Lichenoid Reaction Research Articles

Dyskeratosis Congenita: Squamous Cell Carcinoma of the Buccal Mucosa on a Background of Lichen Planus – A Case Report During COVID-19 Pandemic

Dyskeratosis Congenita is a severe disorder that involves several systems in the human body and is well-known for its transmission hereditarily through generations. The triad of a) reticular atrophy of the skin with pigmentation b) dystrophy of the nails c) leukoplakia of the oral mucosa characterises this uncommon disorder, which most commonly affects men. One of the key reasons for premature death in this disease is malignant transformation within areas of mucosal hyperkeratosis. In Dyskeratosis Congenita, the simultaneous existence of squamous cell carcinoma (SCC) with lichen planus and or lichenoid reactions in the mucosa of the oral cavity is a rare, stated condition. This report discusses a case of a Libyan male patient affected by Dyskeratosis Congenita that ended with buccal mucosal squamous cell carcinoma developed on a lichen planus background after thirty years of suffering at the age of 64.

Intralesional and peripheral plasma of oral lichenoid reactions exhibit different cytokine profiles: A preliminary study

Background/purposeOral lichenoid reactions (OLRs) are commonly characterized by the infiltration and activation of inflammatory cells at the interface of the oral mucosa. This study aimed to compare the cytokine profiles between intralesional and peripheral plasma from patients with OLRs and elucidate the cytokine profile in the OLR microenvironment. Materials and methodsA total of 26 paired intralesional and peripheral plasma samples were collected from patients with OLRs. A panel of 15 cytokines was measured using a Luminex assay. The reticular, erythema, and ulcerative score was used to evaluate the degree of OLR severity. ResultsIL-10 was detected in a fewer number of intralesional samples (19/26) compared to peripheral samples (26/26, p = 0.01). The intralesional plasma exhibited significantly elevated levels of granzyme B (median 108.94 vs. 16.00), TGF-β1 (mean 30448.92 vs. 10199.04), TGF-β2 (mean 1659.73 vs. 1308.49), and TGF-β3 (mean 914.33 vs. 573.13) compared to the peripheral plasma (p = 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). The levels of intralesional IL-2 (median 2.84 vs. 3.45, p = 0.019) and TNF-α (median 7.66 vs. 10.34, p = 0.048) were significantly lower in the intralesional plasma compared to the peripheral plasma. ConclusionThe intralesional concentrations of granzyme B and TGF-β were elevated, whereas IL-2 and TNF-α were decreased in the OLR microenvironment compared to the peripheral plasma. These findings may contribute to establishing a panel of biomarkers that can be used to monitor the disease activity of OLRs in a large cohort study in future.

Observer agreement in the diagnosis of oral lichen planus using the proposed criteria of the American Academy of Oral and Maxillofacial Pathology.

Oral lichen planus (OLP) is a common chronic inflammatory condition with an undefined malignant transformation potential. There have been many attempts at providing a specific definition of OLP without conclusive outcomes. A new set of diagnostic criteria was proposed in 2016 by the American Academy of Oral and Maxillofacial Pathology (AAOMP) in an endeavour to resolve this issue, and this has not yet been evaluated. This study aimed to assess the utility of AAOMP proposed criteria for the diagnosis of OLP. Five pathologists blindly assessed a cohort of 215 digital whole slide images (WSI) obtained from haematoxylin and eosin-stained microscopic slides. Forty-six WSI were included twice to assess the intra-observer agreement. Included cases were diagnosed clinically as either OLP or oral lichenoid reaction. Each pathologist was asked to utilize the AAOMP histopathological criteria while assessing slides. The variations in diagnoses were assessed by unweighted kappa statistics. The level of intra-observer agreement was very good (0.801 to 0.899). The level of inter-observer agreement among the observers varied from good (0.658) to very good (0.842) when the responses were categorized as evident/compatible OLP versus no OLP and was good (0.62 to 0.725) when the responses were categorized as evident OLP, versus compatible OLP, versus no OLP. The clinico-pathological correlation was 87.6%. A reliable level of agreement can be achieved by pathologists for the diagnosis of OLP using the AAOMP criteria for differentiation between lichenoid and other conditions. There are still limitations in discriminating OLP from oral lichenoid lesions microscopically.

