Lichen Planus Research Articles

Therapeutic Intervention in Lichen Planus Pilar (LPP): Synergy of Low-Level Laser Therapy and Topical Corticosteroid

Therapeutic Intervention in Lichen Planus Pilar (LPP): Synergy of Low-Level Laser Therapy and Topical Corticosteroid

The Clinical Behavior and Recurrence Patterns of Oral Cavity Cancer in Oral Lichen Planus Patients.

Oral lichen planus (OLP) is a chronic inflammatory disorder involving epithelia with squamous differentiation. Although described as a potential malignant precursor, the characteristics of malignancies arising among these patients are not widely described. Our goal was to describe the patterns of disease recurrence of patients with oral cavity squamous cell carcinoma (OSCC) arising on the background of OLP. A retrospective analysis of all surgically treated patients with OSCC at a university-affiliated tertiary care center between 2000 and 2020. Two hundred seventy-nine patients with OSCC treated surgically were included. Forty (14.3%) had OLP. The mean age of patients with OLP was 70.9 years compared with 64.3 years for non-OLP patients (p = 0.03). OLP patients had a significantly higher rate of disease recurrence, persistence, or multiple primary disease (70% vs. 33.9%, p < 0.001). The mean number of sequential oncologic events for each patient with recurrence was also significantly higher among OLP patients (1.86 vs. 1.36, p = 0.03), a difference explained by a higher rate of multiple primary presentations (0.71 vs. 0.28, p = 0.008). A significant difference in disease-free survival (DFS) was demonstrated between the groups as patients with OLP had a lower 5-year DFS (34.7% vs. 61.3%, log-rank p value <0.001). On multivariate analysis, OLP was significantly associated with multiple primary events (p < 0.001, Odds ratio = 7.42, 95% confidence interval 2.9-19). OSCC patients with OLP background demand close clinical follow-up, as multiple primary disease is significantly more common and the DFS is significantly lower among these patients. A thorough clinical evaluation for all oral cavity subsites is mandatory. 3 Laryngoscope, 134:3146-3151, 2024.

Oral Bullous Lichen Planus – A Case Report

Oral bullous lichen planus (BLP) is a rare and challenging variant of lichen planus affecting the oral mucosa. A 40-year-old female patient was diagnosed with Bullous lichen planus and treated with hydroxychloroquin, triamcinolone acetonide, levamisole, prednisolone and benzydamine oral rinse. Her main complaint was a burning feeling in her mouth that was linked to generalised pruritis, and skin lesions. The patient has not had any lesions during their year-long follow-up. The incidence of oral bullous lichen planus and its treatment are still poorly understood in Bangladesh. With regard to our local context, this report seeks to advance knowledge of this condition. CBMJ 2024 January: vol. 13 no. 01 P: 98-101

Assessment of periodontal status in patients with oral lichen planus.

Inflammatory pathogenesis is common to periodontitis and oral lichen planus. This study was conducted to assess and compare the periodontal status of patients with and without oral lichen planus. 108 patients comprising 54 with oral lichen planus and 54 age-matched systemically healthy participants without oral lichen planus were selected. Periodontal parameters, ie Plaque Index, Gingival Index, bleeding on probing, probing pocket depth, clinical attachment level, and periodontal phenotype were measured. On comparing the test and control groups, statistically significant differences were observed in respect to Plaque Index (P = .00), Gingival Index (P = .00), and bleeding on probing (P = .00). A higher proportion of sites with deeper pockets was observed in the test group (P = .00). On comparison of various oral lichen planus subtypes, significant difference was observed in respect to Gingival Index (P = .00) and bleeding on probing (P = .00). A higher proportion of sites with deeper pockets (P = .01) and greater CAL (P = .00) was observed in the erosive/atrophic subgroup compared to the reticular group. However, the differences between the reticular (a less severe form of oral lichen planus) and control group in terms of Gingival Index (P = .94), Plaque Index (P = .05), bleeding on probing (P = .17), probing pocket depth (P = .56), and clinical attachment level (P = .23) were not statistically significant. Statistically significant differences were observed in terms of Gingival Index (P = .01) and bleeding on probing (P = .00) between thin and thick periodontal phenotypes in the oral lichen planus group. Statistically significant positive correlations in periodontal parameters with increased gingival involvement and severity were observed using Spearman rank correlation coefficient. Significantly greater periodontal inflammation in the test group means there is a risk of greater attachment loss in future. Thus, increased attention towards periodontal health in these patients might reduce the rate of disease progression.

