Oral lichen planus (OLP) decreases the quality of life because it can cause spontaneous pain during eating and tooth-brushing and an uncomfortable feeling in the mouth. In addition, OLP may be associated with HCV-related liver disease.
We investigated the visual analogue scale (VAS) and effects of oral care gel, REFRECARE-H®, on patients with OLP associated with HCV infection.
Nine OLP patients (mean age 67.9 ± 7.6 years) with HCV-related liver diseases were recruited and their VAS score determined along with a biochemical examination of the blood. Types of OLP included erosive (6 patients) and reticular (3). REFRECARE-H®, an oral care gel (therapeutic dentifrice) containing hinokitiol, was applied by each patient as a thin layer on the oral membrane, after each meal and at bedtime for 30 days. Application of REFRECARE-H® improved the quality of life in all terms of dry mouth, breath odor, oral freshness, oral pain during rest, oral pain at a mealtimes, taste disorder, loss of appetite, sleep disorder, depressive mood and jitteriness. VAS scores of dry mouth, breath odor, oral freshness, and sleep disorder were significantly increased 30 days after application of REFRECARE-H® (P = 0.01, P = 0.05, P = 0.03, P = 0.04). VAS scores of oral pain at a mealtimes and taste disorder were increased 30 days after application of REFRECARE-H® (P = 0.06). There was an absence of side effects.
REFRECARE-H® improved the quality of life for OLP. It is necessary for the hepatologist to educate patients regarding oral hygiene, as well as provide treatment of liver disease.
The aims of this study were to analyze factors motivating the acceptance of interferon (IFN) therapy and to clarify the prevalence of oral mucosal diseases in hepatitis C virus (HCV)-infected Japanese patients treated with IFN.
A total of 94 HCV-infected patients who were admitted to our hospital for IFN therapy were asked questions regarding their motivation to accept IFN therapy and were investigated for the presence of oral lichen planus (OLP) before and during IFN treatment. Recommendation and encouragement from other people were the most common factors motivating the acceptance of IFN therapy (49/94, 52.13%). The other motivators were independent decision (30.85%), economic reasons (5.32%), and others. According to multivariate analysis, three factors – sex (male), retreatment after previous IFN therapy, and independent decision to accept IFN therapy - were associated with patients after curative treatment of hepatocellular carcinoma (HCC). The adjusted odds ratios for these three factors were 26.06, 14.17, and 8.72, respectively. The most common oral mucosal lesions included OLP in 11 cases (11.70%). One patient with OLP had postoperative squamous cell carcinoma of the tongue. The rate of sustained virological response (SVR) was 45.45% in cases with OLP and 54.55% in cases without OLP. There were no patients who discontinued IFN therapy because of side effects such as oral mucosal diseases.
We should give full explanation and recommend a course of treatment for a patient to accept IFN therapy. The system to support liver disease as well as oral diseases is also necessary for patient treated for IFN therapy.
Hepatitis C virus; Interferon therapy; Chronic hepatitis C; Hepatocellular carcinoma; Oral lichen planus
The aims of this study were to assess the prevalence of hepatitis C virus (HCV) infection in Japanese patients with oral lichen planus and identify the impact of amino acid (aa) substitutions in the HCV core region and IFN-sensitivity-determining region (ISDR) of nonstructural protein 5A (NS5A) associated with lichen planus.
In this retrospective study, 59 patients (group 1-A) with oral lichen planus among 226 consecutive patients who visited our hospital and 85 individuals (group 1-B, controls) with normal oral mucosa were investigated for the presence of liver disease and HCV infection. Risk factors for the presence of oral lichen planus were assessed by logistic regression analysis. We compared aa substitutions in the HCV core region (70 and/or 91) and ISDR of NS5A of 12 patients with oral lichen planus (group 2-A) and 7 patients who did not have oral lichen planus (group 2-B) among patients (high viral loads, genotype 1b) who received interferon (IFN) therapy in group1-A.
