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口腔扁平苔藓(oral lichen planus,OLP)是一种常见的口腔黏膜病,好发于女性,尤以30~60岁中年女性最为常见。目前对OLP的治疗尚无特效方法。本研究采用局部微波热凝技术联合小剂量氯喹口服治疗OLP,经过临床观察、随访,取得比较满意疗效。报道如下。     

Therapeutic Hotline: Treatment of prurigo nodularis and lichen simplex chronicus with gabapentin

Psychocutaneous conditions are frequently encountered in dermatology practice. Prurigo nodularis and lichen simplex chronicus are two frustrating conditions that are classified in this category. They are often refractory to classical treatment with topical corticosteroids and antihistamines. Severe, generalized exacerbations require systemic therapy. Phototherapy, erythromycine, retinoids, cyclosporine, azathiopurine, naltrexone, and psychopharmacologic agents (pimozide, selective serotonin reuptake inhibitor antidepressants) were tried with some success. Here five cases with lichen simplex chronicus and four cases with prurigo nodularis, who responded well to gabapentin, are presented.     

Role of TP53 in the progression of pre-malignant and malignant oral mucosal lesions. A follow-up study of 144 patients

Background:  Prediction of progression from pre-malignant oral mucosal lesions to malignancy, or recurrence of an existing oral squamous cell carcinoma (OSCC), is an important clinical problem in oral medicine.
Methods:  This study presents a follow-up of a study published in 2002. Samples from 54 patients with OSCC, 45 with oral lichen planus (OLP) and 45 with hyperkeratosis (clinically leukoplakia), diagnosed between 1987 and 1996, were analysed for TP53 protein expression and TP53 mutation. Follow-up was 11–17 years for OSCC (mean 13.3), 12–22 years for OLP (mean 15.9) and 12–17 years for hyperkeratosis (mean 14.5).
Results:  Of the 54 OSCC patients, 28 experienced recurrent disease, 21 died of OSCC, 22 died of other causes. Of the 14 OSCC patients with mutated TP53 ( n  = 11), the cancer recurred in eight (57%) and in 20/39 (51%) without mutation. Expression of TP53 protein was significantly associated with reduced overall survival. Among OLP patients, nine were TP53- mutated out of 31 tested. One TP53- mutated OLP patient developed OSCC in a different site. Of the hyperkeratosis patients, three were mutated of 22 tested. One hyperkeratosis patient (non-mutated) developed OSCC in the same site.
Conclusion:  TP53 mutations can exist in benign oral mucosal lesions for many years without progression to malignancy. No association was found between TP53 protein expression or TP53 mutation and recurrence of OSCC or disease-related survival. Overall survival was reduced in patients with positive TP53 protein expression.     

Lichen Sclerosis is Associated With a High Rate of Local Failure After Radio(chemo)therapy for Vulvar Cancer

AimsRadio(chemo)therapy plays an important role in the treatment of vulvar cancer, either as postoperative treatment or as definitive treatment in patients who present with inoperable disease. Only limited data are available regarding outcome after modern state of the art radio(chemo)therapy and more information regarding prognostic factors are warranted. The aim of this study was to evaluate disease outcomes after radio(chemo)therapy in patients with vulvar cancer with special emphasis on the impact of lichen sclerosis on local control.Materials and methodsAll consecutive patients (n = 109) from the western half of Denmark who were treated with definitive (n = 52) or postoperative (n = 57) radio(chemo)therapy between January 2013 and January 2020 were included. Local control, cause-specific survival and overall survival, as well as morbidity, were analysed using Kaplan–Meier statistics. Prognostic factors for local control were analysed in univariate and multivariate analysis.ResultsAt a median follow-up of 35 (4–95) months, 46 (42.0%) patients were diagnosed with recurrence. Eighty per cent of the recurrences were located to the vulva region, leading to a 5-year local control of 58.9% (confidence interval 47.9–69.9). Cause-specific survival was 62.9% (confidence interval 53.1–72.7), whereas overall survival was 58.0% (confidence interval 47.6–68.5). Grade 3–4 morbidity was diagnosed in 10 (9%) patients. Lichen sclerosis (hazard ratio 3.89; confidence interval 1.93–7.79) was an independent risk factors for local recurrence. Patients without lichen sclerosis had a 5-year local control rate of 83.6% (confidence interval 67.2–99.0) and 62.6% (confidence interval 43.2–82.0) after postoperative and definitive radio(chemo)therapy, respectively. In patients with lichen sclerosis, the local control rate was 44.0% (confidence interval 19.3–69.0) and 17.6% (confidence interval 0–30.0) after postoperative and definitive radio(chemo)therapy, respectively.ConclusionRadio(chemo)therapy plays an important role in the treatment of vulvar cancer. However, despite dose escalation, a substantial proportion of patients experienced local relapse. Pre-existing lichen sclerosis seems to have a significant impact on the risk of recurrence. This should influence surveillance programmes for these patients.     

