Lichen Planus Lesions Research Articles

Coenzyme Q10 as a dietary supplement combined with topical corticosteroids in the treatment of erosive lesions of oral lichen planus

Introduction: Oral lichen planus (OLP) is a chronic mucocutaneous disease with an immunological etiology. This study was conducted to evaluate the effect of coenzyme Q10 (CoQ10) as an adjunctive to topical corticosteroids in the treatment of erosive–ulcerative lichen planus. Materials and methods: A total of 30 patients with a confirmed clinical diagnosis of OLP participated in this clinical trial. Patients were randomly allocated into one of two groups and treated as follows: group I received topical corticosteroids and group II received CoQ10 combined with topical corticosteroids. Assessment of outcome measures including clinical score and pain was carried out at the time of initial visit (baseline) and at 2, 4, 8, and 12 weeks following treatment protocol. All recorded data were analyzed using paired t-test and independent t-test. The level of significance was established at a P value of 0.05 or less. Results: The two studied groups showed a marked reduction in pain sensation and size of lesions, particularly in the final follow-up period. However, healing and decrease in the size of the lesions were effective in group II, and a significant difference was found between the two groups favoring group II over group I. Conclusion: CoQ10 in combination with topical corticosteroids was found to be effective in managing ulcerative lesions of OLP; however, more studies with a larger sample sizes and longer duration with evaluation of the adjunctive effect of CoQ10 on inflammatory markers expressed in OLP are recommended.

“Comparative assessment of cellular proliferative potential in oral lichen planus and oral lichenoid lesions by quantitative analysis of nucleolar organizer regions”

“Comparative assessment of cellular proliferative potential in oral lichen planus and oral lichenoid lesions by quantitative analysis of nucleolar organizer regions”

Oral mucosal lichen planus in childhood

Lichen planus is a relatively common mucocutaneous disorder in adults, but it is rarely reported in children. Much less data is available regarding lichen planus in children. This is a report with intraoral lesions of lichen planus. Lichen planus, although reportedly rare in childhood, should be considered in the diagnosis of hyperkeratotic or erosive lesions of oral mucosa in children.

The Efficacy of Topical Hyaluronic Acid 0.2% in the Management of Symptomatic Oral Lichen Planus.

Oral lichen planus (OLP) is a condition frequently referred to the specialist dental clinic for diagnosis and management. It is a disease of the skin and mucous membranes with oral manifestations too. It varies in appearance from keratotic to erythematous and ulcerative form. Immunosuppressants are frequently used for patients but some of these drugs could be implicated in malignant transformation, thus there is a clear need to find an alternative therapy for OLP. To evaluate the relief of symptoms and reduction in the size of the lesions of lichen planus with 0.2% hyaluronic acid topical application and to compare the efficacy of topical hyaluronic acid (0.2%) with that of patients on placebo. A randomized controlled study was conducted on 50 symptomatic and biopsy proven patients with lichen planus. The subjective symptoms like Visual Analogue Scale (VAS) and the objective symptoms like degree of erythema and mean area of the lesion were recorded preoperatively and on day 7, day 14, day 21 and day 28. The selected patients were divided randomly into group-I comprising of 25 patients who received topical 0.2% hyaluronic acid therapy for 14 days and group-II comprising of 25 patients who received topical application of placebo for 14 days. The statistical tests used were Mann-Whitney U test, t-test, Wilcoxon matched pairs test by ranks and paired t-test. Symptomatic effect of soreness evaluation- there was a significant reduction in VAS scores in the test group as compared to placebo, similarly there was also significant reduction in the degree of erythema, change in the size of the lesion and area of the lesion in the test group. There was significant improvement in relief of symptoms, in the degree of erythema and mean area of the lesion in Group-I when compared with group-II. Topical application of 0.2% Hyaluronic acid showed a significant clinical response when compared to topical placebo. It is easy to use; hence a frequent application scheme should be advised to improve the efficacy of hyaluronic acid.

Buccal Micronuclei Assay as a Tool For Biomonitoring DNA Damage in Oral Lichen Planus.