The prevalence of anti-HCV and HCV RNA was 67.80% (40/59) and 59.32% (35/59), respectively, in group 1-A and 31.76% (27/85) and 16.47% (14/85), respectively, in group 1-B. The prevalence of anti-HCV (P < 0.0001) and HCV RNA (P < 0.0001) in group 1-A was significantly higher than those in group 1-B. According to multivariate analysis, three factors - positivity for HCV RNA, low albumin level (< 4.0 g/dL), and history of smoking - were associated with the development of oral lichen planus. The adjusted odds ratios for these three factors were 6.58, 3.53 and 2.58, respectively, and each was statistically significant. No significant differences in viral factors, such as aa substitutions in the core region and ISDR of NS5A, were detected between the two groups (groups 2-A and -B).
We observed a high prevalence of HCV infection in patients with oral lichen planus. Longstanding HCV infection, hypoalbuminemia, and smoking were significant risk factors for the presence of oral lichen planus in patients. It is advisable for Japanese patients with lichen planus to be tested for HCV infection during medical examination.
The aim of this study was to determine the prevalence of hepatitis B virus and hepatitis C virus (HCV) infections in patients with oral lichen planus (OLP) and to compare it with that of general population.
Materials and Methods:
A total of 60 patients were included in the study. Patients were selected from the outpatient department of Rama Dental College Research Centre, Kanpur, Uttar Pradesh. Thirty patients with OLP were included in Group 1. Thirty age- and sex-matched healthy patients with no history of oral or skin lesions were included in Group 2. Detailed case history, biopsy (the most representative site of the lesion is chosen for specimen), detection of hepatitis B surface antigen (HBsAg), and detection of anti-HCV antibody were carried out.
The serum of the entire study sample (Group 1 and Group 2) was tested for both hepatitis C antibodies and HBsAgs with the enzyme-linked immunosorbent assay (ELISA) test (using the third generation kit). It was found negative for both HBsAgs and hepatitis C antibodies.
In the present study, all the samples including OLP patients and healthy patients were seronegative for both hepatitis B (HBsAg) and hepatitis C (HCV antibody).
Anti-HCV Abs; hepatitis B surface antigen; oral lichen planus; serum
Oral lichen planush (OLP) is a chronic inflammatory disease, and has been reported to have a correlation with hepatitis C virus (HCV) infection in some regional investigations. In this study, we investigated the prevalence of HCV in patients with oral lichen planus in an ethnic Chinese cohort.
The antibody of HCV infection was detected by using enzyme-linked immunosorbent assay. Moreover, the clinical characteristics of whole the cohort have also been studied, such as the gender, age, clinical type, habits and social factors.
Of all 232 patients, the antibody of HCV infection was detected positive in 4 patients (1.72%) using enzyme-linked immunosorbent assay. It was lower than that in control group of 2.5%, but not significant (P=0.309). The positive rate of HCV antibody in the erosive type ones (4.2%) was higher than that in the reticular type ones (1.0%), but this difference was proved to be not significant (P=0.389). The clinical characteristics of whole cohort, such as the gender, age, clinical type, habits and social factors, showed the outcome obtained in the present study were similar to thao of our previous study.
HCV may play no etiological role in oral lichen planus in ethnic Chinese OLP patients.
hepatitis C virus; oral lichen planus; epidemiology; Chinese cohort
T cell signaling is critical in oral lichen planus (OLP) based on the pathogenesis of this chronic inflammatory autoimmune mucocutaneous lesion.
Lck plays a key role in T cell signaling; ultimately this signaling affects other targets such as PI-3K. Excessive activity in PI-3K inhibits
apoptosis and promotes uncontrolled cell growth. Molecular biomarker profiling in OLP, Chronic Interface Mucosities (CIM), Epithelial
Dysplasia (EpD) and Oral Squamous Cell Carcinoma (SCCA) with application of the principle of biomarker voting may represent a new frontier
in the diagnosis, assessment and the arguable debate of OLP transformation to cancer. The presence of Lck, PI-3K and Survivin, a cancer specific
anti-apoptotic protein was assessed, using immunohistochemistry and tissue micro-array on patient samples, in OLP, SCCA, CIM and EpD. Lck
expression was very high in 78.6 % of OLP patients compared to 3.7% in SCCA; PI-3K was high in 63% of SCCA, 100% of EpD, and 35.7%
OLP cases. Survivin was high in 64.3% of OLP cases, 96.3% of SCCA, and 100% of EpD. CIM cases may be slightly different molecularly to
OLP. Taken together, our data suggest that biomarker protein voting can be effectively used to isolate high-risk OLP cases. Specifically, we
show data with four remarkable cases demonstrating that molecular factors are predictive of histopathology. We conclude that it is safer to treat
OLP as premalignant lesions, to adopt aggressive treatment measure in histopathologic described well and moderately differentiated SCCA, and
to monitor progress of these diseases molecularly using individualized auto-proteomic approach. The use of Lck inhibitors in OLP management
needs to be investigated in the future.