Oral liken planus ve oral likenoid reaksiyonlar: Dental seri yama testi sonuçlarının retrospektif olarak değerlendirilmesi

Objective Oral lichen planus (OLP) and oral lichenoid reactions (OLR) may occur secondary to dental procedures. Patch testing with the dental series is a simple diagnostic method that can guide the identification of the relevant allergen. In this study, it was aimed to evaluate the patch test results with dental series in OLP and OLR patients. Methods A retrospective review of the medical records of patients who were clinically and/or histopathologically diagnosed with OLP or OLR and, who underwent dental series patch testing at our dermatology clinic in between January 2015 and January 2021 was performed. Results In total, 36 patients with a diagnosis of OLP (n=14, 38.9%) or OLR (n=22, 61.1% ) were included, 15 of whom (41.7%) had positive patch test results. The mean age at presentation was 54.6 years (range 28-72 years). The duration of the disease was 21.9 (range 1-144 months) months on average. Positive findings on patch tests were approximately three times higher in OLR patients than in OLP patients. Gold(I) sodium thiosulfate dihydrate was the most frequent positive reaction (n=6) detected against. Habits (smoking, alcohol) and comorbidities were not significantly associated with the patch test results. Conclusion Detection of allergens with patch test is a helpful diagnostic method for effective control of the disease in both OLP and OLL patients. We think that the detection of contact allergies with patch testing may guide decisions regarding related changes such as dental restorations.

Oral Manifestations in Melanoma Patients Treated with Target or Immunomodulatory Therapies.

Background: BRAF (v-raf murine sarcoma viral oncogene homolog B1) and MEK (mitogen activated protein kinase) inhibitors, as well as immunotherapy against cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and the programmed cell death 1 (PD-1) receptor and its ligand (PD-L1), have shown good results in improving the disease-free survival of patients with metastatic melanoma (MM). The aim of this review is to summarize the main oral adverse events (oAEs) occurring in patients undergoing target or immunotherapy. We proposed two separate sections: oAEs during the treatment with (1) target therapies with BRAF and MEK inhibitors and tyrosine kinase inhibitors (gingival hyperplasia, pigmentation disorders, squamo-proliferative lesions) and (2) immunotherapies with CTLA-4 or PD1 inhibitors (lichenoid reactions, immuno-bullous reactions, xerostomia and other reactions). Adverse events frequently include oAEs, although these are often misdiagnosed and under-reported. Indeed, the oral cavity is not routinely evaluated during clinical practice. The symptomatology related to oAEs is significant since it may represent the first manifestation of a severe systemic reaction, possibly leading to difficulties in nutrition with a consequent impact on patients’ quality of life. A careful examination of the oral cavity is recommended during the evaluation of oncologic patients in order to promptly detect the onset of new manifestations.

Oral cancer development in lichen planus and related conditions-3.0 evidence level: A systematic review of systematic reviews.

A systematic review of systematic reviews-aka overview of reviews, a novel type of study design providing a tertiary level of evidence-is presented on systematic reviews (SR) and meta-analyses (MTA) evaluating the cancer development in oral lichen planus (OLP), oral lichenoid lesions (OLL), and oral lichenoid reactions (OLR). We searched for SR-MTA published before January 2021. We evaluated the methodological quality of SR-MTA using AMSTAR2 and checked the quality of evidence. Inclusion criteria were met by seven SR-MTA. Oral cancer ratios ranged between 0.44% and 2.28% for OLP, between 1.88% and 3.80% for OLL, and 1.71% for OLR. Significant factors on cancer development reported in SR-MTA were the presence of epithelial dysplasia, the consumption of tobacco and alcohol, the infection by the hepatitis C virus, the presence of atrophic and erosive lesions, and the location on the tongue. Only, one of the SRs assessed the quality of evidence, and most of them were judged to be of critically low methodological quality. In conclusion, based on the reported evidence on cancer incidence in OLP, our results reaffirm classifying OLP as an oral potentially malignant disorder. In relation to OLLs and OLRs, larger studies are necessary to provide further scientific evidence in this regard. Future follow-up studies on OLP and related lesions should be carried out under stricter criteria that improve their quality of evidence and methodological quality.

