Oral Lichen Planus Lesions Research Articles

Oral lichen planus: A disease or a spectrum of tissue reactions? Types, causes, diagnostic algorhythms, prognosis, management strategies.

Oral lichen planus and lichenoid lesions comprise a group of disorders of the oral mucosa that likely represent a common reaction pattern to 1 or more unknown antigens. The coexistence of hyperkeratotic striation/reticulation, varying degrees of mucosal inflammation from mild erythema to severe widespread ulceration, and a band-like infiltrate of mononuclear inflammatory cells including activated T lymphocytes, macrophages, and dendritic cells, are considered suggestive of oral lichen planus and lichenoid lesions. Several classification systems of oral lichen planus and lichenoid lesions have been attempted, although none seem to be comprehensive. In this paper, we present a classification of oral lichen planus and lichenoid lesions that includes oral lichen planus, oral lichenoid contact lesions, oral lichenoid drug reactions, oral lichenoid lesions of graft vs. host disease, discoid lupus erythematosus, and systemic lupus erythematosus, lichen planus-like variant of paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome, chronic ulcerative stomatitis, lichen planus pemphigoides, solitary fixed drug eruptions, and lichen sclerosus. We present the clinical and diagnostic aspects of oral lichen planus and lichenoid lesions, and discuss related treatment options.

Oral Lichen Planus and Lichenoid Lesions in Sjogren's Syndrome Patients: A Prospective Study.

Objective The aim of this study was to investigate the prevalence and characteristics of oral lichen planus (OLP) and oral lichenoid lesions (OLL) in Sjogren's syndrome (SS) patients. Patients and Methods A prospective clinical study was conducted at the Department of Oral Medicine and Oral Surgery in Sahloul Hospital, Sousse, from January 2012 to June 2018. The patients involved in this study were diagnosed with Sjogren's syndrome according to the AECG (American-European consensus group) diagnostic criteria. Among these patients, we searched for those affected by OLP or OLL as determined by the WHO (World Health Organisation) classification of 2003. Clinical variables such as age, sex, medical conditions and medications, type of SS (primary or secondary), clinical form of OLP, and treatment were analyzed. The assessment of the results was performed using SPSS software. Results We evaluated 30 patients (27 females and 3 males) diagnosed with SS (24 had primary SS) with a mean age of 55 years and 11 months (±11,714). Overall, 9 patients had oral lesions (30%). Two patients had OLP associated with secondary SS (25%). Primary Sjogren's syndrome patients had 6 OLP lesions and one erythematous lichenoid lesion. OLP was erosive in eight patients, among them two had vulvo-vaginal-gingival syndrome. OLP lesions showed improvement in symptoms after topical or general corticosteroids treatment, while OLL showed improvement only under antibiotic treatment. Conclusion The results of our analysis suggest that patients with SS have 30% prevalence of OLP and OLL. This possible association shows the importance of screening for oral dryness in patients with OLP or OLL. Treatment includes topical or general corticosteroids for erosive forms associated or not with topical antifungal treatment to treat or prevent oral candidiasis.

TANTANGAN FARMAKOLOGI PENGGUNAAN STEROID TOPIKAL PADA PASIEN ORAL LICHEN PLANUS

Background: Oral lichen planus (OLP) is a chronic autoimmune disease sprinkled by T cells on the oral mucosal surface. The goal of OLP treatment is to eliminate erythema, ulceration and relieve symptoms. Corticosteroids are the first line in the treatment of OLP, either systemically or topically. The problem arises when using topical steroids, namely the time of topical steroid attachment to the oral mucosa, especially in cases of OLP with clinical desquamative gingivitis. Some studies suggest that the use of individual gingival tray can overcome this problem. Objective: To provide information on topical steroid use in OLP cases with desquamative gingivitis clinical signs.Case Management: Women, age 31, complain that pain with burning on the lips and mouth is aggravated by spicy food. Intraoral examination shows irregular white plaques on the buccal, labial and dorsal mucosa of the tongue accompanied by diffuse erythema in the anterior gingiva of the upper and lower jaws. Patients diagnosed with OLP. Lesions improve 3 months after topical steroid administration, except lesions on the gingiva. Gingival individual tray is then used to obtain adequate attachment of topical steroids on the gingiva surface. The gingiva showed significant improvement after a month later.Conclusion: The use of topical steroid concoctions applied to the gingival individual tray is effective in treating OLP lesions especially with clinical signs of desquamative gingivitis.

