Oral lichen planus: Malignant potential and diagnosis

Oral lichen planus (OLP) is one of the most common diseases of the oral mucosa. Clinically, it has specific and clearly identifiable features; bilateral symmetric presentation showing a lace-like network of fine white lines (known as Wickham's striae) is an essential element of OLP even if the lesion exhibits a mainly atrophic and erosive pattern. There are various lesions that resemble OLP clinically and histologically. These lesions are widely referred to as lichenoid reactions or lichenoid lesions (OLLs). OLLs include contact hypersensitivity to dental materials, drug-induced lichenoid lesions, lichenoid reactions in chronic graft-versus-host disease, and other lesions that resemble OLP. The risk of malignant transformation of OLP is the subject of ongoing debate in the literature. Some authors have suggested that only OLLs, but not OLP, are of a premalignant nature and thus, should be categorized as “other dysplastic conditions.” Contrary to this suggestion, many cases of oral squamous cell carcinoma (OSCC) developing in patients with OLP presenting with no epithelial dysplasia have been reported. In addition, it has been reported that multiple events including multifocal dysplasia and/or OSCC subsequently occurred in some patients with OLP, suggesting possible field cancerization in OLP. In this paper, differential diagnosis between OLP and OLLs and their malignant potential are reviewed.     

Oral lichen planus: Focus on etiopathogenesis

Lichen planus is a chronic mucocutaneous inflammatory disease, which frequently affects the oral mucosa of white females over 40 years old. Its aetiology remains uncertain and the pathogenesis is still the object of much speculation. The present paper presents the most well known antigens, and describes the action of different cells and proteins associated with the development of that disease, as well as the possible agents involved with its malignant transformation. Different external agents, especially virus, and internal agents, like stress, and the heat shock protein antigen expression, associated or not, can alter the basal keratinocytes of the oral mucosa making them susceptible to apoptosis by CD8⁺ cytotoxic T cell as well as activate matrix metalloproteinase and mast cell degranulation, which produce a great range of inflammatory mediators and cytokines determining the clinical onset of the disease. Regarding carcinogenesis, since it is a complex process and presents multifactorial origin, it is believed that there may be a synergism between intrinsic, such as inflammation mediators, and extrinsic agents (tobacco, alcohol, viral infections) for the OLP malignant transformation to occur. However, further studies are needed to better understand the origin, pathogenesis and process of malignant transformation of OLP.     

口腔扁平苔藓合并食道扁平苔藓的诊治及相关文献复习

目的总结分析口腔扁平苔藓（OLP）合并食道扁平苔藓（ELP）的临床发生率、诊出方法、治疗和恶变倾向。 方法对236例OLP确诊患者,根据主诉及问诊有胸部不适、胸前灼痛、烧灼感、吞咽困难、食道狭窄、进食不畅等症状,获得知情同意后进一步进行食道胃镜检查及病理活检,筛选合并ELP,进行规范治疗和追踪。 结果18例出现了ELP病损,OLP合并出现ELP发生率为7.6%（18/236）。其中2例11.1%（2/18）早于OLP出现食道非典型增生,1例5.5%（1/18）已早于OLP出现恶变为食道鳞状细胞癌。 结论扁平苔藓是全身性疾病,ELP和OLP均属于黏膜的慢性炎症性疾病,两者间存在关联性。口腔科医生接诊OLP患者时,应该关注其全身其他部位的病损,尽早发现其他部位早期而隐匿的恶变,以免造成误诊和漏诊。     

口腔扁平苔藓单核/巨噬细胞功能的研究

目的：探讨单核／巨噬细胞在口腔扁平苔藓中的作用。方法：利用细胞增殖法检测OLP患者外周血中单核／巨噬细胞的ADCC效应。结果：OLP患者单核／巨噬细胞的ADCC效应明显低于对照组。结论：说明OLP患者存在着免疫功能低下，同时支持OLP可能为免疫功能低下性疾病。     

Probiotics: A non-conventional therapy for oral lichen planus

Oral lichen planus (OLP) is a common T-cell mediated chronic inflammatory disease. Although the etiology is still unclear, present studies suggest that the composition of the oral microbiota and psychological problems are implicated in the etiology of OLP. The pathogenesis of OLP includes mainly antigen-specific and non-specific mechanisms. Antigen-specific mechanisms involve T-cell activation following antigen presentation and apoptosis of basal keratinocytes triggered by CD8⁺ cytotoxic T cells, while non-specific mechanisms consist of matrix metalloproteinase over-expression and mast cell degranulation in OLP lesions. Therapies for OLP are mainly used to control symptoms and a specific cure is not yet available. Probiotics are capable of modulating the immune response in a strain-specific manner. They are able to alleviate microbial infection and suppress T-cell activation, infiltration and proliferation, as well as suppress keratinocyte apoptosis and nuclear factor-kappa B signaling. Furthermore, probiotics can also modulate the production of inflammatory cytokines and microRNAs, inhibit MMP-9 expression and mast cell degranulation, and ameliorate psychological problems, all of which are involved in the pathogenesis of OLP. Therefore, we hypothesize that probiotics may be applicable to OLP as a safe, inexpensive and non-conventional therapy.     

