Oral Lichenoid Reactions Research Articles

Comparative immunohistochemical expression of Beta catenin and CD163 between dysplastic / non-dysplastic oral lichen planus and lichenoid lesions (EX-VIVO STUDY)

BackgroundOral lichen planus is a well-known chronic inflammatory mucocutaneous disorder, which has clinical and histological presentation that mimics oral lichenoid reaction. According to the fifth edition of WHO, both conditions are considered as oral potentially malignant disorders. Recent studies on oral potential disorders documented deregulation of some signaling molecules related to the Wnt/β-catenin pathway. Therefore this study aimed to compare the immune expression of β-catenin & CD163 in dysplastic /non-dysplastic cases of Oral lichen planus & oral lichenoid lesion. In addition, a statistical correlation between both immune markers was done regardless of the type of the study group.MethodsFour study groups were designated as 2 groups of Oral lichen planus (one dysplastic & one non –dysplastic) and the other 2 groups were oral lichenoid lesions (one dysplastic & one non –dysplastic). Ten cases in each group were collected and investigated by immunohistochemistry. The area percent of beta catenin and also counting of m2 macrophages expressing + CD163 marker was calculated in the study groups.ResultsThe Statistical analysis highlighted a statistically significant difference between the studied groups. Moreover, Pearson correlation test reported a significant moderate positive correlation between beta catenin & CD163 expression in the studied cases.ConclusionOur findings supported new perceptions of the mechanism by which tumor associated macrophage specific β-catenin signaling promotes the aggressive behavior of oral potential malignant disorders.Clinical relevanceEvidence of the relationship between beta catenin and M2 macrophages (+ CD163) may enhance the development of macrophage-based strategies for treatment and improve the prognosis of such cases.

The ABO blood group antigens in patients with oral lichenoid reaction.

Evaluating the association of ABO blood group with different delayed hypersensitivity reactions, such as oral lichenoid reaction (OLR), can provide a new perspective for clinical practice. Therefore, this study designed to investigate ABO blood group antigens in OLR patients. In this case-control study, the ABO blood group of 112 OLR patients and 117 individuals without oral lesions were included. Gender, age, characteristics of the lesions, medications and restorative materials recorded. Chi-square test used to compare the frequency of ABO blood groups in OLR patients with controls. The O blood group was significantly higher in OLR patients and all its subtypes. Also, there were significant relation between O blood group, and severity of lesions. The frequency of dysplasia was non-statistically significant higher in OLR patients with O blood group than other blood group. Based on the results of the present study, O blood group was significantly more in patients with lichenoid reaction than control group, and AB blood group was the lowest. Also, O blood group showed a positive association with the more severe form of OLR lesions and frequency of dysplasia.

Comparative Evaluation of Mast Cells in Lichen Planus and Oral Lichenoid Reaction with Giemsa Staining

Introduction: Lichen planus is a relatively common and chronic mucocutaneous disease with unknown. Oral lichenoid reaction is clinical and histopathological similar to lichen planus, but the cause of it is different. Mast cells are responsible for the accumulation of inflammatory cells in the connective tissue. The aim of study was evaluation of the role of mast cells in pathogenesis of two groups of lesions.
 Methods: This cross-sectional study was performed on 26 samples of oral lichen planus, oral lichenoid reaction lesions and 5 samples of irritation fibroma. After the staining with the Giemsa, sections were observed under the optical microscope (x400), and the number of mast cells was counted. The results were analyzed using the SPSS16 software, T test, Mann- Whitney and Chi-squared statistical tests.
 Results: The total number of mast cells and degranulated mast cells in two groups were significantly higher than the control group (P<0/05). Nevertheless, the total number of mast cells, the number of degranulated mast cells and the ratio of degranulated mast cells to the total mast cells had no significant difference between the two groups of lesions. (P> 0/05).
 Conclusion: Mast cells play a role in the pathogenesis of lichen planus and lichenoid reaction lesions. The number of degranulated mast cells and the ratio of degranulated to the total mast cells cannot help to differentiate these two groups of lesions. Clinical examinations and proper history and attention to their etiologic factors have a significant role in differentiating them.