Severity of oral lichen planus and oral lichenoid lesions is associated with anxiety.

Oral lichen planus (OLP) and oral lichenoid lesions (OLL) are chronic inflammatory diseases whose symptoms can impair patient's quality of life (QoL). Psychological factors seem to play an important role in these diseases. This study aimed to determine the impact of oral health and anxiety levels on the QoL of patients with OLP and OLL. This was a cross-sectional study composed of OLP and OLL patients and a control group matched by age and sex with no autoimmune/inflammatory or malignant oral lesions. Anxiety levels and oral health impact on QoL were assessed using the Hamilton Anxiety Scale (HAM-A) and the Oral Health Impact Profile-14 (OHIP-14), respectively. The instruments were filled through personal interview before starting the treatment for oral lesions. A total of 87 patients diagnosed with OLP (n = 45) and OLL (n = 42), and 87 controls were included in the study. Statistical differences were observed for the psychic and somatic anxiety dimensions between severities of diseases. Patients with OLP or OLL had higher scores for the OHIP-14 dimensions physiological discomfort and social limitation compared with controls. In addition, higher scores for physical pain, physical disability, social disability, and handicap were detected among patients with greater severity. Greater severity of OLP and OLL seems to be associated with increased levels of anxiety, higher scores of oral health impact profile, and decreased QoL. Patients with severe OLP/OLL may benefit from additional therapeutic treatments, such as psychological and/or psychiatric management, concomitant to treatment specific to oral lesions.

Human β-Defensin 2 Expression in Oral Epithelium: Potential Therapeutic Targets in Oral Lichen Planus.

Human β-defensin 2 (hBD-2) is a potent antimicrobial peptide that participates in defense against invading bacteria. We recently showed that bacterial components and histamine, through histamine H4 receptor (H4R), are involved in the pathogenesis of the potentially malignant lesion, oral lichen planus (OLP). However, the underlying mechanisms remain unknown. We, therefore, investigated the role of hBD2–histamine crosstalk signaling in promoting OLP pathology. Biopsies from OLP and oral tongue squamous cell carcinoma (OTSCC) patients, and healthy controls were used. Two OTSCC cell lines and normal human oral keratinocytes (HOKs) were used. HBD-2 and other targets were mapped by immunostaining and analyzed by ImageJ2 software. The highly sensitive droplet-digital PCR technology and qRT-PCR were utilized to study the clinically derived and in vitro samples, respectively. H4R was challenged with the specific agonist HST-10 and inverse agonist ST-1007. HBD-2 was highly induced in OLP lesions. In contrast, hBD2 expression was attenuated in OTSCC tissues, while very low levels of hBD-2 messenger RNA (mRNA) were observed in OTSCC cells. Together with tumor necrosis factor-α (TNF-α), histamine upregulated hBD-2 mRNA expression in HOKs. Activation of H4R seems to modulate the expression of epithelial hBD-2. These findings suggest the involvement of hBD-2 in the pathogenesis of OLP and may, thus, be harnessed for therapeutic interventions in OLP.

The Malignant Transformation of Oral Lichen Planus and Oral Lichenoid Lesions, a Case Report and Review of the Literature

The Malignant Transformation of Oral Lichen Planus and Oral Lichenoid Lesions, a Case Report and Review of the Literature

Implications on pathogenesis and risk of oral lichen planus neoplastic transformation: an ex-vivo retrospective immunohistochemical study.