oral carcinoma; biomarker; cancer; cellular immunity
Several different kinds of drugs have been used to treat chronic oral lichen planus (OLP). During the last decade, there have been several reports demonstrating success with levamisole and low dose prednisolone therapy for treating OLP. However, some OLP patients who have underlying diseases such as diabetes, hypertension and malignancy are unable to take steroids.
The aim of this study was to evaluate levamisole monotherapy for treating OLP.
Eleven patients who had OLP were treated with levamisole between 2005 and 2007. The levamisole was administered at a dose 50 mg thrice daily for three consecutive days, but then it was not administered on the following four days.
After 2 weeks of treatment, 8 patients reported a partial response, 3 patients reported no response and no patients reported clearance of lesion. After 4 weeks of treatment, 6 patients reported a partial response, 3 patients reported no response and 2 patients reported clearance of lesion. Furthermore, after 3 months of treatment, 3 patients reported a partial response, 3 patients reported no response and 5 patients reported complete clearance of lesion. Clinical improvement was shown in 2 weeks, whilst the mean duration to achieve clearance of lesion was 6.2 weeks. Although 1 patient had mild itching, there were no significant adverse effects.
Levamisole monotherapy could be a successful and safe treatment option for patients with chronic OLP and who cannot take steroids.
Levamisole; Oral lichen planus (OLP)
Background and aims
Lichen planus is a relatively common mucocutaneous disease, with an unknown etiology. There is no complete cure for oral lichen planus (OLP), but some drugs, including corticosteroids, retinoids, cyclosporine and antibiotics are commonly used for treatment of OLP. The aim of the present study was to compare the effect of combi-nation of triamcinolone and vitamin A mouthwash with triamcinolone mouthwash alone on OLP.
Materials and methods
Twenty OLP patients were randomly divided into two groups of 10. The experimental group was treated with combination of triamcinolone and vitamin A mouthwash and the control group was treated with triamcinolone-containing mouthwash alone. The patients were examined once every two weeks and the lesion size, pain and burning sensation were recorded based on visual analogue scale during a two-month period. Data were analyzed by Mann-Whitney U test using SPSS software.
The use of combination of triamcinolone-vitamin A mouthwash was effective in decreasing the pain and burning sensation of OLP (P = 0.012). Decrease in pain and burning sensation were similar in both groups (P = 0.73). The use of combination of triamcinolone-vitamin A mouthwash led to a decrease in the size of keratotic, atrophic and erosive OLP lesions (P = 0). Decrease in the size of the lesions was significantly greater in the study group compared to the control group (P = 0.029).
The use of combination of triamcinolone-vitamin A mouthwash is effective in decreasing the size of keratotic, atrophic or erosive lesions.
Mouthwash; oral lichen planus; triamcinolone; vitamin A
To determine the possibility of any association between HBV, HCV, elevated aminotransferase enzymes and Oral Lichen Planus (OLP)patients in Eastern Saudi Arabia.
Sera were collected from OLP patients, to be tested for HbsAg, anti-HCV and ALT/AST levels.
All the patients who were diagnosed clinically in periodontal section, Dammam Central Hospital were from Eastern Saudi Arabia. The histopathological diagnosis was done in Histopathology Section, Dammam Regional Labs, the virological studies in the Virus Diagnosis Lab of Dammam Regional Labs and Blood Bank, and the aminotransferase tests done in the Dammam Central Hospital Labs.
34 serum specimens were collected from OLP patients, and 32 other samples from healthy populations of the same age and sex as the controls of the study.
