We assessed the prevalence of oral lichen sclerosus in a cohort of women affected with vulvar lichen sclerosus (VLS). This prospective, observational study included adult female patients with a histologically proven VLS who attended the Vulva Clinics of three Dermatology Units from January 2020 to July 2023. During this period, all VLS patients were asked to be examined in their oral cavities in order to detect any possible sign of oral diseases, which were then biopsied. Three hundred women (mean age 64.5 ±13.0years) were included, of whom 21 (7%) had a concurrent extragenital LS. In six (2%) patients, white, non-removable lesions were found at oral inspection and biopsied. All cases were histologically lichen planus. No other clinically relevant oral lesions were found. The six women with histologically proven oral lichen planus had more frequent periodontal and autoimmune diseases than the other included subjects. Our findings confirm the absolute rarity of oral involvement in patients with VLS. They suggest that the oral mucosa, unlike the genitals, is a setting which weakly leads to development of LS, also in predisposed subjects.

erosions, discomfort, pain, and impaired oral function. Understanding the precise underlying mechanisms of these conditions is essential for accurate diagnosis and treatment.The field of research surrounding inflammatory disorders of the oral mucosa is rapidly expanding due to advances in immunology, molecular biology, and diagnostic technologies. Researchers are increasingly focusing on understanding the complex interactions between the immune system, microbiome, and environmental factors that contribute to the pathogenesis of oral inflammation. Key areas of interest include the role of dysbiosis (microbial imbalance) in triggering inflammation, the impact of genetic predispositions on disease susceptibility, and the identification of specific biomarkers that could aid in early diagnosis and targeted therapies.Novel therapeutic approaches are also being explored, such as biologics that modulate immune responses and regenerative techniques to repair damaged mucosal tissues (2). Additionally, the growing understanding of links between oral inflammation and systemic conditions like cardiovascular disease, diabetes, and autoimmune disorders is broadening the scope of research (3,4). This interdisciplinary approach is paving the way for more personalized and effective treatments, enhancing both oral and overall health outcomes (5).A central position in the scenario of inflammatory oral disorders is certainly occupied by autoimmune blistering diseases. In fact, oral involvement is particularly common in this subset of dermatological morbid conditions. Mucous membrane pemphigoid (MMP) represents one of the most severe progressive forms potentially affecting the oral mucosa (6). Early diagnosis and prompt treatment are crucial to prevent possible complications, including scarring and functional impairment. The oral cavity is frequently involved in patients with MMP (approximately 90% of cases), either in combination or not with other mucous membranes. Ocular involvement is rarer but potentially leading to visual loss in up to 75% of cases. The gold standard for diagnosis is direct immunofluorescence (DIF). Recent data indicate that oral DIF is positive in 100% of patients with oral involvement, but also in the vast majority of cases with ocular involvement, both isolated and associated with oral MMP. These results highlight that oral biopsy is usually sufficient for the diagnosis, even in patients with exclusively ocular MMP.Despite not as common as in pemphigus vulgaris, oral blisters are also a possible feature of bullous pemphigoid (BP). However, HSV infection is common in BP oral lesions and, therefore, the differential diagnosis of oral blisters in patients affected by BP is particularly challenging. The absence of skin lesions, presence of pain, the concomitant use of high-dose glucocorticoid should alert physicians to HSV infection in oral lesions and treat them with systemic antiviral treatment timely. However, oral lesions in course of BP may also be part of associated syndromic clinical pictures, as described in a recent report of a case of secondary Sjogren syndrome in a patient affected by BP treated with dupilumab (7).OLP often presents as white, lacy patches, painful sores, or red, swollen areas. The exact cause of OLP is not fully understood, but it is thought to involve an immune-mediated response to mucosal tissues. OLP can cause discomfort, burning sensations, and difficulty in eating or speaking, significantly affecting a patient's quality of life. Despite low, a risk of malignant transformation has been described for OLP. Topical and/or intralesional corticosteroids are currently considered the firstline treatment of OLP. However, alternative strategies have been introduced for the management of OLP in the last decades, including immunosuppressants, systemic corticosteroids, biologics and lowlevel laser therapy. An updated systematic review and meta-analysis of 17 randomized clinical trials has recently been conducted with the aim of assessing whether clobetasol propionate could be considered the gold standard for patients affected by OLP; the results of the study supported the longterm application of CLO as an effective regimen in OLP patients (8).Lichen sclerosus (LS) is a chronic inflammatory condition predominantly affecting the anogenital region, with extragenital manifestations being relatively rare (9). Despite uncommon, oral lichen sclerosus (OLS) is a possible presentation, often under-recognized due to its asymptomatic nature and rarity in clinical practice (10). Clinically, OLS often presents as asymptomatic whitish macules or plaques predominantly affecting the labial, gingival and palatal mucosa. Histopathological examination typically reveals subepithelial hyalinization, loss of elastic fibers, and a band-like inflammatory infiltrate. Treatment with topical corticosteroids and/or intralesional triamcinolone acetonide injections was effective in managing the lesions. Given its rarity, increasing awareness among healthcare providers is crucial for early detection.Despite not exhaustive of all the potential disorders affecting the oral mucosa, the present research topic provides an overview of oral involvement in the setting of autoimmune blistering diseases, oral lichen planus, and oral lichen sclerosus (figure 1). The integration of clinical and histopathological findings is crucial for accurate diagnosis and effective management of these conditions. Advances in scientific research are paving the way for better understanding of their pathogenesis and optimization of therapeutic strategies.

