Oral Lichenoid Drug Reaction Research Articles

Autoimmunity and epithelial dysplasia in patients with oral lichenoid diseases.

The primary objective of this study was to explore relationship between autoimmunity and epithelial dysplasia in patients with oral lichenoid diseases. A total of 66 patients with oral lichen planus (OLP), 35 with oral lichenoid lesion (OLL), and 85 with oral lichenoid drug reaction (OLDR) were enrolled. OLP, OLL, and OLDR were diagnosed following the definitions of the modified World Health Organization criteria, except for the absence of epithelial dysplasia. All patients underwent diagnostic incisional biopsy and adjunctive direct immunofluorescence assays. An indirect immunofluorescence assay was conducted to determine the antinuclear antibody (ANA) positivity. OLP and OLDR patients with epithelial dysplasia demonstrated higher prevalence of serum ANA positivity compared to those without epithelial dysplasia. Elevated serum levels of high sensitivity-C reactive proteins were observed in the OLP, OLL, and OLDR patients with epithelial dysplasia. In the DIF analysis, patients with epithelial dysplasia in the OLP exhibited a higher prevalence of C3 deposition in the basement membrane zone. This study proposed that autoimmunity may contribute to elevating levels of focal and chronic systemic inflammation, potentially influencing abnormal wound healing and development of dysplastic changes in the oral epithelium among patients with oral lichenoid disease.

Oral lichenoid drug reaction due to seed oil containing 5% cannabidiol.

Oral lichenoid drug reaction due to seed oil containing 5% cannabidiol.

COMMON ORAL MUCOSAL LESIONS IN PATIENTS WITH OR WITHOUT CHRONIC VIRAL HEPATITIS

<h3>Background</h3> Oral mucosal bullous, desquamative ulcerative diseases involve immunopathologic mechanisms that account for loss of adhesion between contiguous keratinocytes or to structures within the basal lamina. <h3>Objective</h3> To study and understand the etiology and pathogenicity of the oral mucosal lesions in patients with or without chronic viral hepatitis. <h3>Methods</h3> Five patients were selected to make the clinical and morphopathologic diagnosis by biopsy of the affected tissue. Three had chronic viral hepatitis. <h3>Results</h3> Five patients (4 female and 1 male) were diagnosed with oral mucosal lesion. Three had oral lichen planus, 1 had a lichenoid reaction, and 1 had focal (frictional) hyperkeratosis with nicotine stomatitis of hard palate and smoking-associated melanosis. Common lesions were minimal clinical symptomatic lesions on the cheeks, extending to the lateral parts of the tongue, gums, and lips. General status of the patients is distinguished by numerous general chronic diseases including viral chronic hepatitis, erythematous gastritis, reactive arthritis, and vegetative nervous dysfunction. <h3>Conclusions</h3> Oral lichenoid reactions represent a common endpoint in response to extrinsic agents, altered self‐antigens, or superantigens. Oral lichen planus, a common inflammatory disorder with an unidentified etiology, shares many clinical and histopathologic features with oral lichenoid drug reaction and oral lichenoid contact reaction. Oral lichenoid reactions represent a common endpoint in response to extrinsic agents, altered self‐antigens, or superantigens. Clinical presentation can vary from asymptomatic white reticular striae to painful erythema and erosions. Most immunopathologic oral mucosal diseases have the risk of malignancy and require special attention.

Malignant transformation of oral lichen planus: a retrospective study of 565 Japanese patients