Association of oral lichen planus and psoriasis: a case-control study.

The aim of the present study was to investigate whether psoriasis disease constitutes a risk factor for OLP, by assessing the prevalance of psoriasis in a test group with OLP and the control group without. A cohort of consecutive patients diagnosed clinically and histologically with OLP between 2014 and 2022 was analyzed. The results were contrasted with those obtained in control series matched for age and sex. The correlations between OLP and sex, age, tobacco, alcohol consumption, and psoriasis were assessed using Pearson chi-square test. Multivariate regression analysis was performed to evaluate the association between psoriasis and OLP. For the assessment of the quality of the statistical models, the Akaike information criterion was used. The study involved 1,016 patients; 738 women (72.6%) and 278 men (27.4%). The average age was 59.38 ± 12.55 years. Of 508 patients with OLP, 16 (3.15%) had comorbid psoriasis, and this was 5 (0.98%) in the control group. Age, sex, smoking, and alcohol habits were not predictive variables in the relationship between psoriasis and OLP in these patients. There were statistically significant differences in relation to the number of locations, with greater extension in patients with OLP and psoriasis (P = .002). According to the multivariate analysis, the odds ratio of OLP for psoriasis was 3.13 (95% CI 1.20-9.68). This is the first study showing the potential association between psoriasis and OLP, and the results should be considered to improve knowledge of comorbidity of OLP. Based on the results, it is recommended that clinicians collect data regarding history of psoriasis in patients with OLP, and consider possible multiple intraoral locations.

Salivary metabolomics in patients with oral lichen planus: a preliminary study based on NMR spectroscopy

ObjectivesThe present preliminary study aimed to investigate the salivary metabolic profile in patients with asymptomatic oral lichen planus (OLP) using nuclear magnetic resonance (NMR) spectroscopy.Material and methodsStimulated whole mouth saliva (SWMS) samples were collected from 15 reticular OLP female patients and 15 from age- and sex-matched controls (HCs). A total of 23 metabolites were identified and quantified. Mann–Whitney’s U test was used to compare the determined concentration salivary metabolite concentrations between OLP patients and the healthy controls.ResultsThe concentration of acetate, methylamine, and pyruvate was elevated, whereas the concentration of tyrosine was decreased in the saliva of OLP patients compared with HCs. To identify a combination of metabolites, multivariate discrimination function analysis (DFA) was conducted. DFA analysis have shown that the most powerful discrimination between the groups was achieved when methylamine and tyrosine were considered as combined biomarkers.ConclusionsSalivary tyrosine was of particular interest and a promising finding for the screening of OLP and its progression. Further longitudinal studies are required to establish it as a reliable salivary biomarker in OLP.Clinical relevanceThe salivary metabolic profiling can describe the pathologic characteristics of OLP on non-invasive saliva samples and NMR analysis. Salivary metabolites provide details to considered early detectors and to impact oral health of OLP patients.

Lichenoid and psoriasiform drug induced rush during imatinib therapy: a clinical case

Tyrosine kinase inhibitor imatinib is a standard agent for treatment of gastrointestinal stromal tumors (GIST). Treatment courses are quite long and are usually well tolerated. However, skin rash can occur on treatment, with a prevalence of 7 to 88.9%. We describe a clinical case of a patient with GIST, who has been on treatment with imatinib at daily dose of 400 mg for one year. Several weeks from the treatment initiation, she had facial edema, and 4 months thereafter psoriasiform rash appeared which was initially considered to be psoriatic. After 8 months, the patient had lichenoid rash on the inguinal skin and oral, tongue and vulvar mucosae. Clinically, the lichenoid rash was similar with lichen ruber planus. To confirm the diagnosis, we performed biopsy of psoriasiform and lichenoid foci. Histological examination verified the drug-induced rash. Topical treatment of psoriasiform rash with glucocorticosteroids resulted in regression of some plaques, although a proportion of them persisted. Inguinal and vulvar lichenoid rashes completely regressed and numbers of oral and tongue foci decreased after a 6-week daily application of the 0.1% tacrolimus cream. Treatment with imatinib 400 mg daily was not interrupted. The clinical observation illustrates the possibility of skin and mucosal lichenoid and psoriasiform rash simultaneously during treatment with imatinib and demonstrates the first successful experience in the treatment of lichenoid rashes with 0.1% tacrolimus cream.