The impact of diabetes mellitus and the hypoglycemic agent metformin on oral health: A narrative clinical review

Diabetes mellitus (DM) is a common endocrine disorder that affects more than 10% of the adult population globally, 90% of which are type 2 DM (T2DM). DM was extrapolated to affect 20.5% of adult Jordanians by 2025, and around 50% of Jordanians attending dental clinics are at a moderate to high risk of developing T2DM in 10 years. The main morbidities of DM are angiopathy, nephropathy, retinopathy, and neuropathy rendering diabetic patients at a higher risk of myocardial infarctions, chronic kidney disease, blindness, and peripheral neuropathological impairment respectively. The common oral features associated with DM include gingivitis/periodontitis, dental caries, candidosis, xerostomia, sialosis, bacterial sialadenitis, burning mouth, halitosis, and dysgeusia. DM is also accused of being a risk factor for the development of oral/head and neck cancer, potentially malignant disorders and oral lichen planus. Metformin is the first-line treatment of T2DM with versatile use. In addition to its blood glucose-lowering effect, metformin has pleiotropic effects that may influence patients' oral health and dental management. Metformin therapy has a positive impact on oral health such as decreasing the risk of gingivitis/periodontitis, ameliorating the xerostomia, accelerating the healing of periapical pathology following endodontic treatment, increasing the success rate of the dental implant and lowering the incidence and mortality rate of oral cancer, in addition to its anti-microbial activity. On the other hand, metformin has a bitter taste, may cause taste alterations, decreases the orthodontic tooth movement rate, and can induce oral lichenoid reaction. For optimum dental and medical healthcare, providers should be fully aware of the oral manifestation associated with DM and metformin therapy.

Efficacy of comprehensive dental treatment for lichenoid reactions of the mucoparodontal complex: A single-center pilot cohort study

Background. Lichenoid reactions of the oral mucosa are currently recognized as a serious issue for dentists of various specialties, since their knowledge and competence in the diagnosis and pathogenetic treatment of lichenoid lesions of the oral cavity are yet to be improved. Following the data on high oncogenic potential in some forms of lichenoid reactions of oral cavity mucous membranes, the issue should be given serious considerations, and dentists should keep oncology-related suspicion when receiving these patients.Objective. To evaluate the efficacy of comprehensive dental treatment for lichenoid reactions of the mucoparodontal complex.Methods. A single-center pilot cohort study was conducted to evaluate the efficacy of the comprehensive treatment (combination of pharmacotherapy and physiotherapy) of patients with lichenoid reactions of the oral mucosa. The observation group consisted of 49 patients (15 males, 34 females) aged 58.92 ± 0.82 years with verified diagnoses of oral mucosa lichenoid reactions. The suggested treatment included pharmacotherapy (highly-potent topical steroids, calcineurin inhibitors) and physiotherapy in the form of low level laser therapy (635 nm, 10 W) provided via Matrix laser (Matrix, Russia). Treatment efficacy was assessed by the total scale of treatment efficacy, registering indicators of the area of focal lesions and the severity of pain syndrome, as well as by changes in dental quality of life indicators according to OHIP-49-RU (Oral Health Impact Profile) in the Russian version. Statistical processing of the data involved Student’s t-test and Wilcoxon t-test. Differences were considered significant at p ≤ 0.05. Data statistical analysis was performed using SPSS 13.0 (SPSS Inc., USA).Results. During the follow-up period, the indicators of the total scale of treatment efficacy decreased significantly (p < 0.001) in 100% of patients and amounted (as medians and quartiles): 6.0 (4.0–7.0) points before treatment and 1.0 (1.0–2.0) points after treatment to be objectified by a significant reduction in the area of focal lesions (by 63.2%, p < 0.001) and in pain syndrome (spontaneous pain from 2.0 (1.5–3.0) points before treatment to 0.0 (0.0–1.0) points after treatment; induced pain from 3.0 (2.0–3.0) points to 1.0 (0.0–1.0) points). Along with the clinical improvement, the scores in dental quality of life improved from 83.11 ± 2.58 to 39.94 ± 0.86 points, according to OHIP-49 RU (Oral Health Impact Profile).Conclusion. Early detection and differentiation of lichenoid reactions in oral mucous membranes ensure timely treatment using the developed protocol of comprehensive treatment (combination of pharmacotherapy and physiotherapy). The efficacy of the protocol was confirmed clinically and justified in relation to quality of life.