Incidence of HBsAg, anti-HCV, HBsAg+HCV, and elevated aminotransferase enzymes among OLP patients were 8.8%, 14.7%, 2.9%, and 47.05% respectively and the results from the control subjects were 6.25%, 3.12%, 0%, and 3.12% respectively.
There is a significant association between OLP and HCV infection. No clear evidence of this relationship appeared with HBV. All the aminotransferase elevated samples were positive to HCV, giving a clear evidence of the association of chronic HCV infection with the OLP. Aminotransferase elevated results could be used as a clue to clinical signs of asymptomatic hepatopathies, and as a marker to check the OLP cases for the relevant Hepatic Viruses. Despite the limited number of OLP patients in this study, the results could highlight the problem in this geographical area of the world. We recommend a comprehensive study to be carried out using this current study as a preliminary one.
Oral Lichen Planus (OLP); Hepatitis C Virus (HCV); Hepatitis B Virus (HBV); Aminotransferase; Saudi Arabia
Background and aims
The clinical management of oral lichen planus poses considerable difficulties to the clinician. In recent years, researchers have focused on the presence of pathogenic microorganisms such as Candida albicans in the patients with refractory lichen planus. The aim of the present study was to investigate the prevalence of candida species in the erosive oral lichen planus lesions.
Materials and methods
Twenty-one patients with erosive oral lichen planus and twenty-one healthy individuals aged 18-60 were randomly selected; samples were taken from the tongue, saliva and buccal mucosa with swab friction. Theses samples were sent to the laboratory for determining the presence of candida species in cultures and direct examination method.
No significant difference was found between healthy individuals and patients with erosive lichen planus regard-ing presence of candida species. The type of candida in the evaluated samples was Candida albicans in both healthy and patient groups.
According to the results, candida was not confirmed as an etiologic factor for erosive lichen planus lesions.
Candida; erosive lichen planus; etiology
OBJECTIVE: Oral lichen planus (OLP) is chronic inflammatory disease of the oral mucosa, presenting in various clinical forms. The etiology of OLP is still unknown but mounting evidence points to the immunologic basis of this disorder. AIM: Our study was undertaken to quantify the salivary levels of pro-inflammatory tumor necrosis factor-alpha (TNF-alpha) in the reticular and the erosive/atrophic forms of OLP, compared with age-matched healthy control volunteers. SUBJECTS AND METHODS: Whole saliva from 40 patients with active lesions of OLP, as well as from 20 healthy persons, was investigated for the presence of TNF-alpha by enzyme immunoassay. RESULTS: Salivary TNF-alpha levels were significantly increased in patients with OLP in comparison with healthy subjects. The presence of TNF-alpha showed positive correlation to clinical forms of OLP, being significantly higher in the erosive/atrophic type than in the reticular type of disease. CONCLUSION: Saliva provides an ideal medium for the detection of pro-inflammatory markers of the oral cavity. In patients with OLP, TNF-alpha levels in saliva are elevated, correlating with the severity of illness. Salivary TNF-alpha analysis may be a useful diagnostic tool and a potential prognostic marker in OLP.
OLP is a relatively common immune-mediated mucosal condition with a predilection for middle-aged women. Although classified as a premalignant condition, this classification remains controversial. Using stringent diagnostic criteria, some authors have found that OLP patients are not at increased risk for oral SCC. Credible but limited genetic evidence also indicates that epithelial tissues from OLP patients diagnosed using stringent criteria differs from premalignant or malignant oral lesions but is similar to epithelium from benign oral lesions. To further investigate this genetic line of evidence, biopsy specimens diagnosed as fibroma, OLP, low-grade dysplasia, high-grade dysplasia, and SCC were retrieved from the archives of the Oral Pathology Consultants at the Ohio State University. Using laser capture microdissection, tissue of interest was captured from each case and DNA subsequently extracted. Fluorescently labeled PCR primers were used to amplify DNA at 3 tumor suppressor gene loci (3p14.2, 9p21, and 17p13) and evaluated for LOH or microsatellite instability (MSI). OLP was found to be significantly different from low-grade dysplasia, high-grade dysplasia, and SCC when LOH/MSI was found at more than 1 loci (P = .011, P = .032, P = .003), but not different from benign fibromas (P = .395). In agreement with previous studies, well-documented cases of OLP diagnosed using stringent criteria exhibit a genetic profile more similar to a benign or reactive process than a premalignant/malignant one. These findings do not support the classification of OLP as a premalignant condition.