Cutaneous Manifestations in Biological-Treated Inflammatory Bowel Disease Patients: A Narrative Review.

The biologic era has greatly improved the treatment of Crohn’s disease and ulcerative colitis. Biologics can however induce a wide variety of skin eruptions, especially those targeting the TNF-α and Th17 pathway. These include infusion reactions, eczema, psoriasis, lupus, alopecia areata, vitiligo, lichenoid reactions, granulomatous disorders, vasculitis, skin cancer, and cutaneous infections. It is important to recognize these conditions as treatment-induced adverse reactions and adapt the treatment strategy accordingly. Some conditions can be treated topically while others require cessation or switch of the biological therapy. TNF-α antagonists have the highest rate adverse skin eruptions followed by ustekinumab and anti-integrin receptor blockers. In this review, we provide an overview of the most common skin eruptions which can be encountered in clinical practice when treating IBD (Inflammatory bowel disease) patients and propose a therapeutic approach for each condition.

A Quantitative Evaluation of Epithelium and Inflammatory Infiltrate of Lichen Planus and Lichenoid Reactions

A Quantitative Evaluation of Epithelium and Inflammatory Infiltrate of Lichen Planus and Lichenoid Reactions

The Clinical and Histopathological Features of Cutaneous Immune-Related Adverse Events and Their Outcomes.

Immune checkpoint inhibitors (ICIs) cause a variety of inflammatory eruptions. The understanding of ICI-induced inflammatory eruptions with detailed histopathological findings is not adequate, particularly in Asian populations. In this study, we retrospectively reviewed 51 patients who were histopathologically diagnosed with cutaneous immune-related adverse events (irAEs) following ICI therapy between 2014 and 2020 at the Department of Dermatology of Kyushu University Hospital. Of the 51 patients (30 men, 21 women), maculopapular rash (38/51, 74.5%), erythema multiforme (2/51, 3.9%), lichenoid reaction (3/51, 5.9%), psoriasiform reaction (3/51, 5.9%), bullous pemphigoid (3/51, 5.9%), scleroderma-like reaction (1/51, 2.0%), and Stevens–Johnson syndrome (1/51, 2.0%) were observed. The clinical and histopathological findings of these eruptions were equivalent to typical cases of common drug eruptions. The onset of maculopapular rash was relatively early (more than half of events occurred within 1 month), whereas lichenoid reactions and autoimmune diseases occurred relatively late (4–8 months). With appropriate treatment and/or interruption of ICIs, most rashes improved (50/51, 98.0%). The ICI-induced inflammatory eruptions shared similar clinical and histopathological features with classical inflammatory eruptions, but a variety of inflammatory eruptions may occur with different degrees of severity. Dermatologists play an important role in providing specialized care for cutaneous irAEs.

Stratification of methotrexate-induced oral ulcers in rheumatoid arthritis patients.

There is a deficiency in the data concerning the clinical forms of methotrexate-induced oral ulcers. This study was conducted to stratify clinical forms of methotrexate-induced oral ulcers in rheumatoid arthritis patients. This study included rheumatoid arthritis patients receiving methotrexate as monotherapy. All eligible patients were subjected to thorough clinical examination and full history to identify oral events. Drug history, dose, and duration of MTX were recorded. Among 794 rheumatoid arthritis patients, mean methotrexate dose and duration were 14.3 mg/week and 5.2 years, respectively. Oral ulcers were detected in 6.2% of the patients and 30% of the patients reported previous oral ulcers. Among the detected oral ulcers, 44.9% manifested as deep irregular ulcers, 30.6% presented as aphthous-like ulcers, 14.3% were diffuse mucositis, and 10.2% appeared as lichenoid reaction. Methotrexate-induced oral ulceration could be localized or generalized. Localized forms were more noticed than generalized forms. Higher doses and longer durations of methotrexate were detected among patients with generalized oral ulcers.

