group without mucosal changes. The extent of growth was recorded as “sparse” (1–10 colonies), “moderate” (11–40 colonies), or “heavy” (>40 colonies). Yeasts were found to be present on cultures or histologic sections from a total of 19 OLP patients (46%). “Moderate—heavy” growth was obtained in 29% of the OLP cases but in only 7% of the control group. Candida albicans accounted for over 80% of the yeasts. The histological examination revealed only 3 cases of invasive fungal growth. Regarding the criteria of OLP, hyperortho- or hyperparakeratosis and a band-shaped subepithelial infiltration of lymphocytes were present in all specimens, basilar liquefaction degeneration in 87% and an eosinophilic zone in 77%. Local treatment with amphotericin B (Fungizone ®) in 18 OLP patients with positive findings resulted in subjective relief of symptoms in 89% of the patients. Clinical improvement was seen in 94%. The presence of Candida was significantly correlated to low secretion rate in unstimulated saliva.