To evaluate OPN, MCM7, Ki-67, p53, Bcl-2 and 53BP1 presence, together with the abnormal adaptive CD4 and CD8 T-cell response markers expression in a series of oral lichen planus (OLP) affected patients and assess their combined contribution for a more objective disease classification. In this ex-vivo retrospective analysis, biopsy specimens from 28 adults with a clinical diagnosis of OLP at different progression degree (16 reticular, 2 plaque-like, 1 erosive and 9 mixed type) were collected. Sections were immunohistochemically investigated for the proinflammatory cytokine osteopontin (OPN), alpha-beta CD4 and CD8 positive T cells, DNA replication licensing factor (MCM7), proliferating cell marker (Ki-67), apoptotic and tumor antigen (p53), apoptosis modulator (Bcl-2) and cellular response regulator to double-strand breaks tumor suppressor p53-binding protein 1 expression. Statistical analysis revealed that 53BP1 is highly represented among the OLP study patients (p<0.05). Moreover, on the basis of the quantification results of the highly expressed parameters, two illness categories with different severity were evidenced. The classification hypothesis was confirmed by i) OLP lesion persistence, ii) the development of oral severe lesions in the patients belonging to high grade activity OLP group (HGA-OLPs) and iii) the ascertainment of the same evidence both in the oral squamous cell tumor controls (OSCC) and in HGA-OLP cases. This study completes the scenario with respect to early detection, thanks to a more precise histological analysis, for rationalizing the clinical and histological findings toward a sharable international disease scoring system.

Subset of CD8+ and FOXP3 + T cells in lichen planus associated with chronic hepatitis C infection.

To verify whether there are differences between populations of CD8+and FoxP3+T cells in lesions of oral lichen planus associated with hepatitis C virus chronic infection (OLP-HCV) and lesions of idiopathic oral lichen planus (OLP-I). A case-control study was performed using a convenience sample of 11 paraffin-embedded tissue blocks of OLP-HCV and 19 of OLP-I. Histological sections stained with haematoxylin and eosin were used to classify the intensity of inflammatory infiltrate. Immunohistochemistry was used to identify CD8+and FoxP3+T cells. The count of positive cells was compared between the two groups and correlated to clinical and demographic data (p<0.05). There were no statistically significant differences in the distribution of CD8+and FoxP3+T cells regarding the inflammatory infiltrate in lesions of OLP-HCV and OLP-I. Atrophic/erosive lesions showed a higher relationship between counts of CD8/FoxP3 T cells per mm2 (p=0.018) and counts of CD8+T cells per mm2 (p=0.034) in OLP-HCV group compared to OLP-I group. Overall, no difference was found between cell populations in the lesions of OLP-HCV and OLP-I. However, atrophic/erosive lesions of OLP-HCV had a higher amount of CD8+T cells and lower FoxP3 expression.

ALLERGIC CONTACT STOMATITIS (STOMATITIS VENENATA): A CASE REPORT OF ORAL HYPERSENSITIVITY REACTION TO TOOTHPASTE

Allergic contact stomatitis (stomatitis venenata) might resemble oral lichen planus or oral lichenoid lesion clinically which can be acute or chronic in nature. Many offending agents have been attributed to their development and the most common being dental restorative materials, lipstick or flavouring agents in toothpaste or chewing gums. Allergic reactions can be in mild form to life-threatening anaphylaxis. The identification of the exact cause for allergy is difficult. Here, we report the case of a 37-year-old patient who presented with allergic contact stomatitis to a conventional daily routine product. Importance of history taking and awareness by the clinician about the contents of any new products being prescribed to the patient are emphasized by this case report.

In vivo reflectance confocal microscopy of oral lichen planus.