Oral-Genital Lichenoid Reaction: A Rare Hypersensitives to Drug

Oral-Genital Lichenoid Reaction: A Rare Hypersensitives to Drug

Treatment of Discoid Lupus Erythematosus in a Dog with Human Intravenous Immunoglobulin

Background: Discoid lupus erythematosus (DLE) is a common canine autoimmune skin disease, in which systemic manifestations are absent. Skin Lesions are usually present on the nasal planum, and characterised by erythema, depigmentation, erosion, ulceration, and crusting. The diagnosis is based on histopathological results, which should demonstrate lymphoplasmacytic lichenoid-interface dermatitis. Human intravenous immunoglobulin (hIVIg) has been used in veterinary medicine to treat cutaneous diseases including erythema multiforme, PF, and severe adverse cutaneous drug reactions. In human medicine, it has been effective to treat DLE. This report firstly describes the clinical response to hIVIg in a dog with DLE resistant to common immunosuppressive drugs.Case: A 5-year-old, intact female Shih Tzu presented with a 1-month history of slowly progressive black crusting on the nasal planum, chin, and claw. Based on the results of a dermatologic examination, superficial pyoderma was diagnosed. The skin lesions did not improve during and after anti-infective treatment. After removing the crusts, a skin biopsy was obtained from the muzzle. Histopathology of lesional skin biopsy specimens revealed lymphoplasmacytic interface dermatitis at the dermoepidermal junction. Microscopic examination also revealed vacuolar changes and pigmentary incontinence of the basal layer as a lichenoid tissue reaction. No mites or fungi were detected on the skin section. The absence of acantholytic cells excluded pemphigus foliaceus, which is also characterised by the lesions of the nasal planum. Based on the distribution of the lesions, histopathology and exclusion of other dermatoses, the dog was diagnosed with DLE. The skin lesions temporarily improved after treatment with prednisolone (2 mg/kg PO q12h). However, after tapering the dose of prednisolone, new black crusts developed on the nasal planum and claw. Although the dog was successively treated with other immunosuppressive drugs, including azathioprine, cyclosporin with dexamethasone, and mycophenolate mofetil, black crusts still remained. Due to the low efficacy of these immunosuppressive drugs, hIVIg was administered at 0.5 g/kg once daily for 4 days, for a total dose of 2 g/kg. During hIVIg administration, the crusted lesions gradually improved. After the hIVIg administration, the dog was treated with prednisolone (1 mg/kg PO q12h). The lesions were almost in complete remission at 21 days after an additional application of prednisolone. The skin lesions did not recur, and the treatment was eventually discontinued after 6 weeks of additional prednisolone application.Discussion: The standard treatment of canine DLE includes glucocorticoids, and second-line immunosuppressive drugs, such as azathioprine and cyclosporine, are usually added in cases resistant to steroids. This case suggests that hIVIg may be beneficial as an adjunctive treatment option for canine DLE, especially when the application of standard immunosuppressive drugs is limited due to adverse effects or low efficacy. There is evidence from several studies that the steroid-sparing effect of hIVIg is significant in human patients. In the current case, the effective dose of prednisolone was reduced to 2 mg/kg/day after hIVIg administration, and prednisolone therapy was finally discontinued completely. The hIVIg appears to lower the daily steroid dose requirement in this dog. Keywords: autoimmune skin disease, discoid lupus erythematosus, canine dermatology, immunosuppressive drug, human intravenous immunoglobulin.