Oral lichen sclerosus (OLS) represents a diagnostic challenge even for expert dermatologists due to its rarity and subtle clinical manifestations. Only few cases have been reported in literature to date. OLS typically presents with whitish macules in the oral cavity. Histopathological examination remains crucial for definitive diagnosis, with characteristic features including epithelial atrophy, subepithelial hyalinization, loss of elastic fibers, and lymphocytic infiltration. Management strategies vary depending on lesion size and symptomatic presentation, with topical or intralesional corticosteroids being the most commonly used treatment modalities. Long-term monitoring is recommended due to the potential for malignant transformation, although no cases have been reported to date. Greater awareness and understanding of OLS are essential for accurate diagnosis and effective management. Based on these findings, we recommend performing an accurate evaluation of the oral mucosa, especially when dealing with patients affected by genital or extragenital lichen sclerosus (LS). Moreover, we emphasize the importance of multidisciplinary collaboration between dermatologists and other specialists of oral disorders, such as dentists. This short review briefly summarizes available data on OLS, highlighting its diverse clinical presentations and diagnostic challenges. Despite its infrequent occurrence, OLS should be considered in the differential diagnosis of white macules in the oral cavity.

Oral lichen sclerosus: Diagnosis and conservative approach

ORAL LICHEN SCLEROSUS: A RARE CASE REPORT WITH EMPHASIS ON CLINICAL AND MORPHOLOGIC ASPECTS

Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous disease that often affects the anogenital area; oral mucosal lesions are extremely rare. A 52-year-old woman presented for evaluation of an 8-year history of a persistent whitish plaque in the buccal mucosa. Intraoral examination revealed multiple elevated whitish plaques diffusely distributed in the buccal mucosa associated with an area of tissue atrophy. Although both leukoplakia and lichen planus were considered, incisional biopsy and later, full excision confirmed the histopathological diagnosis of oral LS. After 6 months of follow-up, there are no clinical signs of relapse. This case highlights the importance of clinical and histopathological findings for the correct diagnosis and treatment of oral LS.

Aromatase inhibitors are approved hormonal agents for the treatment of breast cancer since the past few decades. These agents are usually well tolerated except some common side effects seen in day-to-day practice such as arthralgia and mood changes. Some of the side effects of these agents are still very uncommon and must be considered in differential diagnosis while evaluating these patients on follow-up as this therapy is usually taken for prolonged time period and careful risk–benefit assessment must be done before considering discontinuation of therapy. In this conversation, we report the occurrence of lichen sclerosis of oral cavity in an elderly female suffering from breast cancer who developed it while being on anastrozole therapy.

