Lichenoid Lesions Research Articles

Oral exfoliative cytology and corrosion of metal piercings. Tissue implications.

A group of adolescents with oral piercings was studied to determine the presence of metallic particles in cells exfoliated from the mucosa surrounding their metal oral piercings and the association between such particles and the metal jewelry, and to evaluate subsequent tissue implications. Sixteen teenage patients who had tongue and/or lip piercings were included. The clinical features of the oral mucosa and lip skin were evaluated. Exfoliative cytology was performed in the area surrounding the piercing. The surface of used and unused jewelry was studied by scanning electron microscopy and energy dispersive X-ray analysis. Hyperplastic, leukoedematous, and lichenoid lesions were observed in the mucosa, as well as lesions associated with metallosis of the lip skin. Cytological smears showed the presence of particles inside the epithelial cells; the particles were found to contain aluminum, tungsten, and molybdenum. In one case requiring surgical removal of the piercing, histological examination of the tissue associated with the piece of jewelry showed the presence particles containing aluminum, iron, and tin inside multinucleated giant cells. Although surface finish defects were observed on both unused and used piercing jewelry, they were more evident on the used pieces. Ion particles are released from the metal piercings and could have been adjuvant factors in the development of the observed lesions. Cells exfoliated from the oral mucosa surrounding metal piercings may serve as bioindicators of corrosion processes. We propose the use of exfoliative cytology to monitor corrosion processes and for routine clinical follow up.

Comparative Study of Histopathological Patterns and Mast Cells in Cutaneous Lichen Planus and Lichenoid Lesions

Background Besides lichen planus various other skin lesions like erythema multiforme, pityriasis lichenoides, etc., show lichenoid reaction pattern. This study was aimed to compare the histological features and number of mast cells in cutaneous lichen planus and lichenoid lesions. Studies have shown increase in mast cell numbers in mucosal lichen planus and lichenoid lesions. Methods Tissue sections of lichen planus and lichenoid lesions, (forty samples for each group) were studied. All the epidermal, dermal changes and mast cell numbers were noted. Results Epidermal and dermal changes like acanthosis, hypergranulosis, hyperkeratosis, location of inflammatory cells, severity of inflammation and basement membrane thickness were statistically significant between the two groups. Cases with severe inflammation showed thin and disrupted basement membrane, severe capillary proliferation and severe basal cell vacuolation. The number of mast cells was not significant on comparison between the two groups. Conclusion The epidermal and dermal changes were consistent with usual histopathological findings in these lesions. The mast cell number was not significant on comparison, which may be due to the common and overlapping mechanisms in the pathogenesis of inflammation in both the groups.

Oral Postinflammatory Pigmentation: Clinicopathologic Features of Nine Cases

Oral postinflammatory pigmentation (OPP) is a pigmentary change of the oral mucosa caused by high melanin production, often associated with chronic inflammatory disorders. Several conditions could lead to OPP, including oral lichen planus (OLP), oral lichenoid lesion (OLL), pemphigus, and pemphigoid. Here, we present 9 OPP cases. The main clinical characteristic in all the cases was oral black to brown pigmentation, localized or diffuse, microscopically exhibiting melanin deposition in the lamina propria. Five were men and 4 women (mean age 52 years). Five cases showed occurrence on the buccal mucosa and the other cases on the lower lip, hard palate, mouth floor, and labial commissure. Four cases were associated with leukoplakia, 2 with OLL, and 1 case each with OLP, actinic cheilitis, and fibrous hyperplasia. More studies involving large series of OPP cases should be conducted for a better understanding of their etiopathogenic mechanisms and clinicopathologic features.

Oral Lichenoid Lesions Associated with Amalgam: a Case Report

Oral Lichenoid Lesions Associated with Amalgam: a Case Report

Direct Immunofluorescence as a Helpful Tool for the Differential Diagnosis of Oral Lichen Planus and Oral Lichenoid Lesions.

