The frequency of Candida in oral lichen planus

ABSTRACT – Histologic material of typical lichen planus lesions from 43 patients was studied. Two sections of each specimen were stained with hematoxylin-eosin and 10 sections by the PAS method. Only 1 of 43 biopsies was invaded by Candida, and hyphae were present in all of the 10 PAS-stained sections of this case. The results show that oral lichen planus has a considerably lesser susceptibility than oral leukoplakia to invasion by Candida albicans.     

Verruciform xanthoma occurring within oral lichen planus

A verruciform xanthoma occurring within lichen planus on the lateral aspect of the tongue in a 68-year-old Japanese woman is reported. The features suggest that the condition of altered epithelial turnover, as in repeated epithelial desquamation, may cause the verruciform xanthoma.     

Keratin staining pattern in clinically normal and diseased oral mucosa of lichen planus patients

The keratin pattern in oral epithelia is related to the type of terminal differentiation observed morphologically (keratinization/nonkeratinization) and to the presence or absence of epithelial dysplasia. Furthermore, it has been suggested recently that inflammatory phenomena influence the keratin expression in human gingiva. The aim of the present study was to describe the keratin pattern in oral lichen planus (OLP) lesions, which are well known to be characterized by hyperkeratinization and severe inflammatory changes, in order to elucidate the role of inflammation in keratin expression of oral epithelia. Tissue sections were stained with antikeratin antibodies directed to groups of keratins (AE1 and AE2) and to single keratin proteins (Nos. 5, 8, 13, and 19). The keratin pattern in OLP lesions differed in some respects from that of leukoplakias and frictional keratoses as characterized in previous studies. No consistent patterns for use in a diagnostic context were found. However, the changes in OLP lesions did not mimic those previously described in inflamed gingival specimens and in oral epithelial dysplasias. Thus, the results encourage further studies on the potential diagnostic use of keratin expression in premalignant oral lesions. Furthermore, the study suggests that the inflammatory reaction seen in OLP lesions does not influence keratin expression in a way comparable with the suggested influence of inflammation in gingival specimens.     

口腔扁平苔藓癌变潜能探讨——P53基因表达及形态计量学研究

目的从P53基因的表达及细胞形态计量变化,研究口腔扁平苔藓（OLP)癌变的潜能。方法采用免疫组化SABC法对28例OLP病损P53基因表达情况进行检测;用图像分析技术,对其中16例OLP的细胞形态学变化进行测量及分析,并分别与正常口腔粘膜、上皮异常增生性白斑、及鳞癌比较。结果P53蛋白在正常口腔粘膜中表达阴性,但可在OLP、白斑（LK）角朊细胞及鳞癌（SCC）癌细胞中表达,阳性细胞数比例由OLP、LK到SCC依次递增,差异有显著性（P＜0.05）。细胞形态定量结果显示OLP各项参数值介于正常与白斑和鳞癌之间,与鳞癌差异显著（P＜0.05）。结论OLP是一种界于正常及癌之间的良性病损,具有一定的恶变潜能,但恶变潜能可能低于白斑。     

Phenotypic and functional analysis of peripheral blood lymphocytes in oral lichen planus

To assess cellular immunity in oral lichen planus (OLP), peripheral blood mononuclear cells (PBMC) were obtained from 19 OLP patients and 30 control subjects. The proportions of circulating CD45RA+ and CD29+ lymphocyte subsets were determined. The proliferative activity of PBMC to the non-specific plant mitogens phytohemagglutinin (PHA) and concanavalin A (Con A) was examined together with the spontaneous proliferative response and the response in the autologous mixed lymphocyte reaction (AMLR). In the OLP group, the proportion of CD4+ CD45RA+ T lymphocytes was significantly less than control subjects and the proportion of CD4+ CD29+ T lymphocytes was increased significantly. The proliferative response to PHA was similar in OLP and controls subjects. Con A-stimulated PBMC proliferation was decreased significantly in the OLP group. Spontaneous PBMC proliferation in patients with non-reticular lesions was significantly less than control subjects. Despite a mildly depressed response in the AMLR in OLP patients, this result was not statistically significant. Results of the phenotypic analysis of peripheral blood lymphocytes indicate a decreased proportion of naive T cells and an increased proportion of primed memory T cells, although the antigen specificity of these memory cells remains to be determined. Results of the functional assays would seem to reflect this phenotypic shift, and as T cells responding to Con A stimulation and in the AMLR possess suppressor-inducer activity, these results may also suggest an association between OLP and defective innate T cell-mediated suppressor circuits.     