BackgroundOral lichen planus (OLP) is a chronic inflammatory oral mucosa disease that is recognized as an oral potentially malignant disorder. However, the potentially malignant nature of OLP remains unclear.MethodsWe designed this study to examine the demographic and clinical characteristics of patients with OLP and evaluate the associated malignant transformation rate. A total of 565 patients with a clinical and histopathological diagnosis of OLP who presented at our department between 2001 and 2017 were retrospectively studied. Patients who had clinical and histopathological features of oral lichenoid lesions (OLLs) classified as oral lichenoid contact lesions, oral lichenoid drug reactions and oral lichenoid lesions of graft-versus-host disease were excluded.ResultsThe study population included 123 men and 442 women aged 21–93 years (mean ± standard deviation, 60.5 ± 11.8). The 565 patients were followed up for a duration of 55.9 ± 45.3 months, during which 4 (0.7%) patients developed squamous cell carcinoma (SCC). In three of these 4 patients who developed SCC, the clinical type of OLP was the red type.ConclusionsOur results suggested that OLP was associated with a low risk of malignant transformation. We recommend regular follow-up for OLP patients and clear differentiation of oral epithelial dysplasia and OLLs to enable early detection of malignant transformation. Further investigation of the clinical risk factors associated with malignant transformation is necessary.

Allopurinol-Induced Oral Lichenoid Drug Reaction with Complete Regression after Drug Withdrawal

Background: Lichen planus is a chronic mucocutaneous inflammatory disease. Oral manifestations are common, and may remain exclusive to the oral mucosa without involvement of the skin or other mucosae. A differential diagnosis includes oral lichenoid drug reactions. Allopurinol, which is the first line hypo-uricemic treatment, is often quoted as being a possible offending drug, though oral reactions have rarely been reported. Case presentation: We describe a 59-year-old male gout patient, successfully treated with allopurinol, who developed acute onset of oral lichenoid lesions, involving bilaterally the buccal mucosa, the tongue and the labial mucosa. Histopathology was consistent with a lichen planus or a drug-induced lichenoid reaction. Improvement of the patient’s condition after withdrawal of allopurinol confirmed the lichenoid nature of the lesion. Remission was complete after a few weeks. Discussion: Although unusual, allopurinol may induce a lichenoid drug reaction. These reactions may mimic clinically and histopathologically idiopathic lichen planus. Improvement or complete regression of the lesions may be attempted to confirm the diagnosis. According to the latest WHO recommendations, these lesions have a potential for malignant transformation.

Oral lichenoid drug reaction due to seed oil containing 5% Cannabidiol

Oral lichenoid drug reaction due to seed oil containing 5% Cannabidiol

Correlation of clinicopathological characteristics and direct immunofluorescence studies in oral lichenoid lesion in Thai patients.

To investigate the correlation between the clinicopathological characteristics, serum antinuclear antibody (ANA) and direct immunofluorescence (DIF) findings in oral lichen planus (OLP) and oral lichenoid lesion (OLL). Fifty three Thai patients with red and white lesions were divided into 3 groups: 17 cases of OLP, 19 cases of OLL and 17 cases of oral lichenoid drug reaction (OLDR), respectively. The medical records, photographs, histopathological evaluation and laboratory ANA and DIF results were analyzed. Atrophic pattern was the most commonly found pattern in the OLDR, OLP and OLL groups. In the OLP group, the DIF interpretation confirmed only 41.2% of cases as OLP, with 23.5% each as lichen planus (LP)/lupus erythematosus (LE) or negative findings. In the OLL group, the most common DIF interpretation (31.6% each) was LP/LE or non-specific finding. In the OLDR group, DIF interpretation was OLP or LP/LE (23.5% each), with 5.9% each of immune complex-mediated disease, compatible with OLP, and mixed connective tissue disease. Interestingly, 1 case in the OLDR group demonstrated mild to moderate dysplasia. There were no significant differences in ANA positivity or patterns between the 3 groups. An OLP-like lesion could be diagnosed as OLP, OLP/LE, chronic ulcerative-like lesion, immune-mediated disease or dysplasia.

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

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

Is Simvastatin Associated with Oral Lichenoid Drug Reaction?