A great number of lichenoid lesions have overlapping clinicopathological features, so the use of adjunct tests to establish definitive diagnosis is recommended for correct management and prognosis of the lesions. In this context, direct immunofluorescence (DIF) can be a useful tool. Thus, this study aimed to characterize the clinical, histopathological, and DIF pattern in patients with oral lichen planus (OLP) and patients with oral lichenoid lesions (OLLs). Patients with OLP and patients with OLL were characterized and compared with patients with mucous membrane pemphigoid, pemphigus vulgaris, and fibrous hyperplasia through a cross-sectional study. Patients with OLP (n = 30) and patients with OLL (n = 26) were mostly white women in the fifth decade of age, with reticular lesions mainly on the buccal mucosa. All patients with OLP and half of the patients with OLL showed liquefaction degeneration at the basal cell layer and a band-like lymphocytic infiltrate in the subepithelial tissue. Twenty-two patients with OLP (73.3%), 10 with OLL (38.4%), 25 with mucous membrane pemphigoid (96.1%), and all with pemphigus vulgaris (100%) had positive DIF. There was no positive DIF in patients with fibrous hyperplasia. The most frequent DIF pattern in patients with OLP and patients with OLL was linear fibrinogen at the basement membrane zone, and a logistic regression model for positive DIF found statistically significant difference in OLP versus OLL (odds ratio, 3.73; confidence interval, 1.23-11.38). Although clinical and histopathological features are sufficient for diagnosing most of the patients with OLP and OLL, DIF is a key tool in differentiating some lichenoid lesions and could improve the diagnosis of OLP and OLL, especially in lesions showing typical clinical and histological features of OLP.

The evaluation of the chemopreventive effect of β-carotene (A-Viton®) on oral premalignant lesions through the estimation of the expression of p53 levels

Background: Oral premalignant lesions (OPL) include a wide range of lesions including leukoplakia, dysplastic leukoplakia, erythroplakia, oral submucous fibrosis, dysplastic lichenoid lesions, and oral lichen planus. Proper diagnosis and management of oral premalignant lesions (OPL) are very important; as 17% of these lesions have been reported to be transformed into malignant lesions within first 7 years of their diagnosis. Vitamin A has always been known for its chemopreventive effect in several diseases through the modulation of cell proliferation and, it is also known for being a potent antioxidant and anti-inflammatory agent. Any alterations in p53 protein results in its accumulation in the cell nuclei; may play a critical role in carcinogenesis, including oral premalignant lesions and oral malignant lesions, i.e., p53 protein is one of the determinants in the progression of oral dysplasia to invasive malignancy.Methods: Fifteen patients having oral premalignant lesions of mild and moderate dysplasia; diagnosed both clinically and histologically, were given a chemopreventive therapy in the form of βeta- carotene (Vit. A) for four months. The levels of p53 protein immunostaining were measured pre- and post-treatment.Results: The mean value of optical staining density of P53 in pre-treatment specimen was (59.78 ± 10.22) compared to (39.74 ± 3.36) in post-treatment cases; this value was higher in pre-treatment cases than post-treatment cases. The p-value was 0.0003.Thus when statistically compared the difference is considered statistically significant.Conclusion: The expression of P53 protein in (OPL) is found to be inversely related to the clinical as well as histopathological response to beta-carotene supplementation.

Rate of malignant transformation of oral lichen planus: A systematic review.

The aim of this study was to systematically review the literature to determine: (a) the malignant transformation rate (TR) of oral lichen planus (OLP) and its risk factors; (b) whether or not oral lichenoid lesions (OLL) have a different malignant TR. PubMed, Scopus, and Web of Science were used as search engines: only observational, full-length, English language studies were investigated. PRISMA protocol was used to evaluate and present results. PROSPERO registration code is CRD42016048529. Among 7,429 records screened, only 21 were included in this review. Ninety-two of 6,559 patients developed oral squamous cell carcinoma, with an overall TR of 1.40% (1.37% for OLP and 2.43% for OLL), an annual TR of 0.20%. Female gender, red clinical forms, and tongue site seem to slightly increase the transformation risk. This 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 done to establish strict clinical and histological criteria to diagnose OLP and to perform sounder methodological observational studies.