Effects of Curcumin on the treatment of oral lichen planus symptoms: a systematic review and meta-analysis study

Background and objectivesOral lichen planus (OLP) is a relatively common chronic T-cell–mediated disease that can cause significant pain, particularly in its erosive or ulcerative forms. This study aimed to examine the therapeutic impact of curcumin on symptoms of OLP.Materials and methodsThis meta-analysis was performed according to the PRISMA guidelines. All related English documents indexed in electronic databases (including PubMed, Web of Science, Scopus, Embase, Wiley, Cochrane, and ProQuest databases [updated to August 15, 2023]) were retrieved. Data were double-extracted into a predefined worksheet, and quality analysis was performed using the Joanna Briggs Institute (JBI) scale. We carried out meta-analyses, and the random effects model was used to estimate the differences in erythema, lesion size, and pain between the curcumin control groups.ResultsThe search identified 289 studies, of which 10 were found to meet the inclusion criteria. The overall findings of the meta-analysis revealed that curcumin did not have a significant effect on erythema of OLP (standardized mean difference [SMD] = -0.14; 95% CI, -0.68 to 0.40; P = 0.61; I2 = 57.50%), lesion size of OLP (SMD = -0.15; 95% CI, -0.45 to 0.15; P = 0.33; I2 = 28.42%), and pain of OLP (SMD = -0.38; 95% CI, -0.97 to 0.22; P = 0.22; I2 = 86.60%). However, subgroup analysis based on treatment duration indicated that 2-week treatment duration was significantly associated with a reduction in OLP pain (n = 3; SMD = -1.21; 95% CI, -2.19 to -0.23; P = 0.01).ConclusionsCurcumin had no significant effect on erythema, lesion size, and pain of OLP compared to the control groups. However, subgroup analysis revealed that curcumin was more effective in reducing pain in non-randomized trials and in trials with a treatment duration of 2 weeks.

Clinicoepidemiological Study of Oral Mucosal Lesions and Its Impact on Quality of Life in Patients Attending Skin OPD At Rural Based Tertiary Health Care Centre

Background Oral mucosa is one of the first barriers to the outside world which encounters various antigens, microorganisms and physical agents and it is in direct continuity with the skin externally and with the mucosa of oropharynx and nasopharynx internally. Objectives The objective of our study was to study the prevalence of oral mucosal lesion, its association with various dermatoses and quality of life in patients with oral mucosal lesions attending outpatient department of dermatology at a tertiary care health centre. Methods This study was an observational, purposive type of study conducted in Department of Dermatology at a tertiary health care centre. All the patients with oral mucosal lesion were included with full history and detailed examination noted in a prestructured proforma. Dermatology Life Quality Index (DLQI) and Children’s Life Quality Index (CDLQI) both were used to assess quality of life. Results: Among 202 (prevalence-0.8%) patients, maximum numbers of patients 53 (26.23 %) belonged to age group 31-40 years followed by 49(24.25 %) patients with age group of 21-30 years. Maximum numbers of patients were female 108 (53.46 %). Among oral ulcers recurrent aphthous stomatitis was the commonest finding seen in 56 (27.72%). Among cutaneous conditions associated with oral lesions oral lichen planus 50(24.75%) was the most common condition followed by pemphigus in 15(7.42%) patients. Out of 195 patients, maximum 86 (44.10%) patients were categorised as a moderately affected DLQI group. Conclusion: Oral ulcers were the most common finding seen in our study. There were a significant number of patients of cutaneous conditions associated with oral lesions seen.