Histologic and Histomorphometric Comparative Study of Oral Lichen Planus Versus Oral Lichenoid Reaction.

Oral lichen planus (OLP) is a T-cell-mediated chronic inflammatory disease classified as an oral potentially malignant disorder (OPMD) and increased transformation risk to oral cancer. Oral lichenoid reactions (OLRs) share the clinical manifestations of OLP. This study aimed to determine histomorphometric changes in OLPs and OLRs in comparison to the healthy control, which helps to plan for the establishment of diagnostic criteria. This cross-sectional prospective study was conducted on a total of 75 tissue-embedded paraffin-block samples, including OLPs (n = 25), OLR cases (n = 25), and healthy control individuals (n = 25). The study groups were compared by chi-squared, Fisher's exact, and one-way ANOVA tests. A p-value less than 0.05 was considered statistically significant. Comparison of the nuclear area and cellular area showed a statistically significant difference between study groups in basal and parabasal layer (P < 0.05). Comparison of the nuclear-to-cytoplasm ratio showed a statistically significant difference between study groups in basal (P < 0.05) but not in the parabasal region (P = 0.681). We showed a significant difference in the nuclear and cellular area, nuclear-to-cytoplasm ratio between OLPs and OLRs, and healthy controls, but there was no statistically significant difference between OLPs and OLRs. Thus, these parameters cannot be applied to differentiate diagnoses between OLPs and OLRs.

Malignant Transformation in Oral Lichen Planus and Lichenoid Reactions in Southern Thai Population

Objectives: This study aimed to determine the prevalence of malignant transformation (MT) and the incidence rate of oral squamous cell carcinoma (OSCC) in oral lichen planus (OLP) and oral lichenoid reaction (OLR) patients from southern Thailand. Methods: This hospital-based retrospective cohort study comprised OLP/OLR patients who were treated between January 2016 and December 2022. Data on the general characteristics, clinical manifestations and laboratory investigations were obtained from the hospital records and analyzed. Descriptive and analytical statistics were performed to assess the demographic data, clinical profiles of the patients and the prevalence and incidence rate of MT. Results: A total of 117 patients were included in the study; 103 (88%) were diagnosed with OLP, and 14 (12%) were diagnosed with OLR. The median follow-up time was 15.6 months (interquartile range; 6.1-46.0). The overall prevalence of MT in OLP/OLR was 1.71% (2/117 patients); specifically, MT in OLP was 1.94% (2/103 patients). The overall annual incidence rate of MT into OSCC was 0.0060 (95% confidence interval, 0.0015-0.0240). Conclusions: These findings suggest that OLP is a potentially malignant disorder with an MT incidence of 1.94% in the southern Thai population. OLP patients must be regularly followed-up and advised about the risk of MT.

Clinicohistological Characteristics of Patients with Oral Lichenoid Mucositis: A Retrospective Study for Dental Hospital Records.

Oral lichenoid mucositis (OLM) of the oral mucosa is a histological diagnosis mainly characterised by a band of inflammatory infiltrate in lamina propria and basal cell degeneration. These features describe oral lichen planus or oral lichenoid reaction. However, it could be seen in oral dysplasia. The study aimed to assess the demographics and clinicohistological characteristics of patients with OLM and their relevance to dysplastic changes in the oral mucosa. This was a cross-sectional and retrospective study of archived and electronic records of individuals with histological confirmation of OLM at King Saud University Medical City, Saudi Arabia. The descriptive and correlation assessments were used to describe the demographics and clinicohistological characteristics and their associations, respectively [p < 0.05]. The analysis included 140 records of patients with histological confirmation of OLM with a mean age of 47 (±13), and 57% (n = 81) were females. Notably, 40% of patients had at least one medical condition, mainly diabetes mellitus, 74% were asymptomatic, and 52% had lesions in the buccal mucosa. Dysplasia was seen in 18 (12%) of the 140 reviewed records. Regarding the associations between study variables, dysplastic changes were associated with the male gender [p = 0.024] and were of no significance with increased age [p = 0.594]. Moreover, having oral symptoms was associated with older age [p < 0.001], medical history of diabetes [p = 0.0132] and hypertension [p < 0.001]. The present study findings could help indicate the individuals with histologically confirmed OLM who suffer the most from the clinical disease and have an increased risk of dysplastic changes. Therefore, symptomatic management and long-term follow-up can be planned accordingly.