Lichen sclerosus (LS) is a mucocutaneous disease with uncommon oral involvement. The etiology is not yet well understood, but LS has been associated with autoimmune, genetic, and immunological factors. We report a 47-year-old man with LS that exhibited an asymptomatic white plaque with red patches on the maxillary alveolar mucosa extending to the labial mucosa. He had no other skin disease. Positive immunostaining for tenascin and scarcity of fibronectin suggested extracellular matrix reorganization. Elastin immunostaining indicated a reduction of elastic fibers. Immunoexpression of collagen IV in blood vessels and its absence in the epithelial basement membrane, together with diffuse MMP-9 immunoexpression, suggested altered proteolytic activity. Mast cell staining bordering areas of sclerosis indicated a possible role in the synthesis of collagen. IgG4 positivity in plasma cells suggested a role in the fibrogenesis. This is an unusual presentation of oral LS and we discuss immunohistochemical findings regarding cellular and extracellular matrix components.

Lichen sclerosus is a chronic muco-cutaneous inflammatory disorder of uncertain etiology. The prevalence of lichen sclerosus affecting only the oral mucosa is extremely rare and only 26 cases with histologically verified oral lichen sclerosus have been reported. A 60-year-old man was referred to our hospital for complaints of white lesions in the oral cavity, which was otherwise asymptomatic and did not have any cutaneous or anogenital lesions. Clinical examination revealed white patches with reddish areas on the buccal mucosa bilaterally and on the maxillary posterior gingiva. Microscopic analysis of the lesion showed atrophied epithelium with basal cell degeneration, hyalinized connective tissue stroma with minimal chronic inflammatory cell infiltrate. Verhoeff's staining revealed scantiness of elastic fibers in the connective tissue stroma. On the basis of these histological findings, the final diagnosis was given as Lichen Sclerosus. LS is rare in the oral cavity, particularly in the absence of simultaneous cutaneous and anogenital lesions. Only 7 cases of oral LS have been reported involving the gingiva. To our knowledge, this is the eigth case to be reported with gingival involvement and the first case to be reported with bilateral involvement of buccal mucosa and gingiva.

Oral lichen sclerosus (LS) has been considered uncommon and involvement of lips extremely rare. We reviewed the clinical and histologic features of 72 cases of LS with oral/genital involvement, seen in our institute from 2002 to 2007. Lichen sclerosus was diagnosed with exclusive genital lesions in 45, exclusive lip involvement in 20, and orogenital involvement in seven cases. Fifteen of 27 histologically confirmed lip LS lesions were considered as early inflammatory or presclerotic, eight were intermediate/progressive, and four as late resolved lesions. Lip LS presented as asymptomatic vitiligoid lesions in 70% and dermal sclerosis was demonstrable in only 44%, which was limited to the papillary layer. This was in contrast with genital LS lesions which were asymptomatic in only 12% and demonstrated both papillary and reticular dermal sclerosis in 69%. Lip LS is far less symptomatic and destructive with limited dermal sclerosis compared with genital LS. Greater awareness and histologic assessment are essential for diagnosis because of the misleading vitiligoid appearance. "Vitiligoid LS" a superficial variant proposed by Borda can be aptly applied to lip LS. Dermatologists need to be aware of this rarely reported manifestation of LS as it adds to the spectrum of oral lichenoid lesions and lichenoid dysplasia, which are suspected to have a malignant potential.

Lichen sclerosus and lichen planus are chronic inflammatory mucocutaneous disorders that may coexist. The aim of this study was to estimate the period prevalence of oral lichen planus in a cohort of patients with vulvar lichen sclerosus and to document their clinical characteristics. We report a series of cases of vulvar lichen sclerosus presenting to two dermatologist-led vulvar clinics in Oxfordshire, England between 1997 and 2007 with coexistent clinical signs of oral lichen planus. Thirteen cases with coexistent vulvar lichen sclerosus and oral lichen planus were identified, of which five had oral biopsies. Four oral biopsies showed histological features consistent with lichen planus. One oral biopsy was not diagnostic but compatible with oral lichen planus. No cases of oral lichen sclerosus were identified. The period prevalence of oral lichen planus was 6 per 1000 cases of vulvar lichen sclerosus. The period prevalence of oral lichen planus in women with vulvar lichen sclerosus (0.6%) is similar to that reported for oral lichen planus in the general population (1-2%).

Lichen sclerosus of the oral mucosa: clinicopathological features of six cases

Oral lichen sclerosus: A case report and review

Oral lichen sclerosus et atrophicus: A case report