Currently, various drugs have been found to induce many oral lesions. Some medications used to treat systemic diseases can affect the oral mucosa and induce lesions known as oral lichenoid drug reaction (OLDR). The diagnosis is made when the oral lesion errupted after the patient took a specific medication. However, diagnosis is challenging when a patient takes multiple medications and the onset of the eruption is unclear. OLDRs commonly cause severe pain in the oral cavity and affect the quality of life. Statins are widely used by patients with cardiovascular disease (CVD) to lower blood cholesterol levels, decreasing the risk of heart attack or stroke. This review will focus the side effects of a hypolipidemic drug group (statins) in the oral cavity. From previous experience, simvastatin may be related to severe oral ulcerations, dysplasia, and carcinoma in situ in the oral mucosa. Moreover, simvastatin combined with amlodipine can induce more severe oral lesions that are very difficult to treat. Therefore, the beneficial effect of these drugs and their side effects should be considered carefully, because simvastatin significantly affects oral and general health.

Comparative evaluation of the presence of serum antibodies SMA, Anti DNA, ANA and RF in the oral lichen planus and oral lichenoid drug and contact reactions

Introduction: Oral lichenoid reactions (OLR) are referred to a group of diseases that clinically and histologically could not be differentiated from the oral lichen planus (OLP) diseases. In the recent years, the two groups of diseases have been considered as T-Cell mediated inflammatory diseases. The aim of this study was to gather more information to help better distinguish these two lesions. Method and Materials: In this descriptive-analytical study, blood samples were taken from 80 patients (59 females and 29 males) and sent to the laboratory for histopathological diagnosis based on WHO criteria. After separating the blood sera of the samples, the sera were evaluated by enzyme linked immunosorbent assay (ELISA) for the presence of ANA, anti-DNA, RF, and SMA auto-antibodies. Data statistically was analyzed with SPSS using the chi-squared test and t-test (a = 0.05). Results: The mean ages were 48.62 and 49.38 for OLP and OLR patients, respectively. There were no significant differences in ANA and RF blood levels (p value g 0.05). Anti-DNA and SMA antibodies were not detected in the blood samples. No significant differences were noted in the blood levels of these antibodies (p value g 0.05). Conclusion: According to the results of the present study, no significant differences were observed between the OLP and OLR patients in relation to the presence or absence of ANA, anti-DNA, RF, and SMA auto-antibodies in the blood samples.

A Review of the Effectiveness and Side-Effects of Fluocinolone Acetonide 0.1% in the Treatment of Oral Mucosal Diseases.

Topical steroids have been widely used in the treatment of symptomatic oral lesions to reduce pain and inflammation. Potent topical steroids such as clobetasol propionate, fluocinolone acetonide (FA), and fluocinonide have been widely used in the treatment of severe oral mucosal lesions. Many reports have demonstrated that these steroids were effective in treating oral lesions with only minor side-effects. This review describes the effectiveness and side-effects of using FA 0.1% in the treatment of symptomatic oral lichen planus (OLP), oral lichenoid drug reaction (OLDR), oral pemphigus, and herpes associated erythema multiforme (HAEM). FA 0.1% was effective and safe in the treatment of patients with multiple systemic diseases and a pregnant patient with HAEM. Moreover, this topical steroid rapidly reduced pain, inflammation, and enhanced lesion healing with no serious side-effects other than pseudomembranous candidiasis, which is easily treated. In some cases, a long-term treatment with FA 0.1% resulted in hyperpigmentation at the areas of previously healed oral lesions; however, this hyperpigmentation was gradually resolved after discontinuing topical steroid treatment.

Challenge Management of Oral Lichenoid Drug Reaction

Challenge Management of Oral Lichenoid Drug Reaction

Topical Steroids and CO2 Laser in the Treatment of Refractory Oral Lichenoid Drug Reaction and Lichenoid Contact Lesion: a Case Report.