Relationship between Personal Temperaments Based on the Traditional Medicine Knowledge and Lichen Planus and Lichenoid Reaction Disorders

Oral lichen planus and lichenoid reactions are autoimmune chronic inflammatory diseases. Since the inflammatory system is the main pathological process in these lesions, some etiological roles for inflammatory cytokines and personal temperaments (Mizaj) are proposed. In this preliminary study, establishing such an association between personal temperaments with oral lichen planus and lichenoid reactions would develop new horizons for better preventive programming to prevent or control the disease course in affected patients. This case-control study was carried out among 384 patients referred to the oral medicine department of dental school, Tehran University of Medical Sciences, from 2000 to 2017. They were categorized into three groups as follows: oral lichen planus (128), oral lichenoid reactions (128), and healthy control group (128). The temperament was assessed by Mojahedi et al. validated questionnaire, and the results were compared across the groups. Warm temperament was significantly higher in the lichen planus group (P=0.0001). The dry temperament was higher in oral lichen planus and lichenoid groups. In these groups, the intermediate group had the least rate, but in the control group, the moist temperament was less common. No statistically significant difference existed between groups in this era (P=0.210). However, among mixed temperaments, the warm and moist temperament was the same across the groups (P=0.195); the warm and dry temperament was significantly more common in cases with oral lichen planus (P &lt; 0.001); and the cold and dry temperament (P=0.017) and cold and moist temperament (P &lt;0.001) were significantly more common in the control group. The only difference between the two groups of control and lichenoid reactions was cold and dry temperament (P=0.008). This study revealed that warm temperament is related to oral lichen planus. Reestablishing this matter in future studies would help develop some evidence-based preventive strategies to reduce the burden of oral lichen planus.

A Novel Approach to Differentiating Erosive and Reticular Lichen Planus Based on the Percentage of Dental Surfaces With Metal Restorations.

Introduction Oral lichen planus (OLP) and oral lichenoid reaction (OLR) constitute clinical entities with strong but unclear etiologic relation to dental materials. The aim of this study was to evaluate a correlation between the clinical form of OLP/OLR and the number of dental metal restorations in the oral cavity thus utilizing an exposure to metal (EM) index. Material and methods The study type is experimental, and the study design is characterized as semiquantitative research that belongs to the branch of experimental research. Twenty-nine patients were chosen based on clinical (either reticular or erosive clinical forms) and histologic findings suggestive of OLP/OLR. The files of patients were retrieved from the archives of the Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Greece, during the period 2009-2019. The medical history of the patients did not include any disorder or medication associated with lichenoid lesions and the measurements took place concurrently with the establishment of the diagnosis, thus no treatment for the lichen planus had been administered prior to the measurements. Quantitative measurement of the percentage of dental surfaces restored through metal restorations and correlation with the clinical and histologic findings of OLP/OLR was evaluated. The EM index was evaluated on a scale of 1-3, which corresponds to the percentage of dental surfaces restored through metal restorations. The statistical analysis wasperformed with the Pearson chi-square test and the significance level was set at p≤0.05. Results The EM index was measured by dividing each tooth into five surfaces (occlusal, mesial, distal, buccal, lingual), subsequently multiplying the number of available teeth with the number 5 to calculate the total number of surfaces, and then counting the number of surfaces with metal restorations - both fillings and crowns (in case of metal-ceramic crowns, the respective dental surface is taken into account only in case of macroscopically exposed metal), dividing the number of surfaces with metal restorations with the total number of surfaces and multiply by 100 so that the results take the form of percentages (%) and finally classifying the percentages into three groups: 1: 0% metal restorations, 2: 1-25% metal restorations, 3: >26% metal restorations). The percentage in female patients ranged from 0% to 100%, whereas it ranged from 0% to 60% in male patients. According to the clinical form of the lichenoid lesion, the percentage ranged from 0% to 60% inreticular lichen planus cases and from 0% to 100% in erosive lichen planus cases. There was nostatistical difference between lichen planus cases, in total, and in normal oral epithelium. However, the levels of EM were marginally similar between the reticular lichen planus and the erosive lichen planus (Fisher's exact test, p = 0.056). Therefore, it may be the case that the EM index is higher in erosive lichenoid lesions. Conclusion In our study, the EM index was higher in female patients and in erosive lichenoid lesions. These findings should be tested and supported by larger samples of patientssince the aforementioned Fisher's Exact Test, p = 0.056 could fall below the threshold of 0.05 if more patients were included. This is the first attempt to establish a novel approach to differentiating erosive and reticular lichen planus based on the percentage of dental surfaces with metal restorations.