The malignant transformation rate of Oral Lichen Planus (OLP) is between 0% and 5.8%. Oral lesions of lichen planus clinically presents itself multifocally, simulating the process of field cancerization in high risk malignancies. The Buccal MicroNucleus Cytome Assay (BMN Assay) provides a platform to identify the high risk individuals by evaluating the markers of nuclear damage at an earliest micro invasive phase. To evaluate DNA damage in exfoliated buccal mucosal cells in individuals with oral lichen planus lesions and thereby to delineate the high risk group. Buccal smears from 22 OLP and 10 control samples were stained in modified Feulgen-Rossenback reaction for micronuclei assay. Cytological evaluation of number of MicroNucleated cells (CMN), Total Number of Micronuclei (TMN) in micronucleated cells was done in both groups. Frequency of micronucleated cells (CMN) when compared among the study and control group, a mean value of 4.27 ± 1.80 and 0.90 ± 0.88 were obtained respectively. On comparing the total number of micronuclei in the micronucleated cells (TMN) between the study and control groups, a mean value of 5.38 ± 2.42 and 1.5 ± 0.88 were obtained respectively. There was a significant increase in the frequency of micronuclei and the micronucleated cells in the oral lichen planus as compared to normal individuals.

Evaluation of the Level of Melatonin , Cortisol and IgA in Saliva of Patients with Oral Lichen Planus Lesions

Back ground: Oral lichen planus is a chronic inflammatory disease that affects the mucous membrane of the mouth. Several researchers suggest that oxidative stress is implicated in the pathogenesis of this disorder. It has been hypothesized that melatonin is powerful anti-oxidants and can easily cross the cell membrane and is considered a free radical scavenger of Hydroxid, Oxygen and Nitrogen dioxide, cortisol as a stress hormone and the immunoglobulin A as first line of defense and protection to the mucous membrane of the mouth are interrelated factors for the emergence of oral lichen planus. Aim of this study was to evaluate the level of melatonin, Cortisol and IgA in saliva of patients with oral lichen planus lesions in comparison with participants with normal oral mucosa. Materials and methods: In this study seventy five subjects with age 18 and over were included. The subjects were divided into two groups; control group, this group comprised of 41 subjects with normal oral mucosa and the study group, which comprised of 34 subjects with clinically and histopathologically diagnosed oral lichen planus lesion. The samples were selected from patients attending College of Dentistry/University of Baghdad and cases that recruited to the AL-Emmam Ali hospital / in Baghdad /Dermatology Department. Samples collection started from 2/ may 2013 to 23/ January 2014.Saliva samples were collected between 10-12 Am. High performance chromatography (HPLC) analyzing technique was used for estimating the salivary melatonin and cortisol level. IgA level was measured by ELIZA method. Results: The mean salivary melatonin level in patients with oral lichen planus was 4.786 µg/ml and the mean saliva melatonin level in normal person was 8.759 µg/ml. significant difference (p<0.01) was observed in the salivary melatonin levels between the study and control group. The mean salivary cortisol level in patients with OLP was 0.730 µg / ml and the mean saliva cortisol level in normal persons was 0.165 µg/ml. significant difference (p<0.01) was observed in the salivary cortisol levels between the study and control, group. The mean salivary IgA level in patients with OLP was 221.4 µg/ml and the mean saliva IgA level in normal person was 125.8 µg/ml. There was a high significant difference (p<0.01) the study and control groups. Conclusions: The level of salivary melatonin was lower in patients with oral lichen planus, however cortisol and IgA was higher when comparing the salivary level with that of the control groups.

Vulvovaginal-gingival Lichen Planus: Association with Lichen Planopilaris and Stratified Epithelium-specific Antinuclear Antibodies.

Vulvovaginal-gingival lichen planus (VVG-LP) consists of a triad of symptoms: vulval, vaginal and gingival lichen planus lesions. The aim of this study was to analyse the prevalence of lesions in various anatomical locations in patients with VVG-LP. The study included 126 consecutive patients with lichen planus. Sixteen (12.7%) patients fulfilled the criteria of VVG-LP. In 12/16 (75%) patients with VVG-LP scalp lesions were also observed. Stratified epithelium-specific antinuclear antibodies (SES-ANA) and anti-ΔNp.3α antibodies were detected in 10/16 (75%) patients with VVG-LP and in 15/110 (13.6%) patients with other forms of lichen planus (p < 0.05). In conclusion, VVG-LP is frequently associated with lichen planopilaris. The new entity may be termed "vulvovaginal-gingival-pilar lichen planus" and our study indicates that SES-ANA is a marker of this type of lichen planus with extensive, severe and refractory-to-therapy involvement of the mucous membranes, skin and scalp.