In vivo reflectance confocal microscopy (RCM) is an imaging technique that can virtually biopsy vital tissues, noninvasively and in real time. It results in horizontal virtual slices at a microscopic resolution that correlates well with conventional histopathology. Despite the widespread use of RCM in dermatology, it is still rarely applied to the study of oral pathologies. The aim of the present work is to describe RCM cellular and architectural findings in oral mucosae affected by oral lichen planus (OLP). A series of conventionally diagnosed OLP lesions underwent RCM imaging with a portable reflectance confocal microscope that could scan from the surface to the submucosa. The confocal findings were collected, described, and compared with the literature. A total of 31 oral sites affected by OLP in 12 patients were considered. According to their clinical appearance, 22 lesions showed a reticular-plaque pattern, six lesions were mainly atrophic-erosive, and the remaining three presented a mixed pattern. RCM examination showed hypergranulosis, epithelial disarray, spongiosis, necrotic keratinocytes, epithelial and subepithelial inflammatory cell infiltration, and dilated vessels; all findings were in lichen planus, with differences noted between the "white" and "red" manifestations of this pathology. The use of RCM in routine clinical oral pathology tests is recommended to avoid recurrence of OLP and changes in its responsiveness to therapy, thus limiting the need for biopsy of lesions suspected of tumoral changes.

Characterization of Intratissue Bacterial Communities and Isolation of &lt;i&gt;Escherichia coli&lt;/i&gt; from the Lesions of Oral Lichen Planus

Characterization of Intratissue Bacterial Communities and Isolation of &lt;i&gt;Escherichia coli&lt;/i&gt; from the Lesions of Oral Lichen Planus

Chronic ulcerative stomatitis: A systematic review of the clinical and microscopic features.

Background the purpose of this study was to perform a systematic review regarding clinical and histopathological characteristics, immunopathological findings, and treatment for chronic ulcerative stomatitis (CUS). Material and Methods articles in English, published from January 1962 up to November 2017, assessing clinical and immunological features, treatment, and follow-up of patientes with CUS, were retrieved from three databases (PubMed, Cochrane Library and SCOPUS). A manual literature search was also conducted. A total of 12 studies met inclusion criteria, therefore, were analyzed in this review. Results CUS shares similiar clinical and microscopic features to those found in oral lichen planus (OLP) and oral lichenoid lesions (OLL). Hence, direct immunofluorescence (DIF) is indispensable to define a final diagnosis. Due to the poor sample availability in the current literature, it is not possible to accurately confirm the prevalence and features of CUS. Conclusions in order to better evaluate this condition’s findings, further studies with a greater amount of similar immune-mediated diseases should be performed. Key words:Chronic ulcerative stomatitis, immune-mediated diseases, immunofluorescence, lichen planus.

Oral lichen planus and associated comorbidities: An approach to holistic health.

Lichen planus (LP) is a chronic inflammatory disorder with involvement of skin, oral and genital mucosa, scalp, and nail appendages. Oral lichen planus (OLP) lesions demonstrate a number of morphologic presentations, persist for a long time with rare self-resolution, and undergo malignant changes. OLP has been associated with numerous systemic connotations such as metabolic syndrome, diabetes mellitus, hypertension, thyroid diseases, psychosomatic ailments, chronic liver disease, gastrointestinal diseases, and genetic susceptibility to cancer. The oral health physician should be aware of these systemic associations and should work in close connect with the primary healthcare physicians to rule out the predisposing factors for the associated comorbidities. This article aims to highlight the various systemic associations of OLP and warrants the screening of these ailments in OLP for prevention and effective management.

Immunohistochemical study of Wnt5a expression in cutaneous and oral lichen planus

Background Lichen planus (LP) is an inflammatory disease that affects the skin, mucous membranes, and skin appendages. Although the exact cause of LP is unclear, it was thought to be a T cell-mediated autoimmune disease. Wnt5a is one of the most extensively studied Wnt proteins, which has an important role in stimulating inflammation, cellular proliferation, differentiation, apoptosis, migration, and polarity. Objective To study the immunohistochemical expression of Wnt5a in patients with cutaneous and oral LP in comparison with healthy participants to study its possible role in the pathogenesis of the disease. Patients and methods Sixty patients with cutaneous and oral LP were included in this study, in addition to 40 healthy skin and oral mucosa specimens serving as controls. Punch biopsies of 3 mm were taken from lesional skin and control skin and were immunohistochemically stained for Wnt5a expression. Results There was a statistically significant increase in Wnt5a expression in cutaneous and oral LP lesions compared with normal controls. Moreover, Wnt5a expression was increased in hypertrophic and oral types of LP when compared with other types: classic, atrophic, and actinic. Moreover, a statistically higher expression of Wnt5a was found in hepatitis C antibodies-positive patients when compared with hepatitis C antibodies-negative patients. Conclusion Expression of Wnt5a was significantly increased in patients with LP than in controls, and this supports that Wnt5a might be involved in the pathogenesis of LP. Overexpression of Wnt5a in hypertrophic and oral types of lichen may predispose to malignant transformation. Therefore, these patients should be followed up regularly.