A 54-year-old female presented with severe pain on the gingiva and buccal mucosa. Oral findings revealed generalized fiery red gingiva, ulcerative with white striae covered by pseudo-membranes on both buccal mucosae. She had hypertension, dyslipidemia, subclinical hypothyroidism and arthritis. She was treated with atorvastatin, hydrochlorothiazide, valsartan, levothyroxine and non-steroidal anti-inflammatory drug (NSAIDs). Her oral lesions were a slight improvement from a previous treatment with pimecrolimus cream, triamcinolone acetonide 0.1% orabase and injection. After diclofenac was replaced with tenoxicam and oral lesions were treated with various topical steroids, the lesions showed marked improvement. The biopsy from the buccal mucosa revealed oral lichen planus. Patch test showed positivity to mercury, gold sodium thiosulfate and palladium. One year later the left buccal mucosa showed red, round papillomatous-like lesions. The histopathological report showed a non-specific ulcer with chronic inflammation. The lesions flared up after replacing amalgam with crowns. After CO2 laser treatment, the lesions showed some improvement. Direct and indirect immunofluorescence of the lesions proved to be negative. This first case report showed that the palliative treatment of refractory oral lichenoid lesions with potent topical steroids for 7 years had no side-effects. CO2 laser can be an alternative treatment of refractory lesion in this case.

Oral lichenoid lesions and serum antinuclear antibodies in Thai patients

The aim of this study was to investigate the presence of serum antinuclear antibodies (ANA) in Thai oral lichenoid drug reaction (OLDR) and oral lichen planus (OLP) patients. This study comprised 20 patients diagnosed with OLDR, 23 patients with OLP, and 24 healthy control subjects. Participants' blood samples were assayed for ANA staining patterns and serum ANA titer levels by immunofluorescence using human epithelial type 2 (HEp-2) as a substrate. The serum ANA titer levels were defined as low (1:40-1:80), medium (1:160-1:320), and high (>1:640). Serum ANA were detected in 73.9%, 70%, and 25% of OLP, OLDR, and control subjects, respectively. There was a statistically significant difference between the number of serum-ANA-positive subjects in the OLP or OLDR groups and the control group (P < 0.01), but no significant difference between the OLP and OLDR groups. The speckled pattern was the most commonly found staining pattern, present in 60.9%, 55.0%, and 20.8% of the OLP, OLDR, and control subjects, respectively. The number of subjects with low ANA titers in the OLP and OLDR groups was significantly higher than that of the control group (P < 0.01). Medium ANA titers were found in 15%, 4.4%, and 4.2% of the OLDR, OLP, and control subjects, respectively, while high ANA titers were not found in any group. The number of serum-ANA-positive OLP and OLDR patients was significantly higher than the control group. Speckled pattern and low titer levels were the most common findings in both OLP and OLDR groups.

Lichenoid Mucosal Reaction to Rituximab

A case of rituximab-induced oral lichenoid drug reaction in a patient with follicular non-Hodgkin lymphoma is presented. In light of the wide use of rituximab for the treatment of lymphoma and the increasing use for autoimmune diseases, awareness and recognition of this unusual side effect of treatment with rituximab is critical to allow for prompt management to reduce morbidity.

Medications in Thai Patients with Oral Lichen Planus, Oral Lichenoid Drug Reaction and Glossitis

ABSTRACT Introduction Medications have been widely used in the dental patients for the treatment of their systemic diseases. In fact, those drugs have some side-effects to many organs and also the oral cavity. The aim of our study was to investigate the relationship between medications and oral lichen planus (OLP), oral lichenoid drug reaction (OLDR) and glossitis (GT) in Thai patients. Materials and methods One hundred and thirty-eight cases of Thai patients were included in this study. Medical records of all cases with oral lesions and symptoms referred to the oral medicine clinic during 2007 to 2010 were extracted. Oral lichen planus group consisted of 88 cases, GT 26 cases and OLDR 24 cases. All data were analyzed using SPSS for Windows version 11.5. Results In our study, 75.5% of patients used more than one medication while single drug used was 24.5%. Antihypertensive drugs were the most commonly used in all groups. Antihypertensive and hypolipidemic drugs were equally taken 22.4% in OLP patients. Patients with OLDR taking antihypertensive in 54.2% followed by hypolipidemic (37.5%), NSAIDs (25%), hypoglycemic/antiplatelet (16.7%) each and others 25%. Patients in GT group were also used antihypertensive drugs 35%, NSAIDs 25%, hypolipidemic 20% respectively. Conclusion Most of patients with oral lesions took more than one medication. Antihypertensive drugs were the most commonly used in Thai patients with oral lesions. How to cite this article Nalamliang N, Tangnantachai N, Thongprasom K. Medications in Thai Patients with Oral Lichen Planus, Oral Lichenoid Drug Reaction and Glossitis. Int J Experiment Dent Sci 2014;3(2):73-76.