复方甘菊利多卡因凝胶和地塞米松联用局部治疗扁平苔藓的疗效

目的观察和评价复方甘菊利多卡因凝胶和地塞米松(肾上腺皮质激素药)联用局部治疗口腔扁平苔藓的疗效。方法选择扁平苔藓患者240例,随机分成4组:A组患者用地塞米松粉剂(0.75mg)与复方甘菊利多卡因凝胶(1cm)混合均匀后,患处涂抹;B组患者用地塞米松粉剂(0.75mg)在患处涂抹;C组患者用复方甘菊利多卡因凝胶(1cm)患处涂抹;D组患者用口腔溃疡膏(1mg)在患处涂抹。观察1～4周,观察有效率、糜烂和白色斑纹面积的变化以及愈合时间。结果A组有效率明显高于其他组;非糜烂型患者的白色斑纹面积的变化也明显高于其他组(80.0±3.4)mm2;临床痊愈时间明显的小于其他组(3.0±1.4)周,均具有统计学意义。B组糜烂面积的变化明显高于其他组(78.0±5.6)mm2,具有统计学意义。结论复方甘菊利多卡因凝胶和地塞米松局部联用治疗非糜烂型口腔扁平苔藓具有良好的临床疗效。     

人口腔扁平苔藓角质形成细胞的体外培养及生物学鉴定

目的建立人口腔扁平苔藓（orallichenplanus，OLP）角质形成细胞体外培养方法，观察其生物学特性。方法选择组织病理学确诊的OLP患者黏膜组织，无血清角化细胞培养基进行体外原代及传代培养，倒置相差显微镜下观察细胞形态学变化，角蛋白间接免疫荧光鉴定和电镜观察细胞超微结构。结果成功培养了Ⅰ型OLP（网状、斑块型）角质形成细胞，连续传代5～6代，整个细胞生长期间为单一的角质形成细胞，呈典型的铺路石状。角蛋白间接免疫荧光反应阳性，透射电镜显示：细胞胞浆内可见大量的空泡性结构，与OLP的病理学特征一致，能够鉴定我们培养的细胞为OLP角质形成细胞。结论本研究成功建立了体外培养人OLP角质形成细胞的方法，为人OLP细胞模型的建立打下坚实基础。     

Desquamative gingivitis: a sign of mucocutaneous disorders--a review

Desquamative gingivitis is a clinical term to describe red, painful, glazed and friable gingivae which may be a manifestation of some mucocutaneous conditions such as lichen planus or the vesiculobullous disorders. It is important to be aware of this rare clinical entity so as to distinguish desquamative gingivitis from plaque induced gingivitis which is an extremely common condition, easily recognized and treated daily by the dental practitioner. This article gives an overview of desquamative gingivitis, its presentation, the possible causes, diagnosis and treatment. Early recognition of these lesions may prevent delayed diagnosis and inappropriate treatment of potentially serious dermatological diseases.