Vitamin D in the treatment of oral lichen planus: A pilot clinical study

Introduction: Lichen planus is an autoimmune disease with unknown etiology. Vitamin D not only affects the health of the bone but also has an impact on immunity. To understand the possible role of vitamin D in the pathophysiology of oral lichen planus (OLP), a clinical study was conducted on patients suffering from OLP who reported to the dental outpatient department of our dental college in Aligarh. Aims: To evaluate the possible co-relation between the OLP with vitamin D deficiency and the effect of vitamin D supplementation on the treatment of the OLP lesion. Settings and Design: A pilot clinical study was conducted in a dental college in Aligarh. Materials and Methods: Patients with clinical presentation of OLP were included in our study. Patients with drug-induced oral lesion or lesion associated with dental restoration (lichenoid reactions) were excluded from the study. Patients were divided into three different groups depending on factors such as stress, low vitamin D levels, or a combination of the above factors. Patients with severe vitamin D deficiency were supplemented with vitamin D. Statistical Analysis Used: Fisher's exact test. Results: There was a statistically significant improvement in both subjective and objective symptoms in patients who were supplemented with vitamin D with or without psychological counseling apart from topical steroid application for a short period. Conclusion: Marked improvement and long-term remission in the symptoms in vitamin D–deficient patients after restoration of normal vitamin D level suggests its role in pathogenesis of OLP like other autoimmune diseases. Therefore, further study and research work need to be carried out to understand the pathway through which vitamin D is related to the pathogenesis of OLP.

Malignant transformation rates in Oral Lichen Planus.

Data sourcesPubMed, Scopus and Web of Science databases.Study selectionCohort, case-control or retrospective studies involving more than 50 patients with biopsy proven diagnosis and absence of dysplasia at initial diagnosis of oral lichen planus (OLP) or oral lichenoid lesions (OLL) were considered.Data extraction and synthesisTwo reviewers independently selected the studies and abstracted data. Study quality was assessed using the Newcastle-Ottawa Scale. A third reviewer arbitrated any disagreements. A random effects meta-analysis of malignant transformation rates was conducted.ResultsTwenty-one studies were included, 18 were retrospective and three prospective. In total there were 6559 patients; 6353 with OLP and 206 with OLL. The follow-up periods ranged from 18-300 months. Ninety-two cases of oral squamous cell carcinoma developed during the observation period. The overall transformation rate (TR) was 1.4%; 1.37% for OLP and 2.43% for OLL.ConclusionsThis systematic review confirms that both OLP and OLL, the latter with a slightly higher TR, may be considered potentially malignant disorders and suggest that erosive type, female gender and tongue site should be considered as risk factors for OLP transformation. Major efforts should be made to establish strict clinical and histological criteria to diagnose OLP and to perform sounder methodological observational studies.

SnapshotDx Quiz: December 2018

SnapshotDx Quiz: December 2018

IL-25 promotes Th2-type reactions and correlates with disease severity in the pathogenesis of oral lichen planus