Skin manifestations and treatment of graft-versus-host disease

Graft-versus-host disease (GVHD) is an autoimmune disease caused by graft-versus-host reaction, occurring most frequently in patients receiving allogeneic hematopoietic stem cell transplantation and occasionally in patients receiving organ transplantation. It often involves multiple organ systems, of which, skin and mucous membranes are the most frequently affected system with various clinical manifestations. Acute GVHD often appears as measles- or scarlet fever-like skin rashes with severe systemic symptoms such as fever and poor appetite, and may rapidly progress into toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS) in a few days. Lichen planus and sclerodermoid lesions are the most common clinical manifestations of chronic GVHD. With further understanding of this disease in recent years, some new manifestations have been observed, such as psoriasis- and atopic dermatitis-like skin lesions, as well as nail changes in some cases. It is especially important to select appropriate treatment protocols according to clinical manifestations. Glucocorticoids combined with immunosuppressive agents are a conventional treatment for GVHD, and innovative treatments have emerged with the development of therapeutics. Key words: Graft vs host disease; Skin manifestations; Clinical protocols; Biological agents; Mesenchymal stem cell transplantation

CLA and CD62E expression in oral lichen planus lesions.

There are few reports on the migration of CLA+ T cells through E-selectin in cutaneous lichen planus, with only one study on oral lichen planus (OLP). This study aimed to analyze CLA expression and assess whether there is a correlation with E-selectin (CD62E) in OLP lesions. Biopsies were performed on 11 patients including two areas: one without clinical and histopathological features of OLP [perilesional group (PLG)] and the other with clinical and histopathological features of OLP [OLP group (OLPG)]. The specimens obtained were divided into two: One was fixed in formalin for routine analysis (H&E), and the other was frozen for CD3, CD4, CD8, CLA, and CD62E immunofluorescence markers. More CD4+ (median 1409, range 860-2519), CD8+ (median 1568, range 654-3258), and CLA+ T cells (median 958, range 453-2198) and higher CD62E expression (median 37, range 27-85) were identified in OLPG (P = 0.003; P = 0.003; P = 0.004; P = 0.003, respectively) than those in PLG. The median prevalence analysis was also significantly higher for CLA+CD8+ T cells in OLPG (OLPG = 39.4%, range 18.4-64.2; PLG = 29.4%, range 12.1-47.1) (P = 0.026). None of the correlations between CD3+ or CLA+ T cells and CD62E in OLPG and in PLG were significant. The significant presence of CLA+ T cells and E-selectin expressions in the OLPG suggests their involvement in the etiopathogenesis of OLP; however, only a weak correlation between CLA+ T cells and E-selectin was observed.

The Role of Dental Metal Allergy in Oral Lichen Planus

Oral lichen planus (OLP) and oral lichenoid lesions (OLL) present a diagnostic challenge. Etiologies and mechanisms for these are currently theoretical and the lesions are often clinically indistinguishable. Allergic reactions to dental materials may play a role in the genesis and course of these lesions. This study examined patch testing results for dental metals in subjects diagnosed with OLP and OLL.

Update on lichen planus and its clinical variants.

Lichen planus (LP) is an inflammatory skin condition with characteristic clinical and histopathological findings. Classic LP typically presents as pruritic, polygonal, violaceous flat-topped papules and plaques; many variants in morphology and location also exist, including oral, nail, linear, annular, atrophic, hypertrophic, inverse, eruptive, bullous, ulcerative, lichen planus pigmentosus, lichen planopilaris, vulvovaginal, actinic, lichen planus-lupus erythematosus overlap syndrome, and lichen planus pemphigoides. Clinical presentation of the rarer variant lesions may be largely dissimilar to classic LP and therefore difficult to diagnose based solely on clinical examination. However, histopathological examination of LP and LP-variant lesions reveal similar features, aiding in the proper diagnosis of the disease. Management of LP and LP variants aims to control symptoms and to decrease time from onset to resolution; it often involves topical corticosteroids, but varies depending on the severity and location of the lesion. The literature contains an array of reports on the variations in presentation and successful management of LP and its variants. A familiarity with LP and its variants is important in achieving timely recognition and management of the disease.