JAK Inhibitor Baricitinib in the Treatment of Oral Lichen Planus: A Case Report

Baricitinib, a JAK1/2 inhibitor, has been expanding its role as a therapeutic agent with recent FDA approval for dermatologic use with alopecia areata. Clinical trials are underway for further use of baricitinib for severe atopic dermatitis and multiple off-label uses in inflammatory dermatologic conditions such as lichen planus have been suggested. Few reports exist of patients with concomitant alopecia areata and lichen planus treated with baricitinib. We present a case of refractory oral lichen planus with marked improvement within one month following treatment with once daily baricitinib. Our case adds to the growing body of literature regarding the therapeutic benefits of JAK inhibitors in the treatment of lichen planus.

Oral lichen planus: An overview

Oral lichen planus (OLP) is an immune-related disorder with an exact etiology unknown. It is a chronic inflammatory disease characterized by relapses and remission. Regular follow-up and keeping under observation are required as this lesion poses a chance for malignant transformation. In this article, we will discuss the various treatment modalities available for Oral Lichen Planus.

Diagnostic Infrared Thermography of the Tongue and Taste Perception in Patients with Oral Lichen Planus: Case-Control Study.

Oral lichen planus (OLP) is a chronic inflammatory disease of autoimmune origin that affects the skin and mucous membranes. The aim of this study was to assess the effectiveness of infrared thermography (IRT) as a diagnostic tool in patients with oral lichen planus (OLP), as well as disturbances in taste perception, in cases with and without tongue involvement. A case-control study was carried out in a sample of 87 patients divided into three groups: healthy individuals (controls; n = 43), OLP patients without involvement of the tongue (n = 24), and OLP patients with involvement of the tongue (n = 20). The patient symptoms and the clinical characteristics of the lesions were assessed. Four thermal images of the tongue were obtained using IRT: dorsum, right and left lateral surface, and tip of the tongue. General taste perception capacity and subjective sweet, acid, salty, and bitter sensation were evaluated in all three groups. There were no statistically significant differences in the IRT values among the three groups (p ≥ 0.05). In the OLP patients with involvement of the tongue, significantly higher values were observed in the mixed forms of the disease (p = 0.032). The OLP patients with and without involvement of the tongue showed no significant alterations in taste sensation (p = 0.69). IRT may serve as a complementary tool for assessing the activity of OLP with involvement of the tongue. However, more research is needed in this field.

Role of habit behaviours in severity of Oral lichen planus, Oral submucous fibrosis and Leukoplakia: A cross sectional study

Role of habit behaviours in severity of Oral lichen planus, Oral submucous fibrosis and Leukoplakia: A cross sectional study

Ultrasound Features of Nail Lichen Planus.

To describe the ultrasonographic features of nail lichen planus (NLP), which, so far, have not been reported in the literature. A retrospective single-center study of NLP patients' color Doppler ultrasound examinations was performed between March 2014 and January 2023. Inclusion criteria were patients ≥15 years with a confirmed clinical diagnosis of NLP in sequential order. Exclusion criteria included concomitant systemic or local cutaneous or nail diseases and systemic or local nail treatments before the ultrasound examination. The ultrasound protocol included the examination of all fingernails or toenails following the reported protocol for dermatologic ultrasound examinations at high and ultra-high frequencies. Patient demographics and ultrasound features of the nail bed, periungual region, nail plate, and regional vascularity were registered and analyzed statistically. A total of 36 patients met the criteria. All cases presented thickened and decreased echogenicity of the nail bed. A hypoechoic halo surrounding the origin of the nail plate was present in 78% of cases. Exactly 58% of patients presented decreased echogenicity of the proximal periungual dermis, and 86% showed thickening of the periungual dermis. Hypervascularity of the nail bed was seen in 94% of cases. The mean maximum thickness of vessels, the peak systolic velocity of the arterial vessels, and other blood flow findings are provided. Ultrasonography can support the diagnosis of NLP, which benefits the non-invasive discrimination of nail conditions and can avoid the potential permanent scars derived from nail biopsies. Furthermore, ultrasound may be a powerful tool to monitor this disease's treatment.

A Comparative Study of the Treatment of Oral Premalignant Lesions with Surgical Excision and Medical Therapy.