ObjectiveThe aim of the present study was to investigate the correlation between IL-25 expression and disease severity, and the potential immunoregulatory role of IL-25 expression in oral lichen planus (OLP). Materials and MethodsThe oral mucosal tissue samples obtained from OLP patients and healthy controls (HCs) were analyzed for IL-25 expression by real-time quantitative PCR (qPCR) and immunohistochemistry. Recombinant IL-25 was used to stimulate OLP patient-derived CD4 + T cells, and then IL-4 secretion and mRNA expression were evaluated by ELISA and qPCR, respectively. The efficiency of the siRNA-mediated knockdown of IL-25R expression in oral keratinocytes was determined by qPCR and Western blotting. Human oral keratinocyte cells were cultured with the recombinant human cytokines IL-25, IL-17 A and IL−17 F. The production of associated cytokines by keratinocytes was determined by qPCR. Statistical analyses of quantitative data were performed using SPSS software. ResultsThe IL-25 and IL-4 mRNA levels were elevated and correlated significantly with each other in specific OLP subtype lesions compared to HCs, while the numbers of IL-25 positive cells were also increased in local OLP lesions as compared to HCs. In vitro culture with recombinant IL-25 could significantly promote CD4 + T cells from both subtypes of OLP to produce IL-4 mRNA and remarkably elevate supernatant IL-4 levels in reticular OLP CD4 + T cell cultures, which may be attributed to the elevated expression of IL-25R in local OLP lesions. Statistical analyses demonstrated that the simultaneously increased levels of IL-4, CXCL8 and CCL20 in keratinocytes were induced by IL-25 but not IL-17 A or IL−17 F. Decreasing IL-25R subunit expression by siRNA-mediated knockdown significantly blocked the expression of all cytokine-produced inflammatory mediators in oral keratinocytes. ConclusionsIn OLP lesions, IL-25 can function to mediate the Th2 response in specific disease subtypes, which may be an important cause of OLP disease chronicity and persistent inflammation.

A clinical evaluation of efficacy of photodynamic therapy in treatment of reticular oral lichen planus: A case series.

Background The aim of the study was to clinically evaluate the efficacy of photodynamic therapy in treatment of reticular oral lichen planus (OLP). Methods Fifty patients aged 26-84, with 124 OLP lesions in total, underwent photodynamic therapy (PDT) mediated with topically applied 5% 5-aminolevulinic acid. ALA was activated by a custom-made diode lamp with a high-power LED emitting light at 630 nm and 300 mW delivered through an optical fiber probe. A light exposure dose was 150 J/cm2. The therapy comprised of 10 weekly illumination sessions. The lesions' response was macroscopically measured in millimeters with a periodontal probe and clinically evaluated at each session, then on completion of the series and throughout the 12-month follow-up. Results The baseline mean size of lesions was 3.99 cm2±3.73. The lesions on the buccal mucosa and lips (lining mucosa) were larger than those on the gingiva and tongue (masticatory mucosa) - 4.58 cm2±4.01 and 2.93 cm2±2.91 respectively. On completion of the therapy 109 sites improved, including 46 in complete remission. The mean reduction in size was 62.91% (p = 0.000000). 12-month after therapy mean reduction of the lesions was 78.7% (p = 0.000000), specifically 79.48% (p = 0.000000) within the lining mucosa and 76.11% on the masticatory mucosa. Conclusions The results proved that ALA-mediated photodynamic therapy with a 630 nm light was effective and as such it can be used as an optional treatment for symptomatic OLP.

Clinical evaluation of photodynamic therapy for the treatment of refractory oral Lichen planus – A case series

Oral lichen planus (OLP) is a chronic inflammatory, immune mediated mucocutaneous disorder of uncertain etiology. Psychologic stress has been found to be a main contributing factor in onset and progression of lesions. Most erosive OLP patients are refractory to available therapies, even corticosteroids, and report remarkable side effects. As photodynamic therapy (PDT) has proved it to be an effective and safe alternative treatment of abnormal or neoplastic cells we employed PDT for this diagnosis. Due to limited literature on application of this method for treatment of refractory erosive OLP, we present a series of 10 cases of bilateral erosive LP treated by 5 -Aminolevulinic acid mediated PDT. Outcome of our clinical cases showed remarkable improvement in lesions with reduction in Reticulation, Erythema, Ulceration (REU) score (from 5 to 3) and burning sensation as recorded by Visual Analogue Scale (Pretreatment VAS ranged from 5 to 8, posttreatment VAS was 0-1). PDT could be used as a complementary treatment method for symptomatic resistant OLP lesions, although our findings necessitate further research to validate the efficacy of this method for control of resistant oral lichen planus.