Hypertrophic Lichen Planus–like Eruption Following Pembrolizumab

With an increased use of immunotherapy medications such as pembrolizumab for various cancers, it is important that dermatologists are aware of the wide range of adverse cutaneous reactions that can occur, including lichenoid reactions. Hypertrophic lichen planus should be considered in the differential diagnosis of patients with cutaneous lesions in addition to nail findings developing after starting programmed cell death protein 1 inhibitor therapy.

Oral lichenoid reaction to dental amalgam and its association with desquamative gingivitis “a diagnostic conundrum”: A case report

Oral lichenoid lesions (OLLs) are chronic inflammatory lesions of the oral cavity, and they can hardly be distinguished from oral lichen planus (OLP). Various terms have been used in the literature, including lichenoid contact lesions, lichenoid contact stomatitis, and oral lichenoid reactions. The concept of contact allergy to dental restorative materials in OLLs has been widely recognized but somewhat controversial. The most common causative allergen is mercury in dental amalgam, with a few reported cases from other materials. These lesions are most often seen in direct topographic relation to the causative agent. The possible correlation between the presence of desquamative gingivitis (DG) associated with autoimmune diseases and the worsening of periodontal parameters has been discussed in the literature, since both conditions can share immuno-inflammatory mechanisms in their pathogenesis. The DG may indirectly worsen the accumulation of plaque in the affected sites, since pain and bleeding may inhibit the patient’s oral hygiene. The aim of this report is to present a clinical case of OLLs associated with amalgam restoration and its association with DG for a three-month follow-up period.

ASSESSMENT OF ALLERGIES TO FOOD AND ADDITIVES IN PATIENTS WITH ANGIOEDEMA, BURNING MOUTH SYNDROME, CHEILITIS, GINGIVOSTOMATITIS, ORAL LICHENOID REACTIONS, AND PERIORAL DERMATITIS.

SUMMARYOral cavity and perioral area are constantly exposed to a variety of antigens, including food and additives, which have a potential role in the development of different oral mucosal and perioral cutaneous diseases since they can cause hypersensitivity reactions. Oral and perioral diseases mainly include angioedema, burning mouth syndrome, cheilitis, gingivostomatitis, oral lichenoid reactions, and perioral dermatitis. Previous studies were focused on delayed-type oral allergies by performing patch testing but did not include tests for immediate-type allergic reactions. Therefore, the objective of this study was to determine common nutritive and additive allergens in the prevalent oral and perioral diseases by using skin prick tests. Our study evaluated 230 participants, i.e. 180 patients with oral/perioral diseases (angioedema, burning mouth syndrome, cheilitis, gingivostomatitis, oral lichenoid reactions, and perioral dermatitis), and 50 healthy control subjects. The results of skin prick tests showed that immediate-type allergic reactions to food and additives were mostly seen in patients with burning mouth syndrome (40%) and cheilitis (33.3%), whereas allergies were least frequently observed in perioral dermatitis (10%) and gingivostomatitis (20%). Fruits, mushrooms, and vegetables were the most frequent causes of nutritive allergies in oral and perioral diseases. The most commonly identified additive allergens were glutaraldehyde, citric acid, and sodium glutamate. Study results suggest the possible association with nutritive and additive allergies be considered in cases of persistent oral mucosal or perioral skin disease accompanied by respective medical history.

Oral Manifestations in Hemodialysis Patients and Their Knowledge and Attitude Towards Oral Health

Oral cavity is the mirror of systemic health. Amongst various systemic diseases, Chronic Kidney Disease (CKD) is one such disease that presents with a spectrum of oral manifestations. The oral health care professionals need to attain a holistic approach to the management of patients with complex medical problems and should be in par with the changing technology and medical advances. Amongst all the systemic disorders, diseases of the renal system pose a major cause of morbidity and mortality worldwide, as the kidneys are vital organs for maintaining a stable internal environment. The plethora of oral manifestations observed in chronic renal failure and associated therapies are altered taste, gingival enlargement, xerostomia, various mucosal lesions like hairy leukoplakia, lichenoid reactions, ulcerations, angular chelitis, candidiasis etc. With growing awareness about the inter-relationship between dental and medical problems, the role of dentist has become pivotal in overall health care of patients with CKD and also to render services for the oral findings of such diseases. This information can be used for designing effective intervention strategies to prevent and manage oral manifestations in adult hemodialysis patients of Nepal. The objective of this cross sectional study was to see the oral manifestations in hemodialysis patients and their Knowledge and attitude towards Oral Health. Face to face interviews was done with the patients to gather knowledge regarding socio-demographic variables and tobacco history. Following statistical analysis, it was seen that multiple oral manifestations were seen in patients undergoing hemodialysis.