Correlation Between Oral Lichen Planus and Thyroid Disease in China: A Case-Control Study.

A possible relationship between oral lichen planus (OLP) and thyroid disease has received attention in recent years. This study aimed to evaluate the correlation between OLP and thyroid diseases in Chinese ethnic patients. 192 OLP patients, 123 patients with oral lichenoid lesions (OLLs), and 162 controls were recruited in this case-control study. All participants received screening for thyroid function and underwent ultrasound. Sex and age of the patients in the three groups were matched. The prevalence of thyroid diseases in the subjects was analyzed. Using logistic regression, the odds ratio (OR) with 95% confidence intervals was appraised for associations between OLP, OLL, and different types of thyroid diseases [Hashimoto's thyroiditis (HT), hypothyroidism, and thyroid nodule]. The prevalence of thyroid diseases in the OLP group (72.4%) and OLL group (68.3%) was higher than the control group (49.4%) with statistical significance. The OR of HT was 3.16 (1.87-5.33) for OLP, 2.09 (1.18-3.70) for OLL, while the OR of thyroid nodule was 2.31 (1.30-4.09) for OLP. Our study suggested a close relationship between OLP/OLL and HT and thyroid nodule in a Chinese population. The possible mechanism behind this association warrants further investigation.

Extracorporeal Photopheresis: An Efficacious and Well-Tolerated Treatment for Cutaneous and Oral Mucosal Chronic Graft-versus-Host Disease

Background: Extracorporeal photopheresis (ECP) is a second-line therapy for steroid-refractory chronic graft-versus-host disease (cGVHD). Objective: We describe the long-term efficacy and tolerability of ECP according to the cutaneous phenotype of cGVHD and report on the reduced need for immunosuppressant drugs in this setting. Patients and Methods: Fourteen patients (8 females) with cutaneous and/or mucosal cGVHD, treated with ECP between October 2010 and May 2016 within a single center, were included. Final analyses included patients who had received ECP for at least 12 months. We prospectively evaluated the efficacy of ECP using lesion-specific clinical scores and by recording changed doses of systemic immunosuppressants. Results: Of the 14 patients, sclerotic skin lesions were present in 10 (71%). The mRODNAN score decreased in all patients from month 9 onwards, with 40 and 77% reductions at 12 and 36 months, respectively. Six patients (43%) presented with cutaneous lichenoid lesions: this score was reduced in all patients by month 3, reaching a 93% reduction by month 12. Five patients (36%) experienced oral mucosal lichenoid lesions: these scores were decreased by 55% at month 12 and by 100% by month 33. The use of systemic immunosuppressants was reduced in all patients; 4 patients could stop all immunosuppressant drugs after 2 years. ECP was stopped in 3 patients after a complete response. No major ECP-associated adverse effects were observed. Discussion and Conclusion: ECP was an effective long-term therapy for oral and cutaneous cGVHD: consequently, dose levels of therapeutic immunosuppression could be reduced.

Potentially malignant disorders revisited-The lichenoid lesion/proliferative verrucous leukoplakia conundrum.