Potentially malignant oral epithelial lesions are a group of oral conditions with an altered morphological state of the normal mucosal lining and include different lesions such as leukoplakia, erythroplakia, submucosal fibrosis, and lichen planus. To compare the outcome of premalignant oral lesions after medical therapy consisting of submucosal intralesional injection of triamcinolone with hyaluronidase and surgical excision. This was a comparative prospective interventional study and the study was conducted among 50 patients presented to the Department of Otorhinolaryngology with premalignant oral lesions from the year 2020 to 2022. Patients were divided into two groups by random allocation, group A was treated with medical therapy, and Group B was treated with surgical excision and followed for a minimum of 6months and the outcome has been categorized. All patients were divided into two groups-group A and group B, group A consisted of 22 (44%) patients who were given medical therapy, and group B consisted of 28 (56%) patients who underwent surgical excision. In group A, the clinical response was seen in 8 (36.36%) and in group B, the clinical response was seen in 18 (64.29%) patients. Surgical excision was found to be better with more cases of clinical response (64.29%) when compared to medical treatment (36.36%) with a p value of 0.0497 which is significant whereas malignant transformation was almost equal in medical therapy and surgical treatment which was 13.64% and 14.28%, respectively.

Inter-relationships of galectin-3 and NLR family pyrin domain containing 3 inflammasomes with oral lichen planus: a preliminary cross-sectional in vitro study

BackgroundThe nucleotide-binding oligomerization domain (NOD)-like receptor (NLR) family pyrin domain-containing 3 (NLRP3) inflammasome has been reported to be highly expressed in oral lesions with the potential for malignant development such as oral lichen planus (OLP). And the NLRP3 inflammasome can be activated by galectin-3 (Gal-3) in immune-mediated chronic inflammatory diseases. This study aimed to explore the inter-relationships among Gal-3, NLRP3 inflammasome, and OLP.MethodsA cross-sectional analysis of oral biopsy specimens from 30 patients with Erosive OLP and 30 healthy controls was performed. Immunohistochemical staining was used to evaluate the expression of Gal-3 and NLRP3 inflammasome. Two-sample t-test and Pearson correlation test were applied to analyze the data.Results Erosive OLP patients had significantly higher Gal-3 levels compared with controls (p < 0.0001). A similar pattern emerged for NLRP3 inflammasome. In the overall sample, a positive correlation was observed between Gal-3 and NLRP3 (r = 0.92, p < 0.01).ConclusionsPatients with Erosive OLP lesions showed increased protein expression levels of Gal-3. A positive correlation was observed between Gal-3 and NLRP3 inflammasome.

Noval advance of histone modification in inflammatory skin diseases and related treatment methods.

Inflammatory skin diseases are a group of diseases caused by the disruption of skin tissue due to immune system disorders. Histone modification plays a pivotal role in the pathogenesis and treatment of chronic inflammatory skin diseases, encompassing a wide range of conditions, including psoriasis, atopic dermatitis, lupus, systemic sclerosis, contact dermatitis, lichen planus, and alopecia areata. Analyzing histone modification as a significant epigenetic regulatory approach holds great promise for advancing our understanding and managing these complex disorders. Additionally, therapeutic interventions targeting histone modifications have emerged as promising strategies for effectively managing inflammatory skin disorders. This comprehensive review provides an overview of the diverse types of histone modification. We discuss the intricate association between histone modification and prevalent chronic inflammatory skin diseases. We also review current and potential therapeutic approaches that revolve around modulating histone modifications. Finally, we investigated the prospects of research on histone modifications in the context of chronic inflammatory skin diseases, paving the way for innovative therapeutic interventions and improved patient outcomes.

Effectiveness of Injectable Platelet-Rich Fibrin in the Treatment of Oral Lichen Planus: A Systematic Review and Meta-Analysis.