Oral lichen planus (OLP) is a chronic autoimmune disease characterized by multiple clinical presentations and a relatively high prevalence in the population. This retrospective patient record study investigated the profile of OLP in a group of Brazilian patients seen between 1989 and 2009.
The clinical records were analyzed and data such as gender, age, race, clinical presentation of OLP, site affected, presence of symptoms and extraoral manifestations of the disease, smoking habit, and consumption of alcoholic beverages were obtained. Among the 1822 records of patients with oral mucosal lesions, OLP was identified in 6.03%. Of these, 76.36% were females, with a mean age of 54 years, and 85% were whites. The reticular form was the most frequent (81.81%). Extraoral lesions were observed in 32.72% of the patients and painful symptoms were reported by 50.90%. The cheek mucosa was the site most affected (92.72%) and multiple oral lesions were observed in 77.27% of the patients. Among patients with OLP, 18.18% reported a smoking habit and 29.09% the consumption of alcoholic beverages.
This retrospective study showed a relatively high prevalence of OLP in the population studied, with a predominance of the disease among middle-aged white women and bilateral involvement of the cheek mucosa. Reticular lesions were the most frequent, followed by the erosive form which is mainly associated with painful symptoms. No relationship with tobacco or alcohol consumption was observed.
Endothelin-1 (ET-1) is a potent vasoconstrictor involved not only in vascular biology but also in carcinogenesis. Results of a study in 2007 suggested salivary ET-1 as a potential biomarker for oral squamous cell carcinoma (OSCC), but a later study showed conflicting results. The purpose of our pilot study was to investigate feasibility of using salivary ET-1 as a biomarker for OSCC in two groups: oral lichen planus (OLP) patients and patients with OSCC in remission.
Materials and Methods
Saliva samples were collected from five groups of subjects: patients with newly diagnosed, active OSCC (Group A); patients with OSCC in remission (Group B); patients with active OLP lesions (Group C); patients with OLP in remission (Group D); and normal controls (Group E). Salivary ET-1 levels were determined by enzyme-linked immunosorbent assay, and the results were analyzed by the Mann Whitney U test.
The mean salivary ET-1 level in Group A was significantly higher than that found in Group C (p=0.001), Group D (p=0.015) or Group E (p=0.004). There were no significant differences (p>0.05) in the mean salivary ET-1 levels between Groups A and B; Groups B and C; Groups B and D; Groups B and E; Groups C and D; Groups C and E; or Groups D and E.
Salivary ET-1 could be a good biomarker for OSCC development in OLP patients regardless of the degree of OLP disease activity. However, it appeared not to be a good biomarker for detecting recurrence of OSCC in patients in remission.
Oral cancer; oral squamous cell carcinoma; saliva; endothelin; ET-1; lichen planus; biomarker
The association of lichen planus with hepatitis C (HCV) has been widely reported in the literature. However, there are wide geographical variations in the reported prevalence of HCV infection in patients with lichen planus. This study was conducted to determine the frequency of hepatitis C in Iranian patients with lichen planus at Razi hospital, Tehran.
During the years 1997 and 1998, 146 cases of lichen planus, 78 (53.1%) women and 69 (46.9%) men were diagnosed. They were diagnosed on the basis of the usual clinical features and, if necessary, typical histological findings. The patients were screened for the presence of anti-HCV antibodies by third generation ELISA and liver function tests. We used the results from screening of blood donors for anti HCV (carried out by Iranian Blood Transfusion Organization) for comparison as the control group.
Anti-HCV antibodies were detected in seven cases (4.8%). This was significantly higher than that of the blood donors' antibodies (p < 0.001). The odds ratio was 50.37(21.45–112.24). A statistically significant association was demonstrated between erosive lichen planus and HCV infection. Liver function tests were not significantly different between HCV infected and non-infected patients.