Clinically identifiable potentially malignant disorders (PMD) precede oral squamous cell carcinoma development. Oral lichenoid lesions (OLL) and proliferative verrucous leukoplakia (PVL) are specific precursor lesions believed to exhibit both treatment resistance and a high risk of malignant transformation (MT). A retrospective review of 590 PMD patients treated in Northern England by CO2 laser surgery between 1996 and 2014 was carried out. Lesions exhibiting lichenoid or proliferative verrucous features were identified from the patient database and their clinicopathological features and outcome post-treatment determined at the study census date of 31 December 2014. One hundred and 98 patients were identified as follows: 118 OLL and 80 PVL, most frequently leukoplakia at ventrolateral tongue and floor of mouth sites, equally distributed between males and females. Most exhibited dysplasia on incision biopsy (72% OLL; 85% PVL) and were treated by laser excision rather than ablation (88.1% OLL; 86.25% PVL). OLL were more common in younger patients (OLL 57.1year; PVL 62.25years; P=.008) and more likely than PVL to present as erythroleukoplakia (OLL 15.3%; PVL 2.5%; P=.003). Whilst no significant difference was seen between OLL and PVL achieving disease-free status (69.5% and 65%, respectively; P=.55), this was less than the overall PMD cohort (74.2%). MT was identified in 2 OLL (1.7%) and 2 PVL (2.5%) during follow-up. One-third of PMD cases showed features of OLL or PVL, probably representing a disease presentation continuum. Post-treatment disease-free status was less common in OLL and PVL, although MT was infrequent.

Oral lichenoid lesions of the upper lip and gingiva: What we know so far.

The clinical presentation of oral lichen planus and oral lichenoid lesions is diverse. A special category of patients presents with lichenoid lesions affecting only the mucosa of their upper lip and the anterior upper gingiva. This is a concise review summarizing the specific characteristics of these patients.

Oral erythroplakia-What is it?

Oral erythroplakia is a rare type of lesion, and little is known about the origin of the lesion. It has traditionally been described as the red counterpart of oral leukoplakia, which implies that it is a red lesion that cannot be characterized clinically or pathologically as any other definable lesion. A definition by exclusion is less satisfactory than a positive description to define a lesion, and as erythroplakia probably is related to lichenoid lesions, a new approach to perceive the lesion is proposed based on the clinical features of a fiery red, sharply demarcated lesion situated at a slightly lower level than the surrounding mucosa. Such a definition would probably help clinicians distinguish erythroplakia from other red lesions of the oral mucosa. Although the course of such lesions varies, a significant proportion will develop malignancy, which is why they should be followed at short intervals.

Outcomes of oral lichen planus and oral lichenoid lesions treated with topical corticosteroid.

To determine corticosteroid treatment effectiveness in patients with oral lichen planus/oral lichenoid lesions (OLP/OLL). Twenty-one patients with OLP and eighty-one patients with OLL received 0.05% clobetasol propionate (CP) or 0.05% triamcinolone acetonide (TA) in aqueous solution (AS) or orabase (OB), evaluating responses to treatment and follow-up compliance. Lesions were atrophic (72 of 102; 70.6%), extensive (58 of 100; 58%), producing eating difficulties (62 of 102; 60.8%), and spontaneous pain (30 of 102; 29.4%); 50 patients (49%) received CP-AS. The mean±SD percentage of follow-ups attended was 43±32%. Symptom remission was achieved in 46% of patients receiving CP-AS, 36.36% of those receiving TA-AS, 20% of those receiving CP-OB, and 25% of those receiving TA-OB. Follow-up compliance was poor in 66.7% of patients. Among 51 patients with continuous symptoms, 64.7% evidenced total remission at treatment completion; among 33 with intermittent symptoms, 73.1% had outbreaks 2-3times/year and 51.5% controlled outbreaks with <6 corticosteroid applications. Adverse effects were observed in seven patients (6.8%) (moon face, hirsutism, capillary fragility) in induction stage, subsiding with dose; among 15 patients under maintenance treatment for >6months, one showed hypothalamic-pituitary-adrenal (HPA) axis inhibition but not adrenal insufficiency. Our treatment proved highly effective and safe. Recall programs are desirable to enhance follow-up compliance.

Current Perspectives on Erythema Multiforme.