Pembrolizumab-induced erosive lichenoid reaction in a patient with metastatic lung adenocarcinoma: A case report

Introduction: Immune-related adverse events induced by immune checkpoint inhibitors are quite common. Cutaneous lichenoid immune-related adverse events are among the most frequent. However, oral lichenoid adverse reactions are extremely rare. We herein describe a patient who was treated with pembrolizumab for metastatic lung cancer and developed an erosive oral lichenoid reaction induced by immunotherapy. Case presentation: An 87-year-old man treated with pembrolizumab for metastatic lung adenocarcinoma (stage IVa based on AJCC 2018) developed multifocal erosions of the oral mucosa mainly located on the buccal mucosa, palate, and inner portion of the lips with multiple small, irregular, hyperkeratotic areas. Histopathological examination showed epithelial necrosis and a dense band-like layer of an inflammatory infiltrate of lymphocytes and histiocytes within the upper dermis. Direct immunofluorescence was negative for both IgG and C3. A diagnosis of erosive oral lichenoid reaction of the mucosa induced by immunotherapy was established. Given the severity of the condition, pembrolizumab treatment was withheld and concomitant topical and systemic steroids were started. After 1 month, the drug-related toxicity was ameliorated and immunotherapy was re-introduced. Discussion: Only one other case of pembrolizumab-induced erosive lichen planus of the oral mucosa has been described to date. Previously reported drug-induced lichenoid rashes were mainly localized on the skin. Clinically, the main differential diagnoses of lichenoid erosive lesions are bullous immune-related disorders and should be excluded. In our patient, histological examination combined with negative results of both direct immunofluorescence and enzyme-linked immunosorbent assays confirmed the diagnosis of erosive lichenoid drug reaction. Conclusion: Clinicians should be aware of lichenoid involvement of the oral mucosa because related pain and food intake difficulties may seriously compromise treatment compliance. Prompt treatment of oral drug-related reactions may prevent interruption of immunotherapy and improve patients’ quality of life.

Oral Potentially Malignant Disorders and Candida in Oral Tongue Squamous Cell Carcinoma Patients.

This retrospective study addressed the role of oral potentially malignant disorders and the presence of intraepithelial Candida hyphae in the carcinogenesis of the oral tongue squamous cell carcinoma and its association with smoking, alcohol consumption, and oral inflammatory burden. The medical records of 183 subjects diagnosed with oral tongue squamous cell carcinoma at the Helsinki University Hospital were investigated. Preceding oral lichen planus, lichenoid reaction, and leukoplakia diagnosis were recorded. Further, the data on Candida hyphae in histological samples as an indicator of oral candidiasis, oral inflammatory burden, smoking, and alcohol consumption were recorded and analyzed. The histopathological diagnosis of oral lichen planus/lichenoid reaction (p < 0.001) and the presence of Candida hyphae (p = 0.005) were associated significantly with female gender. Oral lichen planus/lichenoid reaction patients were less often smokers than patients without these lesions. Candida hyphae were more often recorded in patients without alcohol use (p = 0.012). Oral lichen planus/lichenoid reaction and Candida hyphae in histological samples were associated with female gender and lower levels of typical risk factors, such as alcohol use and smoking, in oral tongue squamous cell carcinoma patients. Therefore, these patients should be well monitored despite a potential lack of the classical risk factors of oral carcinoma.