HCV apears to have an etiologic role for lichen planus in Iranian patients. On the other hand, liver function tests are not good screening means for HCV infection.
Lichen planus; Hepatitis C; Epidemiology
Lichen planus is a chronic inflammatory mucocutaneous disease. Mucosal lesions are classified into six clinical forms and there is malignant potential for two forms of OLP; therefore, follow-up should be considered. There are many un-established etiological factors for OLP and some different treatment modalities are based on etiology. The aims of current OLP therapy are to eliminate mucosal erythema and ulceration, alleviate symptoms and reduce the risk of oral cancer. We have used review papers, case reports, cohort studies, and case-and-control studies published from 1985 to 2010 to prepare this review of literature.
Oral lichen planus; literature review; clinical features; therapy
Background. Oral lichen planus (OLP) is a common chronic inflammatory immune-mediated disease, with an etiopathogenesis associated with cell-mediated immunological dysfunction. Viral infection has been hypothesized as a predisposing factor in the pathogenesis of this disease. Viruses may alter host cell function by inducing the abnormal expression of cellular proteins leading to disease development. However, reports on the relationship between human papillomavirus (HPV) and OLP are inconclusive. Objective. To explore the association between HPV and OLP in Thai patients. Materials and Methods. DNA was extracted from thirty-seven fresh-frozen tissue biopsy specimens from OLP lesions, and polymerase chain reaction assay for the L1 and E1 genes covering 32 types of high- and low-risk HPV was performed. Results. HPV DNA was detected in one tissue biopsy from an atrophic-type OLP lesion. All control samples were negative. Genomic sequencing of the E1 gene PCR product demonstrated that the HPV-type 16 found in the lesion is closely related to the East Asian type. Conclusion. Our data indicate a low prevalence of HPV infection in OLP lesions in Thai patients.
Background and aims
Oral lichen planus (OLP) is a common chronic mucocutaneous disease. Patients with atrophic and erosive lichen planus often have symptoms of soreness and need proper treatment. The main therapy of OLP has been the administration of topical or systemic corticosteroids. Potent topical corticosteroids have been increasingly prescribed in the treatment of erosive lichen planus. The purpose of this study was to compare the efficacy of adcortyl ointment (triamcinolone in orabase) with topical tacrolimus for the treatment of erosive oral lichen planus.
Materials and methods
Sixty Patients with histopathologically confirmed oral lichen planus were enrolled in the study. The severity of lesions was scored from 0 to 5 according to the criteria
described in a previous study. Patients were randomly given adcortyl (group A) and topical tacrolimus ointment (group B) and asked to apply the medication on dried lesions 4 times a day. The lesions were evaluated after 4 weeks of treatment. Visual analogue scale was used to assess the severity of pain before and after treatment. The severity scores were analyzed using the Kruskal-Wallis k-sample test.
The average score of lesions improved from 3.4 to 1.5 in patients who received adcortyl ointment and from 3.2 to 1.2 in patients who received topical tacrolimus ointment. The differences between the im-provements in scores were not statistically significant in the two groups. The average pain severity in A and B groups was 8.2 and 7.8 at the beginning of treatment, and 3.5 and 3.2 at the end of treatment, respectively. There was a statistically significant reduction in pain severity in both groups.
Topical tacrolimus is a safe and effective alternative therapy in the treatment of oral lichen planus.
Adcortyl; Lichen Planus; Sore-ness; Tacrolimus; Triamcinolone
The study objective was clinical assessment of the efficacy of photodynamic therapy (PDT) in the treatment of oral lichen planus (OLP). There were 23 patients aged 31–82 included in the study with oral lichen planus diagnosed clinically and histopathologically. In all patients photodynamic therapy was performed with the use of chlorin e6 (Photolon®), containing 20 % chlorin e6 and 10 % dimethyl sulfoxide as a photosensitizer. PDT was performed using a semiconductor laser, with power up to 300 mW and a wavelength of 660 nm. A series of illumination sessions was conducted with the use of superficial light energy density of 90 J/cm2. Changes of lesion size were monitored at one, two, five, and ten PDT appointments from the series of ten according to the authors' own method. The sizes of clinical OLP lesions exposed to PDT were reduced significantly (on average by 55 %). The best effects were observed for the lesions on the lining mucosa (57.6 %). The therapy was statistically significantly less effective when masticatory mucosa was affected (reduction, 30.0 %). Due to substantial efficacy and noninvasiveness, PDT can be useful in the treatment of OLP lesions.