Recognition and timely adequate treatment of erythema multiforme remain a major challenge. In this review, current diagnostic guidelines, potential pitfalls, and modern/novel treatment options are summarized with the aim to help clinicians with diagnostic and therapeutic decision-making. The diagnosis of erythema multiforme, that has an acute, self-limiting course, is based on its typical clinical picture of targetoid erythematous lesions with predominant acral localization as well as histological findings. Clinically, erythema multiforme can be differentiated into isolated cutaneous and combined mucocutaneous forms. Atypical erythema multiforme manifestations include lichenoid or granulomatous lesions as well as lesional infiltrates of T cell lymphoma and histiocytes. Herpes simplex virus infection being the most common cause, other infectious agents like-especially in children-Mycoplasma pneumoniae, hepatitis C virus, Coxsackie virus, and Epstein Barr virus may also trigger erythema multiforme. The second most frequently identified cause of erythema multiforme is drugs. In different studies, e.g., allopurinol, phenobarbital, phenytoin, valproic acid, antibacterial sulfonamides, penicillins, erythromycin, nitrofurantoin, tetracyclines, chlormezanone, acetylsalicylic acid, statins, as well as different TNF-α inhibitors such as adalimumab, infliximab, and etanercept were reported as possible implicated drugs. Recently, cases of erythema multiforme associated with vaccination, immunotherapy for melanoma, and even with topical drugs like imiquimod have been described. In patients with recurrent herpes simplex virus-associated erythema multiforme, the topical prophylactic treatment with acyclovir does not seem to prevent further episodes of erythema multiforme. In case of resistance to one virostatic drug, the switch to an alternative drug, and in patients non-responsive to virostatic agents, the use of dapsone as well as new treatment options, e.g., JAK-inhibitors or apremilast, might be considered.

Pediatric Cutaneous Graft Versus Host Disease: A Review.

Graft versus host disease (GVHD) is a significant complication following hematopoietic stem cell transplantation in the pediatric population. The most common clinical manifestation of GVHD is in the skin. This article will present a review of key concepts related to pediatric cutaneous GVHD, including pathophysiology, clinical epidemiology, diagnosis, and treatment options. GVHD is an immune-mediated process characterized by an inflammatory immune response in acute GVHD and mixed inflammatory and fibrotic states in chronic GVHD. The clinical presentations of cutaneous GVHD are heterogeneous. Acute cutaneous GVHD classically presents as an erythematous morbilliform eruption appearing within a few weeks after transplantation. Chronic cutaneous GVHD may manifest as poikiloderma, lichenoid lesions, or sclerodermatous changes. The sclerodermatous form of cutaneous GVHD is associated with substantial long-term morbidity, including joint contractures, myalgias, and mobility restriction. First-line pharmacologic treatment options typically include corticosteroids and in some cases, calcineurin inhibitors. Biologics and immunotherapies are an active area of investigation for GVHD that is refractory to corticosteroid treatment. Non-pharmacologic treatment options that have shown benefit for cutaneous GVHD include extracorporeal photopheresis and phototherapy. Accurate diagnosis and treatment of cutaneous GVHD is essential to preventing and alleviating the long-term sequelae and morbidity associated with this condition.

Lichenoid lesions of the upper lip: A retrospective study of 24 cases.

BackgroundLichenoid lesions of the upper labial mucosa, without other oral or extraoral manifestations seem to be rare. The clinicopathologic features of 24 such cases are presented and the pertinent literature is reviewed.Material and Methods24 Caucasian patients that clinically presented lichenoid features on the upper labial mucosa, with or without lichenoid lesions on the adjacent gingiva, were included in the study. Clinical features were extracted from the patients’ records, while dental plaque/calculus accumulation and composite resin restorations of the adjacent teeth were recorded. Four cases where an incisional biopsy was performed were further evaluated.ResultsThere were 8 males and 16 females, with a mean age of 62.7 years. 64.2% were under hypertensive therapy. In 13 cases gingival involvement was noticed, 16 cases exhibited calculus deposition, while 6 cases presented with composite resin fillings of the adjacent teeth. In 4 cases an incisional biopsy was performed showing features of lichenoid reaction. In 37.5% significant improvement was observed after topical treatment with corticosteroids and antimicrobial agents.ConclusionsLichenoid lesions of the upper lip may represent a distinct variety of oral lichenoid lesions, but as the number of cases reported so far is too small for definite conclusions on pathogenesis and management to be made, a long-term follow-up is mandatory. Key words:Lichenoid lesions, upper lip, oral lichen planus, lichenoid reactions.