ALDH1 EXPRESSION IN LAMINA PROPRIA OF LICHEN PLANUS, LICHENOID REACTION, LEUCOPLAKIA, AND INFLAMMATORY PROCESSES

Objective To evaluate the differences in ALDH1 expression in lamina propria of oral lichen planus (OLP), oral lichenoid reaction (OLR), leucoplakia, and the nonspecific chronic inflammatory process (NCIP). Study Design This study selected 16 samples from each group. The OLP and OLR followed van der Meij and van der Waal criteria, the leucoplakia and NCIP presented subepithelial chronic inflammatory infiltrate. The ALDH1 expression of the samples was investigated by immunohistochemistry. The percentage of positive cells in the selected fields from the lamina propria were evaluated and categorized in 1 to 3. The final score from each sample was defined as the fields' mean score. Only the cells located at the inflammatory infiltrate were considered. Results The OLP presented a higher median expression of ALDH1 in lamina propria (2.00) than RLO (1.25; p=0.012), leucoplakia (1.32; p=0.027), and NCIP (1.15; p=0.005). Moreover, in 4 RLO samples (25.0%), 6 leucoplakia (37.5%), and 5 NCIP (31.25%), all the evaluated fields showed less than 10% of the cells expressing ALDH1. In OLP, this event did not occur. Conclusion the ALDH1 expression in lamina propria was higher in OLP cases, raising the hypothesis that this protein is involved in an autoimmune response. Funding FAPEMIG To evaluate the differences in ALDH1 expression in lamina propria of oral lichen planus (OLP), oral lichenoid reaction (OLR), leucoplakia, and the nonspecific chronic inflammatory process (NCIP). This study selected 16 samples from each group. The OLP and OLR followed van der Meij and van der Waal criteria, the leucoplakia and NCIP presented subepithelial chronic inflammatory infiltrate. The ALDH1 expression of the samples was investigated by immunohistochemistry. The percentage of positive cells in the selected fields from the lamina propria were evaluated and categorized in 1 to 3. The final score from each sample was defined as the fields' mean score. Only the cells located at the inflammatory infiltrate were considered. The OLP presented a higher median expression of ALDH1 in lamina propria (2.00) than RLO (1.25; p=0.012), leucoplakia (1.32; p=0.027), and NCIP (1.15; p=0.005). Moreover, in 4 RLO samples (25.0%), 6 leucoplakia (37.5%), and 5 NCIP (31.25%), all the evaluated fields showed less than 10% of the cells expressing ALDH1. In OLP, this event did not occur. the ALDH1 expression in lamina propria was higher in OLP cases, raising the hypothesis that this protein is involved in an autoimmune response.

Reaksi Likenoid Sebagai Akibat Penggunaan Obat Antihipertensi pada Rongga Mulut

A lichenoid reaction is commonly finding in the oral cavity. A lichenoid reaction may be caused by systemic drugs. Among the drugs are antihypertensive drugs. The aim of this study is to know the treatment of patient with oral lichenoid reaction. Male patient came into RSGM Unsoed complaining of white patches on the right gums near 3rd molar three months ago. The white patches were painless and approximately 0.5 in diameter. Anamnesis was presenting patients is conducted and has been shown that they take 6 years of antihypertensive drugs and are prescribed by their own physician in the city of Semarang. The patient was then instructed on how to keep the oral hygiene and be evaluated two weeks later. Patients then having a normal tension and were off drugs for the following 2 weeks and got a slightly reduced lesion when it was carried out by control. Treatment of a lichenoid reaction can be done with communication, information, and education about his condition to the patient first. Another conservative treatment of topical corticosteroids is recommended when symptomatic symptoms occur. Treatment of patients with an asymptomatic reaction can be done with communication, information, and education to the patient and drug substitution if perceived as needed. Another treatment that can be taken is by using the topical corticosteroid if the lesion is symptomatic.