Oral lichenplanus: Etiology,pathogenesis, diagnosis,and management

Oral Lichen planus (OLP) is a common chronic mucocutaneous disorder with an immune mediated pathogenesis. Its appearance may vary from presence of keratotic to erythematous areas. Etiology of OLP is unknown, but it is thought to be the result of an autoimmune process with an unknown predisposing factor. Oral lichen planus is a complex and poorly understood clinical condition with periods of remissions and exacerbations. Management of the OLP is diversified with few lesions requiring treatment for years and few others are mild, requiring no treatment.     

Oral lichen planus and dental hygiene: a case report

To cite this article:
Int J Dent Hygiene 9 , 2011; 163–166
DOI: 10.1111/j.1601‐5037.2010.00454.x
Scattarella A, Petruzzi M, Ballini A, Grassi FR, Nardi GM. Oral lichen planus and dental hygiene: a case report. Abstract: Background: The presence of atrophic‐erosive lesions among gingival tissues makes oral hygiene procedures difficult for several reasons. Plaque control and rigorous oral hygiene are a fundamental requisite for the treatment of any oromucosal disease. Case report: A patient suffering from a mixed atrophic‐erosive form of oral lichen planus (OLP), with serious gingival involvement, was also treated with the topical application of clobetasol propionate 0.05% using gingival trays. The highest hygiene standards of both patient and trays were of fundamental importance. Discussion: The management of the patient suffering from gingival atrophic‐erosive OLP requires the synergic treatment of both dentist and dental hygienist, whose contribution supports the corticosteroid and/or immunosuppressive treatment.     

Oral lichen planus: a retrospective study of 690 British patients

OBJECTIVE: This is the largest UK patient group with oral lichen planus (OLP) to be studied in terms of the demographic and clinical characteristics. MATERIALS AND METHODS: Data were taken from the medical records of 690 consecutive patients referred to Oral Medicine subsequently found to have clinical, and usually histopathological confirmatory features of OLP. Over two-thirds (68.7%) of the patients were Caucasians. RESULTS: Eighty-two per cent of the patients had been referred to a specialist Oral Medicine service by general dental practitioners, 62% of the patients being referred as a consequence of oral mucosal and/or gingival pain. Reticular OLP was the most common intra-oral presentation, but 60% of such lesions were accompanied by other clinical types of OLP. 95% of lesions were bilateral. About 13% of patients reported symptoms or signs, or had a known history of lichen planus or possible lichen planus affecting non-oral epithelia. In only 13% of patients did all signs and symptoms of OLP resolve within 12-246 months (median 35 months). A malignant transformation rate of 1.9% was observed in the present group. CONCLUSIONS: Oral lichen planus in UK persons almost always gives rise to bilateral reticular OLP, rarely resolves spontaneously, and has a low rate of malignant transformation.     

口腔扁平苔藓凋亡相关基因的表达及意义

目的：探讨凋亡相关基因P53，Bcl-2,Fas,Fas-L的表达在口腔扁平苔藓（Oral Lichen Planus OLP)病变形成及发展中的作用。方法：采用免疫组化SABC法对28例OLP病损中凋亡调节蛋白P53，Bcl-2,Fas,Fas-L进行检测，并与正常口腔粘膜比较，结果：（1）P53蛋白在正常口腔粘膜中表达阴性，但可在OLP上皮基底细胞及部分棘细胞中表达。（2）Bcl-2蛋白在正常口腔粘膜及OLP病损上皮中表达很弱或阴性，但在OLP固有层浸润的淋巴细胞呈强阳性表达。（3）Fas和Fas-L在正常口腔粘膜及OLP病损上皮中表达差异不显著（P＞0．05），结论：口腔扁平苔藓病变的形成及发展部分归因于凋亡，P53和Bcl-2蛋白对OLP局部上皮病变及炎性细胞浸润的存在可能有一定作用。而Fas和Fas-L系统在OLP病变形成及发展中可能不起主要作用。     

Oral lichen planus: controversies surrounding malignant transformation

Studies of the malignant potential of oral lichen planus (OLP) have been hampered by inconsistencies in the diagnostic criteria used for OLP, the criteria adopted to identify a true case of malignant transformation in OLP, the risk factors for malignant transformation and the optimum management of patients to ensure the early diagnosis of transformation. Consensus remains elusive, and leading workers in this field have recently published conflicting reports on the malignant potential of OLP and on the important question of the advisability of excluding patients with epithelial dysplasia or a tobacco habit from studies on this issue. The present review outlines these debates and proposes a possible a molecular basis for the malignant transformation in this disease.     