Oral lichen planus; Photodynamic therapy
The purpose of this study was to investigate the efficacy and safety of 0.1% tacrolimus powder in Oraguard-B for the treatment of patients with symptomatic oral lichen planus (OLP).
This was a nonrandomized, nonblinded study conducted in the outpatient department. The 20 patients with symptomatic OLP oral lichen planus who were asked to participate in the study were provided with 20-g containers of the study medication. Patients were asked to use the medication over the symptomatic areas three times a day until resolution of the lesion. Patients were recalled to assess the drug response every 15 days.
The duration of treatment ranged from 30 to 183 days, with a mean of 81.8 ± 44.4 days; all 20 patients reported a favourable response to the topical tacrolimus therapy. Eleven patients had complete resolution of their lesions. In 16 of 20 patients, there was marked resolution in symptoms as recorded by visual analogue scale. Out of 10 patients followed up for a period of 3 months, 5 had recurrence of their lesions but with less intensity, and the patients were symptomless. No serious side effects were associated with the study medication.
Topical tacrolimus 0.1% in Oraguard-B was effective and safe in treating patients with OLP. However, there is still a need to undertake more detailed and objective clinical studies to determine the exact benefit of tacrolimus compared with conventional therapies and examine the influence of different dose regimes and formulations and assess the incidence of recurrence.
Oral lichen planus; Topical tacrolimus; Oraguard-B
Recent attention has been directed toward the role of mast cells in the pathogenesis of oral lichen planus. Mast cells are responsible for trafficking inflammatory cells into the connective tissue that in turn helps in progression and maintenance of chronicity of oral lichen planus (OLP). OLP is a T-cell-mediated chronic inflammatory oral mucosal disease of unknown etiology, and lesions contain few B-cells or plasma cells and minimal deposits of immunoglobulin or complement. Hence, OLP is ideally positioned for the study of human T-cell-mediated inflammation and autoimmunity. This study was done to evaluate the mast cell count using toluidine blue stain in OLP and compares it with oral lichenoid reaction (OLR), and to propose the possible role of mast cells in the pathogenesis of OLP and OLR. Ten cases each of OLP and OLR and five cases of normal buccal mucosa were taken from the archives of Department of Oral Pathology. The samples were stained with toluidine blue using standard toluidine blue method by Wolman 1971. An increase in mast cell count was observed in OLP and OLR in comparison to normal oral mucosa. However, no significant differences in mast cell count were noted between OLP and OLR.
Lichen planus; lichenoid reaction; mast cells
Background: Oral lichen planus (OLP) is a chronic inflammatory condition. Clinically, it is characterised by the presence of a white lace-like lesion on the buccal mucosa, tongue, and gingivae, with erosions and ulceration. The World Health Organisation considers OLP to be a premalignant condition.
Aims: To investigate expression of the telomerase RNA component (hTR) in OLP compared with normal control buccal mucosa and to assess the possibility of using hTR expression as a marker for malignant transformation in OLP.
Methods: hTR expression was analysed in 40 cases of OLP and 18 normal control buccal mucosa samples using an RNA in situ hybridisation approach.
Results: Strong hTR RNA expression was seen in the basal, suprabasal, and to a lesser extent in the upper epithelial layers in 36 of the 40 OLP lesions examined. Infiltrating subepithelial lymphocytes in OLP were also shown to express hTR RNA. Weak hTR RNA expression was seen in seven of the 18 normal control buccal mucosa specimens, with expression confined exclusively to the basal layer of the epithelium and absent in the suprabasal and upper layers.
Conclusion: The telomerase RNA component hTR is found to be highly expressed in the epithelium of non-dysplastic OLP lesions. It is possible that this high expression is related to the increased cellular proliferation seen in OLP lesions rather than being an indicator of susceptibility to malignancy. Thus, hTR RNA expression may not be a suitable marker for predicting malignant transformation in OLP.
oral lichen planus; RNA in situ hybridisation; telomerase; malignant transformation
Objective: The purpose of this study was to detect and enumerate T cells secreting type 1 and 2 cytokines in the peripheral blood of patients with oral lichen planus (OLP) and in healthy controls.