Prevalence of and prognostic factors for Candida superinfection in oral lichen planus and lichenoid reactions: A retrospective cohort study.

Oral candidiasis occasionally occurs in patients with oral lichen planus (OLP) or lichenoid reaction (OLR). However, not all patients undergoing corticosteroid therapy develop Candida superinfection. Thus, the identification of prognostic risk factors may help to identify patients at risk of Candida superinfection. A retrospective cohort study was conducted to review patients with OLP/OLR who received steroid therapy at a single dental hospital between January 2016 and December 2021. The prevalence of Candida superinfection and prognostic factors were assessed. Eighty-two eligible patients with OLP/OLR were retrospectively reviewed. The overall prevalence of Candida superinfection during the study period was 35.37%; the median time-to-event between initiation of corticosteroid therapy and diagnosis of superinfection was 60 days (interquartile range; 34-296). The ulcerative type of OLP/OLR, number of topical steroid applications, poor oral hygiene, and oral dryness were significantly associated with superinfection (p < 0.05; Fisher's Exact test) and were identified as prognostic factors in univariable risk ratio regression. Multivariable risk ratio regression revealed the ulcerative type of OLP/OLR and number of topical steroid applications were significant prognostic factors for Candida superinfection in patients with OLP/OLR. Candida superinfection occurs in approximately one-third of patients with OLP/OLR undergoing corticosteroid therapy. Patients with OLP/OLR should be closely monitored in the first 2months (60 days; median time to infection) after steroid prescription. The ulcerative type of OLP/OLR and a higher number of topical steroid applications per day may represent prognostic factors to identify patients at risk of Candida superinfection.

Drug-induced oral lichenoid reactions in patients consuming antihypertensive drugs

Objectives: High blood pressure (HBP) is a persistent and widespread condition, and increasing numbers of patients are taking medication to reduce HBP symptoms and control blood pressure. Patients taking specific antihypertensive medications have been reported to experience oral lichenoid reactions. Various antihypertensive drugs have entered the market, and it is essential to study how they may affect the occurrence of oral lichenoid reactions. This study aimed at assessing the frequency of drug-induced oral lichenoid responses in patients receiving antihypertensive medications.&#x0D; Methods: Four hundred fifty patients who took hypertension medications referring to Seyed al-Shohdai Hospital in Urmia in 2021 were the subject of this cross-sectional study. After the patient's first visit to the hospital, a thorough medical history was obtained from them. The type, dose, and duration of antihypertensive medications taken at the study's time were questioned and documented together with demographic data. The diagnosis of the oral lichenoid reactions was then made by examining the patients. Chi-square and Spearman's correlation tests were used in SPSS version 26 to evaluate the data.&#x0D; Results: Oral lichenoid reaction was observed in about 3.3% of patients. The average age of patients who showed oral lichenoid reaction was 53.7 ± 7.1, they had taken medicine for an average of 1 to 30 months, and 66.7% were female.&#x0D; Conclusions: Patients taking antihypertensive drugs, e.g., hydrochlorothiazide, methyldopa, metoprolol, and propranolol, should be examined and followed up regarding oral lichenoid reactions.

Senescence in oral lichen planus as assessed by the immunohistochemical evaluation of senescence marker protein-30 (Regucalcin).