Oral lichenoid drug reaction with autoantibodies in peripheral blood: Case report

A 51-year-old man complained of oral roughness and pain. At the age of 49 years, he was admitted for 8 months for bipolar emotional disorder. Oral administration of lithium carbonate was started. Extensive, hemorrhagic, erythema-mixed white lace-like patches were noted on the lip, buccal mucosae, and lingual margins. On biopsy, all lesions were consistent with oral lichen planus. A drug lymphocyte stimulation test showed a positive reaction to lithium carbonate. Blood examination revealed marked increases in the peripheral blood levels of antinuclear antibodies. To relieve the symptoms, the systemic administration of prednisolone was performed while continuing the lithium carbonate.

Lichen planus and lichenoid reactions of the oral mucosa

Oral lichenoid reactions represent a common end point in response to extrinsic agents (drugs, allergens), altered self-antigens, or superantigens. Oral lichen planus, a common and under-recognized inflammatory disorder, shares many clinical and histopathological features with oral lichenoid drug reaction and oral lichenoid contact reaction. Clinical presentation can vary from asymptomatic white reticular striae to painful erythema and erosions. Cutaneous and additional mucosal involvement is common. Delay in diagnosis of extraoral mucocutaneous lichen planus (LP) results in conjunctival scarring; vaginal stenosis; vulvar destruction; and stricture of the esophagus, urethra, and external auditory meatus. Although the etiology of LP is idiopathic, oral lichenoid reactions may be caused by medications or exogenous agents such as cinnamates and other flavorings. The clinical features, evaluation, and management of these oral lichenoid reactions are discussed.

Antiretroviral Drug-Associated Oral Lichenoid Reaction in HIV Patient: A Case Report

Antiretroviral therapy has changed the course of HIV disease and improved quality of life in HIV patients. Incidence of an oral lichenoid drug reaction induced by zidovudine is not common. Once it occurs, it affects a patient's well being, in particular their oral functions. Here we report the first case of a 34-year-old Thai man with painful erosive lesions involving the lip and buccal mucosa. Treatment with topical fluocinolone acetonide 0.1% alleviated the patient's oral pain, but it was not until the subsequent withdrawal of zidovudine that the patient showed improvement and resolution of the lesions. Long-term follow-up was useful in the management of this patient, and no recurrence of the lesion was found during 21-month follow-up in this patient.

Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations

Several therapeutic agents have been investigated for the treatment of oral lichen planus (OLP). Among these are corticosteroids, retinoids, cyclosporine, and phototherapy, in addition to other treatment modalities. A systematic review of clinical trials showed that particularly topical corticosteroids are often effective in the management of symptomatic OLP lichen planus. Systemic corticosteroids should be only considered for severe widespread OLP and for lichen planus involving other mucocutaneous sites. Because of the ongoing controversy in the literature about the possible premalignant character of OLP, periodic follow-up is recommended. There is a spectrum of oral lichen planus-like ("lichenoid") lesions that may confuse the differential diagnosis. These include lichenoid contact lesions, lichenoid drug reactions and lichenoid lesions of graft-versus-host disease. In regard to the approach to oral lichenoid contact lesions the value of patch testing remains controversial. Confirmation of the diagnosis of an oral lichenoid drug reaction may be difficult, since empiric withdrawal of the suspected drug and/or its substitution by an alternative agent may be complicated. Oral lichenoid lesions of graft-versus-host disease (OLL-GVHD) are recognized to have an association with malignancy. Local therapy for these lesions rests in topical agents, predominantly corticosteroids.