Betel-nut-induced oral lichenoid lesion in oral submucous fibrosis and its relation with liver enzymes and hepatitis C virus-ribonucleic acid

Introduction: Reticular, annular, and pigmented lichenoid lesionsare associated with oral submucous fibrosis (OSMF). Both, betel-nut alkaloid and aflatoxin are responsible for hepatic damage. Occurrence of hepatic disorder with hepatitis C infection is associated with lichen planus. Considering the co-relation of oral lichen planus (OLP) with hepatitis C infection and similar lichen-planus-like lesion in OSMF probe to investigate the co-relation of liver enzymes and hepatitis C virus and OSMF associated with oral lichen-planus-like lesion. Methods: A cross-sectional case–control study was conducted on total 60 patients. Out of 60 patients, 20 were with lichen-planus-like lesions with OSMF, 20 with OSMF, and 20 healthy individuals. The sera of the patients and controls were tested for HCV (RNA) using Mini Vidas and liver function tests (bilirubin, transaminases, and alkaline phosphatase). Results: Among the total 60 patients, OLP-like lesions with OSMF patients had higher serum bilirubin, transaminases, and alkaline phosphatase level as compared with control patients. Conclusions: Increased titer of HCV-RNA with increased liver enzymes was found in OSMF with betel-nut-induced lichenoid lesions. This demonstrates the dual action of betel-nut alkaloids with plausible role of aflatoxin in liver damage in OSMF.

Two Cases of Delayed Diagnosis of Leprosy in Mauritania

Leprosy is a chronic infectious disease that mainly affects the skin, mucous membranes, and peripheral nervous system. The clinical manifestations of leprosy are numerous and polymorphic with the most frequent signs involving skin and neurological damage. Some of its manifestations, such as joint pain, are unusual. Its elimination as a public health problem in many countries seems to lead to a lack of practical knowledge among health care personnel and as a consequence a risk of late diagnosis. As in other countries, leprosy has become rare in Mauritania. We report two cases of misdiagnosed leprosy in two male patients aged 17 and 65 years. Clinical manifestations included polyarthritis, bilateral plantar perforation, and severely deformed hands and feet in the first case and lichenoid lesions, hypopigmented papules, and unilateral bronchial rales in the second case. The duration of development and persistence of clinical signs before establishment of correct diagnosis was seven to ten years despite the presence of anesthetic, hypochromic maculopapular skin lesions and neurologic signs suggestive of leprosy in both cases. A multilevel chemotherapeutic regimen recommended by the World Health Organization (WHO) was effective, and the patients' condition evolved satisfactorily. The scarcity of leprosy in our health care facilities often leads to a wrong diagnosis. It is imperative to inform physicians to increase their vigilance for appropriate screening and reporting of these cases. The prognosis depends largely on early diagnosis and appropriate treatment.

Paraneoplastic pemphigus without antibodies to desmoglein 1 and

Paraneoplastic pemphigus is a severe autoimmune blistering disease presenting in the setting of underlying malignancy. Paraneoplastic pemphigus is associated with diffuse painful stomatitis throughout the oral cavity with extension to the lips. The cutaneous findings are varied and have been described as lichenoid, pemphigoid, and targetoid lesions. Herein, we report a patient with paraneoplastic pemphigus whose routine testing led to a diagnosis of pemphigus vulgaris. However, further testing was pursued revealing an antibody profile consistent with paraneoplastic pemphigus. Subsequent neoplastic workup revealed an intra-abdominal mass. Our case represents a subtle, non-classic presentation of paraneoplastic pemphigus and suggests the importance of a comprehensive investigative work-up in atypical cases of pemphigus.

Betel quid lichenoid lesion: A case series and review of literature

Betel quid lichenoid lesion: A case series and review of literature