Oral lichen planus (OLP) is a chronic inflammatory condition affecting the oral mucosa. The current reviewinvestigated the potential effectiveness of injectable platelet-rich fibrin (i-PRF) as a treatment for OLP when compared to other interventions. The current review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search strategy was implemented across databases such as PubMed, Embase, Scopus, Web of Science, CINAHL, and Google Scholar. The search utilized a combination of Boolean operators (AND, OR) and Medical Subject Headings (MeSH) terms to capture relevant studies. Comparative clinical studies focusing on i-PRF as a treatment for OLPand other interventions were included. Outcomes assessed were pain, surface area of lesions, and patient satisfaction. Review Manager 5.4 was used for statistical analysis. The Risk of Bias 2.0 (RoB 2.0) tool was used to assess the methodological quality of the studies. Three studies were included for the final analysis. The findings indicated that both the i-PRF and comparison treatment groups demonstrated reductions in pain and lesion size. The post-treatment Visual Analogue Scale (VAS) scores showed a decrease in pain intensity, and there was an improvement in lesion extension in the i-PRF-treated sites. The results also revealed increased patient satisfaction with i-PRF treatment. Adverse effects were not reported or specified in the included studies. Quantitative analysis for pain (VAS) showed a mean difference of 0.38 (95% CI: 0.63-1.40), but there was no significant difference between the i-PRF and control groups at p=0.46. Though intragroup differences showed statistically significant differences between pre and post intervention, intergroup differences were not significant for any of the assessed outcomes. The findings from this study suggest that i-PRF holds promise as a potential treatment for OLP. The use of i-PRF resulted in pain reduction, lesion size improvement, and increased patient satisfaction. However, it is important to consider the limitations of the included studies, such as variability in study designs, small sample sizes, and the limited number of studies.

Prevalence and diagnostic significance of p16, p53 expression in lichen planus as a potential premalignant lesion in oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is a prevalent malignancy with significant morbidity and mortality. Identifying potential premalignant lesions is crucial for early detection and effective management. Lichen planus (LP), a chronic inflammatory disorder has been associated with an increased risk of developing OSCC. This study aimed to assess the diagnostic importance of p16 and p53 expression in identifying LP as a potential premalignant lesion for OSCC. A retrospective analysis was conducted on archived tissue samples from patients diagnosed with LP (n = 80) and OSCC (n = 60) between 2017 and 2022. Immunohistochemistry was performed to evaluate p16 and p53 protein expression levels in both LP and OSCC tissues. Clinical data, including patient demographics and lesion characteristics, were collected and correlated with the immunohistochemical findings. The results revealed a significantly higher prevalence of p16 and p53 expression in LP tissues compared to normal oral mucosa (P < 0.001). Notably, p16 expression was observed in 70% of LP cases, while p53 was detected in 55% of LP cases. Furthermore, a significant association was established between p53 expression and the presence of dysplasia within LP lesions (P = 0.003). This indicates the potential of p53 as a predictive biomarker for malignant transformation in LP. The correlation between p16 and p53 expression levels in LP and OSCC tissues suggests a potential mechanistic link between LP and OSCC development. This study underscores the diagnostic importance of p16 and p53 expression as potential markers for identifying LP as a premalignant lesion in the context of OSCC. The elevated prevalence of these markers in LP tissues suggests a potential role in predicting malignant transformation. The findings contribute to a deeper understanding of the molecular pathways underlying OSCC development from LP and emphasize the need for regular monitoring and early intervention in patients diagnosed with LP. Further prospective studies are warranted to validate these findings and to explore the clinical utility of p16 and p53 as biomarkers for predicting OSCC risk in LP patients.

Oral Infection by Lichen Planus: Types, Relevance, and Significance: A Review

Lichen planus is a chronic inflammatory condition that affects the skin. It is referred to as oral lichen planus (OLP) when it develops inside the mouth. The condition may only occur in the mouth or also affect other body parts at the same time. It can also occur in the genitals, nails, and scalp. The condition is marked by the onset of a non-infectious, itchy rash. The rash is often small with an irregular shape. It also has a flat top and appears as pink or purple bumps. OLP affects about 1% of the population. OLP is sometimes triggered by the body's reaction to metals placed in the mouth. Examples are dental fillings and metal braces. There have also been reports of the disorder occurring due to mouth mannerisms. Examples are biting the cheeks or tongue. Clinically, six types of OLP, namely reticular, popular, plaque-like, atrophic/erosive, ulcerative, and bullous types, can be identified. OLP more commonly affects the buccal mucosa, tongue, and gingiva. It is important to note that OLP is not an infection. It is also not contagious. It is not passed on from person to person. It is also not linked to nutrition or nutritional deficiency. However, eating certain fruits, tomato-based products, and spicy food has been found to make the symptoms worse. OLP is more common in women than men. It is often diagnosed in patients aged 40 and above. However, it can also affect children and young adults.