口腔黏膜扁平苔藓癌变的诊断与综合治疗

目的:探讨口腔黏膜扁平苔藓(OLP)癌变的诊断和以手术为主的综合治疗的效果。方法:对1998—2007年间收治的经临床初诊并经病理学证实的64例OLP癌变患者,从临床角度进行回顾性分析。为便于观察,均选择位于颊黏膜的患者,在PVP诱导化疗21d后选择根治性手术。结果:术后1、3年的生存率分别为87.50%和75.00%,局部复发11例(17.18%)。结论:探讨OLP癌变的诊断标准,解决了Krutchkoff等提出的不同意OLP癌变的3点质疑;OLP癌变治疗的重点在于综合治疗。     

激素局部应用加抗真菌药物治疗口腔扁平苔藓的疗效观察

为探讨治疗口腔扁平苔藓（ＯＬＰ）的较有效途径，本文将８８例ＯＬＰ患者随机分为三组，激素局注射真菌药物组（４０例）以病损区局注酮缩去炎舒松抗真菌物进行治疗，局部注射治疗组（３０例）以病损区局注丙酮缩去炎舒松进行治疗，抗真菌药物组（１８丙）单纯给予抗真菌药物治疗，结果表明，激素局注射加抗真菌药物组疗效优于局部注射治疗组（Ｐ〈０．０５）。而复发率低于后者（Ｐ〈０．０５），说明采用本疗法治疗口腔扁平苔藓能     

Oral lichen planus among 4277 patients from Gizan, Saudi Arabia

This paper reports on the prevalence of oral lichen planus among 4277 Saudi patients, aged 18-73 yr, seen in the dental department of King Fahd Central Hospital, Gizan, Saudi Arabia, between 1982 and 1987, 63% of the patients were males. Oral mucosal lesions consistent with lichen planus were identified both clinically and histologically in 72 patients (40 males and 32 females). The average age of the affected group was 49 yr. No correlation was evident between lichen planus and tobacco habits in this study, nor was there any association with diabetes or hypertension. The average period of follow-up was 3.2 yr, during which four cases developed malignant transformation of the oral lesions. The prevalence of oral lichen planus in this study was 1.7%, which is higher than the prevalence figures reported earlier for the population of Saudi Arabia.     

儿童口腔扁平苔藓病例报告2例

口腔扁平苔藓（oral lichen planus,OLP）是口腔黏膜常见疾病之一,发病率为1％～2％,好发于中年人,儿童发病较为少见[1],国内只有极少的文献报告。本文将报告2例儿童口腔扁平苔藓,同时探讨儿童口腔扁平苔藓的病因、发病年龄、临床表现以及治疗方法。     

Oral lichen planus – a demographic study

Among 20,333 Swedish people aged 15 yr and above, oral lichen planus was found in 1.9%; 1.6% among men and 2.2% among women. The highest prevalences were found in the age groups 65-74 and 55-64 yr. Reticular lichen planus was the most common type, found in 77.3%. The most prevalent intraoral location of lichen planus was the buccal mucosa, which was affected in 92%. Lichen planus was less prevalent among smokers than among non-smokers, except for the plaque type, which showed no difference in this context.     

Oral lichen planus: a preliminary clinical study on treatment with tazarotene

OBJECTIVE: The rationale for using tazarotene in oral lichen planus (OLP) is its regulatory action on the growth and differentiation of keratinocytes and on inflammation. This randomized, placebo-controlled study addresses evaluation of the effects of topic tazarotene in the treatment of OLP. DESIGN: The degree of lesions before and after treatment scored by a 6-score scale in six cases treated with tazarotene was statistically compared with those of six controls treated with placebo. SUBJECTS: Twelve patients with hyperkeratosic OLP were randomly allocated to treatment with tazarotene gel 0.1% b.i.d. or with placebo for eight consecutive weeks. METHODS: The statistical comparison was executed by means of Wilcoxon analysis for paired data. RESULTS: Patients treated with tazarotene presented a significant reduction of their lesions as compared with the control group. Among transitory side-effects, burning sensation and taste abnormalities were observed. CONCLUSION: Topical tazarotene may be a valuable therapeutic tool in the treatment of hyperkeratotic OLP.     

Oral lichen planus in Arab countries : a review

Oral lichen planus (OLP) is a chronic mucocutaneous inflammatory disease of unknown etiology with a potential for malignant transformation. Little is known about the epidemiology of this condition in the Arab world. A computer‐based literature search was conducted using relevant keywords to retrieve studies conducted in Arab world pertaining to OLP, 28 articles were identified initially. After screening for exclusion criteria/retrieving full texts, a total of 15 articles were used for this review. Three studies were cross‐sectional and found a prevalence ranging from 0.35% to 1.7%. Studies about risk factors and prognostic markers were conducted in clinical settings, using a case–control design mostly (n = 9), cohort (n = 2), and clinical trial (n = 1). Genetic expressions of various proteins (e.g., BCL family), cultural determinants (Deram chewing), bacterial and viral infections [Helicobacter pylori and Hepatitis C virus (HCV)] were among factors investigated. Evidence extracted from these studies shows a possible link between OLP and Deram use, H. pylori and HCV Infections with a prevalence of the latter infection ranging from 14.7% to 26.3% in patients with OLP. However, paucity of population‐based studies limits generalizability of such evidence. Future studies in the Arab world should focus upon surveying the extent of OLP, identifying cultural risk factors, utilization of OLP genetic markers in diagnostic, and prognostic applications.