Effects of chemotherapy on oral mucosa

Cancer leads to several oral and dental complications arise during the course of a malignant condition, oral or non-oral. These are largely due to the direct effect of cancer but may also result from the complication of treatment modality undertaken to cure the malignancy. This article elaborates on complications of the chemotherapeutic agents, which when employed to combat cancerous cells, may target the host cells. The oral complications of such a therapy results in several conditions like oral mucositis, infections, hemorrhage, salivary alterations, dysgeusia, lichenoid reactions amongst others. Thus, an in-depth understanding of these complications is a must in order to provide better care for an already frail and ailing patient.

Lichenoid Skin Reaction in a Patient on Anti-Tubercular Drugs: a Rare Case Report Ruchi

First line anti-tubercular drugs are known to cause various adverse drug reactions including cutaneous reactions. We report a rare case of anti-tubercular treatment (ATT) induced lichenoid skin reaction in a 58 years old female with no prior history of rashes. She was put on fi xed dose combination (FDC) tablets of fi rst line anti-tuberculosis drugs and developed reaction one month after initiation of therapy.

Clinical and morphological characteristics of lichen planus and lichenoid drug eruption of the skin

Background: Lichen ruber planus (LP) and lichenoid skin reaction (LSR) are clinically and histologically similar. The performance of histological diagnosis in these diseases remains controversial.&#x0D; Materials and methods: We prospectively studied 33 patients with clinical manifestations and histological signs of the classic form of LP and LSR to assess the accuracy of an isolated histological LP and LSR examinations and to identify a variety of microscopic features. Each histological study was conducted by a pathomorphologist, who was blinded to the patients clinical characteristics and diagnosis.&#x0D; Results: Isolated histopathological examination made it possible to make a correct diagnosis in 25 (75%) of 33 patients: in particular, the diagnosis of LRC was established in 10 (30%), CPL-in 15 (45%) cases. Based on a combined assessment of histological and clinical data and response to therapy, the final diagnosis was established in 30 (91%) of the 33 patients who were divided into two groups. The first group comprised 18 patients diagnosed with LSR, and the second group comprised 12 patients diagnosed with the classic form of LP.&#x0D; Conclusions: Through this investigation, some differences in these diseases based on their clinical and pathomorphological features were identified. The diseases were characterized by different typical localizations and lesion sizes. The pathomorphology of both diseases is represented by lichenoid type of interface dermatitis.

Adverse Oral Reactions Associated with Low Doses of Methotrexate

Doctors of various medical specialties often encounter adverse drug reactions in their clinical practice. Methotrexate (MTX) can cause adverse reactions in the oral cavity, primarily erosions and ulcerations. The aim of the study was to analyse scientific literature on the prevalence, pathophysiological mechanisms, risk factors for oral lesions associated with low doses of MTX, their prevention and treatment. It was demonstrated that the most frequent oral adverse reactions associated with low doses of MTX are hard-to-heal painful necrotic and often irregularly shaped lesions of the oral mucosa (including aphthae and ulcers). The spectrum of histopathological changes ranges from nonspecific ulcerations to lichenoid reactions. Treatment of oral lesions induced by low doses of MTX consists in drug withdrawal or dose tapering. Folic acid and local symptomatic therapy can also be used, if necessary. Practitioners should be aware of the potential development of MTX-induced oral lesions, and specific aspects of the drug pharmacokinetics and pharmacodynamics in order to be able to ensure timely detection of adverse reactions and their effective treatment.