Subjects and Methods: The study group consisted of 80 OLP patients and 80 healthy individuals. Cytokine secreting T cells were detected using ELISPOT assay.
Results: There was a statistically significant decrease (p<0.05) in the number of IFN– and IL–12 secreting cells in the peripheral blood of patients with OLP compared to the controls. No statistical difference was observed in the number of IL–2 and TNF–a secreting cells between OLP patients and controls (p>0.05). Also there was no significant difference in the numbers of IFN–γ, IL–12, IL–2 and TNF–a secreting cells between reticular and erosive forms of OLP (p>0.05).
As regards type 2 cytokines, the number of IL–5 and IL–10 secreting cells was significantly decreased in OLP patients compared to the healthy control group (p<0.05). No statistical difference was observed in the number of IL–6 secreting cells between OLP patients and control group (p>0.05). Similarly, no statistical difference was observed in the number of IL–4 secreting cells between OLP patients and controls (p>0.05). No significant difference was also found in the numbers of IL–4, IL–5, IL–10 and IL–6 secreting cells between reticular and erosive OLP group.
Conclusion: These data suggest decreased type 1 and type 2 cytokine production (except IL–4) in OLP patients.
T helper cells; type 1 cytokine; type 2 cytokines; peripheral blood; oral lichen planus
Oral lichen planus (OLP) is a relatively common inflammatory mucocutaneous disorder that frequently involves the oral mucosa. The clinical presentation of OLP ranges from mild painless white keratotic lesions to painful erosions and ulcerations. An important complication of OLP is the development of oral squamous cell carcinoma, which led the World Health Organization (WHO) to classify OLP as a potentially malignant disorder. The demographic and clinical characteristics of OLP have been well-described in several relatively large series from developed countries, whereas such series from developing countries are rare.
The objective of this retrospective study was to investigate the epidemiological and clinical characteristics of 128 OLP patients in rural population of India.
Materials and Methods:
In this study, the diagnostic criteria proposed by van der Meij et al. in 2003 based on the WHO definition of OLP were used to identify cases.
In 128 patients, M:F ratio was 1.61:1. The buccal mucosa was the most common site (88.20%). White lichen was seen in 83.59% and red lichen in 16.40% cases. Reticular type of OLP was the most common form (83.5%) followed by erosive (15.6%) and atrophic OLP (0.78%). The incidence of systemic diseases included hypertension (11%), diabetes mellitus (2.4%), and hypothyroidism (0.78%). Histopathologically epithelial dysplasia was present in 4 cases.
Most of the characteristics are consistent with previous studies with differences in few. Lichen planus is a chronic disease where treatment is directed to control of symptoms. Long-term follow-up is essential to monitor for symptomatic flare ups and possible malignant transformation.
Clinical features; lichen planus; oral mucosa
Oral lichen planus (OLP) is a common chronic inflammatory mucocutaneous disease. Clinical diagnosis of OLP requires clinical work-up and histologic examination to rule out possible dysplasia and carcinoma. It is possible that oral mucosal viral infections including HPV infection may have a causative role in OLP pathogenesis. The aim of this study was to examine the coincidence of human papilloma virus type 18 and oral lichen planus.
This study was a case-control study. Twenty nine paraffinized specimens of previously diagnosed oral lichen planus and 14 paraffinized specimens of nonpathogenic mucosa were studied. Polymerase Chain Reaction (PCR) analyze used for detection of DNA HPV 18. The data were analyzed with SPSS software and Fisher’s exact test was used to find the possible relation between HPV18 infection and oral lichen planus.
Nine out of 29 (31.0%) lichen planus samples and one out of 14 (7.1%) controls were HPV 18 positive. No significant correlation (P = 0.128) was observed between HPV18 infection and oral lichen planus.
According to the findings there might be a co-incidence of human papilloma virus type 18 and oral lichen planus.
Human papillomavirus 18; Lichen Planus; Oral; Polymerase chain reaction