Oral lichen planus is a T-cell-mediated chronic inflammatory disease affecting approximately 1% to 2% of the population, the etiology of which is currently unknown. The objectives of this study were to observe if senescence occurs in oral lichen planus, through the assessment of the immunohistochemical expression of a novel marker for senescence called Senescence marker protein-30 or regucalcin, and compare the expression to that in oral lichenoid reaction and non-specific inflammation. The study material consisted of 30 cases of oral lichen planus, 15 cases of oral lichenoid reaction and 15 cases of non-specific inflammation. The number of positive cells in ten randomly selected high power fields were counted in the epithelium and the connective tissue separately and the mean was determined. Mann-Whitney U test was used to statistically analyze if there was any significant difference in the expression of Senescence marker protein-30 between oral lichen planus, oral lichenoid reaction and non-specific inflammation. Even though a greater expression was seen in the oral lichen planus cases than oral lichenoid reaction, the difference in both the epithelium and connective tissue was not statistically significant. This study shows that in addition to the already known mechanisms like apoptosis and increased cell proliferation rates, the activated T-lymphocytes may also trigger a senescent change in the cells of oral lichen planus. As with the other mechanisms, this is also seen only in a small proportion of the cases.

Assessment of the Association between Oral Lichenoid Reactions and Amalgam Restorations and to determine the Salivary Concentrations of Interleukin-6 (IL-6) and IL-8 before and after Replacement of the Amalgam Restorations

Assessment of the Association between Oral Lichenoid Reactions and Amalgam Restorations and to determine the Salivary Concentrations of Interleukin-6 (IL-6) and IL-8 before and after Replacement of the Amalgam Restorations

Oral Squamous Cell Carcinoma arising from Lichenoid Contact Reaction: A Case Report

Lichenoid contact reaction is a type of delayed hypersensitivity reaction to constituents derived from dental materials. It may occasionally transform into oral squamous cell carcinoma. A 62-year-male reported with the chief complaint of a wound in the inner aspect of right cheek for 2 weeks. On initial examination, a diffuse erythematous area with interspersed non- scrapable white striae was present on the right buccal mucosa and residual alveolar ridge with respect to 47 extending till gingivobuccal aspect of 45, roughly linear in shape, approximately 3x1 cm2 in size, with a rough overlying surface. Ointment triamcinolone 0.1% was prescribed for 1 week. The patient visited after 3 months. Clinical examination revealed an ulcer with peripheral induration of size approximately 2.5 mm on right buccal mucosa adjacent to 46. An incisional biopsy revealed oral squamous cell carcinoma. Long-term follow-up of patients with oral lichenoid reaction is mandatory for early detection of malignant transformation.

Lymphocyte and CD62E expression in lichen planus and lichenoid reaction

BackgroundIt is difficult to distinguish the clinical and histopathological aspects of oral lichen planus lesions from those of oral lichenoid reaction. Some criteria were proposed to distinguish them, mainly because they have different biological behaviors. The aim of the present study was to compare the lymphocyte population and the expression of E-selectin between these lesions.MethodsParticipants with a clinical diagnosis of oral lichen planus (GOLP) and oral lichenoid reaction (GOLR) who needed to perform a biopsy were selected. The tissue was frozen and immunostaining was performed for CD3/CD4, CD3/CD8, CD4/CLA, CD8/CLA, and CD62E. The analysis of each immunostaining was accomplished using the ImageJ program.ResultsIn total, 25 participants with oral lichen planus and 11 with oral lichenoid reaction were seen. In the evaluation of CD3 + CD4+/CD3 + and CD3 + CD8+/CD3 + proportions, there was a higher percentage of these cells in the oral lichen planus group when compared with the oral lichenoid reaction group (p = 0.027 and p = 0.038 respectively). The average number of CLA + lymphocytes for CD4+/CLA + and CD8+/CLA + in both groups was not statistically significant (p = 0.840; d = 0.363). In GOLP, the number of CD4 + CLA+/E-selectin and CD8 + CLA+/E-selectin was not statistically significant (p = 0.951 and p = 0.454 respectively); neither in GOLR (p = 0.454 and p = 0.989 respectively).ConclusionOur results indicate that CD3 + CD4+, CD3 + CD8+, CD4 + CLA+, CD8 + CLA + lymphocytes and E-selectin are present in both lesions. However, the proportion of CD3 + CD4+/CD3 + and CD3 + CD8/CD3 + cells is higher in the oral lichen planus group when compared with the oral lichenoid reaction group, suggesting that these cells may be important for the etiopathogenic mechanism of these lesions.