Oral Lichen Planus Clinical Features Changed by Candidiasis Infection

Oral lichen planus (OLP) lesions manifest in different patterns. Erosive OLP can cause pain, itching, and burning. The clinical profile of OLP can change when associated with Candida sp. infection. We present 2 cases in which infection with Candida sp. significantly changed clinical aspects of OLP and evident areas of erythroleukoplakia were associated with burning and itching. In both cases, samples were obtained by superficial scraping. Cytopathology of the oral scrapings revealed candidiasis. A topical antifungal agent was prescribed, and both patients showed improvement of the clinical aspects and symptoms, only the classical reticular pattern being observed. In 1 patient, biopsy was performed in order to confirm the diagnosis. At this writing, both patients were under follow-up. Cytopathology is an important tool for the evaluation and monitoring of patients with OLP. The combination of candidiasis and OLP can lead to changes in the clinical aspects and symptoms. Other types of erythroleukoplakia should be considered in the differential diagnosis, and biopsy should be performed if necessary.

Assessment of Angiogenesis in Oral Lichen Planus Lesions

Assessment of Angiogenesis in Oral Lichen Planus Lesions

Epigenetic Modifications and Accumulation of DNA Double-Strand Breaks in Oral Lichen Planus Lesions Presenting Poor Response to Therapy.

Epigenetics refers to changes in cell characteristics that occur independently of modifications to the deoxyribonucleic acid (DNA) sequence. Alterations mediated by epigenetic mechanisms are important factors in cancer progression. Although an exciting prospect, the identification of early epigenetic markers associated with clinical outcome in premalignant and malignant disorders remains elusive. We examined alterations in chromatin acetylation in oral lichen planus (OLP) with distinct clinical behavior and compared the alterations to the levels of DNA double-strand breaks (DSBs). We analyzed 42 OLP patients, who had different responses to therapy, for acetyl-histone H3 at lys9 (H3K9ac), which is associated with enhanced transcription and nuclear decondensation, and the presence of DSBs, as determined by accumulation of phosphorylated γH2AX foci. Patients with high levels of H3K9ac acetylation failed to respond to therapy or experienced disease recurrence shortly after therapy. Similar to H3K9ac, patients who responded poorly to therapy had increased accumulation of DNA DSB, indicating genomic instability. These findings suggest that histone modifications occur in OLP, and H3K9ac and γH2AX histones may serve as epigenetic markers for OLP recurrence.

Effect of supportive periodontal treatment in the oral lichen planus patients

Lichen planus is an immune-mediated mucocutaneous disease, affects more frequently middle-aged Caucasian women and makes signs and symptoms in the oral mucosa. Cutaneous lichen planus lesions cause itching but they are self-limiting, oral lichen planus lesions are usually chronic, recalcitrant to treatment and potentially premalignant in some cases. Although, oral lichen planus is non-plaque related disease, they possess particular problems because plaque control is complicated by pain and bleeding and might cause plaque-related disease. The resulting condition comprises accumulations of plaque, which again can influence the progress of oral lichen planus with burning sensation, spontaneous gingival bleeding. Thus, it should be noted that both medication and supportive periodontal treatment are essential for the remission of the lesions. This case report introduces topical corticosteroid therapy and supportive periodontal treatment including intensive oral hygiene procedures to obtain an improvement of subjective symptoms and objective changes and to prevent relapse the lesions.

Expression of cdk4 and p16 in Oral Lichen Planus.

ABSTRACTObjectivesThe purpose of this study was to evaluate the expression of cdk4 and p16, the proteins implicated in hyperproliferation and arrest in oral lichen planus and to compare their expression in erosive and non-erosive oral lichen planus and with normal mucosa and oral squamous cell carcinoma.Material and MethodsAnalysis of cdk4 and p16 expression was done in 43 erosive oral lichen planus (EOLP) and 17 non-erosive oral lichen planus (NOLP) cases, 10 normal mucosa and 10 oral squamous cell carcinoma (OSCC) cases with immunohistochemistry.ResultsThis study demonstrated a significantly increased expression of cytoplasmic cdk4 (80% cases, cells stained - 19.6%), and cytoplasmic p16 (68.3% cases, cells stained - 16.4%) in oral lichen planus (OLP) compared to normal mucosa. cdk4 was much higher in OSCC in both cytoplasm and nuclei compared to normal mucosa. Also, while comparing OLP with positive control, significant difference was noted for cdk4 and p16, with expression being more in OSCC. While comparing EOLP with NOLP; significant differences were seen for cdk4 cytoplasmic staining only, for number of cases with positive staining as well as number of cells stained.ConclusionsOverexpression of cytoplasmic cdk4 and p16 was registered in oral lichen planus, however considerably lower than in squamous cell carcinoma. Erosive oral lichen planus demonstrated overexpression of cytoplasmic cdk4 and premalignant nature compared to non-erosive lesion. Therefore there is an obvious possibility for cytoplasmic expression of cdk4 and p16 to predict malignant potential of oral lichen planus lesions.

Salivary 8-hydroxy-2-deoxyguanosine, malondialdehyde, vitamin C, and vitamin E in oral pre-cancer and cancer: diagnostic value and free radical mechanism of action.

The objectives of this study are to analyze oxidative DNA and lipid damage using salivary 8-hydroxy-2-deoxyguanosine (8-OHdG), malondialdehyde (MDA), and vitamins C and E in oral lichen planus lesions, oral leukoplakia, oral submucous fibrosis, oral squamous cell carcinoma (SCC), and controls and to determine the value of salivary biomarkers in the diagnosis of oral pre-cancer and cancer patients. Unstimulated saliva was collected from a group of patients diagnosed with 40 oral squamous cell carcinoma (OSCC), 40 oral lichen planus lesions, 40 oral leukoplakia, 40 oral submucous fibrosis, and from a control group of healthy age- and gender-matched individuals. Salivary 8-OHdG, MDA, and vitamins C and E were measured. Squamous cell carcinoma and pre-cancer patients showed significantly higher levels of salivary 8-OHdG and MDA and lower levels of vitamins C and E when compared to levels in healthy normal subjects. The specificity and sensitivity of the combination of 8-OHdG, MDA, vitamin C, and vitamin E are high for the diagnosis of oral pre-cancer and SCC compared to an individual biomarker approach using either 8-OHdG, MDA, or vitamin C and vitamin E independently. This study indicates the presence of oxidative DNA and lipid damage in pre-cancerous and SCC patients. It is postulated that the mechanism may have a significant link to carcinogenesis in oral cancer. Detection of salivary 8-OHdG, MDA, vitamin C, and vitamin E can act as suitable diagnostic biomarkers of oral pre-cancer and cancer. Of clinical importance is that salivary 8-OHdG, MDA, vitamin C, and vitamin E could play a significant role in oral cancer and pre-cancer patients and could therefore be useful for diagnosis in patients with oral lichen planus lesions, oral leukoplakia, oral submucous fibrosis, and oral squamous cell carcinoma.

Dermoscopic patterns in active and regressive lichen planus and lichen planus variants: a morphological study.

Background: Lichen planus (LP) is an acute or chronic inflammatory skin disorder characterized by discrete, violaceous, polygonal papules.&#x0D; Objective: In this study, we aimed to categorize the dermoscopic images of LP and LP variants before and after treatment.&#x0D; Methods: We analyzed and categorized the dermoscopic images of 255 LP lesions from 60 patients who had been clinically diagnosed with LP or LP variants and confirmed by histopathological examination. We reanalyzed and categorized the dermoscopic images of 50 lesions from fifteen patients after treatment.&#x0D; Results: We observed different Wickham striae (WS), pigment, and vascular patterns according to the LP variant, lesion localization and disease duration. Reticular, circular, linear, globular, radial streaming, perpendicular, and veil-like (structureless) WS patterns were detected on dermoscopic examination. Peripheral/diffuse dot globules, peripheral/diffuse peppering, perifollicular/annular, linear, reticular, circular, cobblestone, and homogeneous cloud-like pigment patterns were especially prevalent in LP pigmentosus and regressive LP lesions. As for vascular patterns, there were red dots/globules, radial linear, and peripheral homogeneous patterns described upon dermoscopic evaluation.&#x0D; Conclusion: Dermoscopic evaluation can be useful both in the diagnosis and follow up of LP.

Is the Safe Margin Essential for the Lichen Planus?

In this study evaluation of molecular changes Marker p53 in lichen planus lesions and safe margins around the lesion was performed.

Evaluation of Mast Cell Distribution in Oral Lichen Planus and Lichenoid Lesions by Histochemical Analysis

Evaluation of Mast Cell Distribution in Oral Lichen Planus and Lichenoid Lesions by Histochemical Analysis