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提要：口腔扁平苔藓（oral lichen planus,OLP）是口腔黏膜病中最常见且难以治愈的疾病之一。该病反复发作,可迁延终身,对患者身心造成很大痛苦,故寻找切实有效的治疗方法是非常必要的。目前,国内外学者提出了很多治疗OLP的方法,主要有局部激素治疗、全身应用激素及免疫调节剂等方法,同时,中医中药治疗也取得了较好的疗效。本文主要就近年来国内外报道的OLP治疗进展做一综述。     

Immunohistochemical study of oral lichen planus associated with hepatitis C virus infection,oral lichenoid contact sensitivity reaction and idiopathic oral lichen planus

OBJECTIVES: Oral lichen planus (OLP) is a common mucocutaneous disorder and might be associated to a possible pathogenic relationship with hepatitis C virus (HCV) infection or hypersensitivity to dental alloy. We examined the clinical and immunohistochemical features of OLP associated with HCV infection (OLP-HCV), oral lichenoid contact sensitivity reaction (OLCSR), and idiopathic oral lichen planus (iOLP). The immunohistochemical expressions of CD4, CD8, B cells, Class II major histocompatibility complex antigen (HLA-DR), S-100, HSP60, Proliferating cell nuclear antigen (PCNA) and Ki-67 were compared to study the pathogenic differences of the three OLP groups. MATERIALS AND METHODS: Three groups of OLP patients, (I) OLP-HCV patients (n = 17), (2) OLCSR patients (n = 10) and (3) iOLP patients (n = 14) were retrieved from clinical records and tissues examined immunohistochemically by the avidin-biotin-complex technique. RESULTS: The patients with OLP-HCV showed widespread lesions. The proportion of CD8+ cells was found to be significantly higher in the lamina propria of the OLP-HCV patients and a significantly lower proportion of CD8+ cells of the OLCSR patients was noticed in the epithelium or the connective tissue papillae than in the iOLP patients. There were no significant differences in either the number of CD4+ cells or B cells between the three OLP groups. No significant differences in the number of HLA-DR+ cells were found between the three OLP groups and some OLP-HCV patients showed a significant increase of S-100+ cells in the epithelium compared with iOLP patients. There were no significant differences in either the number of PCNA+ or Ki-67+ cells between the groups. The patients showed similar weak expressions of HSP60 in the three OLP groups. CONCLUSION: The different distributions of the CD8+ cells that could have functionally different roles might be related to the distinct pathogenic mechanisms in the three OLP groups.     

Immunohistochemical localization of mast cells and mast cell-nerve interactions in oral lichen planus

OBJECTIVES: Mast cell mediators are likely to be involved in at least some aspects of the immunopathogenesis of oral lichen planus (OLP). The aim of this project was to map mast cell populations in OLP and identify possible sites of mast cell-nerve interactions.
MATERIALS AND METHODS: Monoclonal antibodies specific for tryptase and neurofilaments were used to identify mast cells and nerves respectively in an immunohistochemical study of OLP ( n = 25) and normal oral buccal mucosa (NOBM) ( n = 13) using a double-labelling protocol. Data analysis used paired t-test, multiway analysis of variance and Wilcoxon rank testS. RESULTS: Morphometric analyses showed the greatest mast cell density in the most superficial of the three depth layers examined in OLP, an increase of 130% compared with NOBM.Mast cells associated with neurofilaments ranged from 21.9% in OLP to 10.2% in NOBM.Mean epithelial thickness was significantly lower in OLP ( P < 0.001) but without a strong correlation with mast cell density.
CONCLUSIONS: Increased mast cell and mast cell-nerve interactions in OLP suggest both a controlling role over the lesional cell populations and a secondary role to the immune response once this becomes established.     

Hepatitis C virus-associated oral lichen planus: no influence from hepatitis G virus co-infection

There is a variable geographic distribution in the prevalence of hepatitis C virus (HCV)-related oral lichen planus (OLP), which appears unrelated to either HCV genotype or HCV epidemiology. The present study investigated whether hepatitis G virus (HGV) co-infection may be a feature of patients with HCV-related OLP, which might explain these phenomena. HGV co-infection was detected in 6 of 39 Italian patients with HCV-related OLP, but the presence of HGV did not influence the clinical presentation of OLP. It is concluded that HGV co-infection is unlikely to influence the clinical detection of HCV-related OLP.     

Possible premalignant character of oral lichen planus the Amsterdam experience

In the present paper the 21-yr experience of the Department of Oral and Maxillofacial Surgery and Oral Pathology, and the Department of Otorhinolaryngology of the Free University Hospital, Amsterdam, is reported with regard to the possible premalignant character of oral lichen planus. The study consists of two parts: 1) the follow-up of 113 patients with histopathologically proven oral lichen planus, and 2) a search for lichen planus in 727 patients who have been admitted for oral cancer. Three patients with histopathologically proven lichen planus developed a squamous cell carcinoma in an average follow-up period of 7 yr. In the 727 patients with oral cancer, two additional patients with the simultaneous occurrence of oral lichen planus were observed. Our experience gives some but not very strong support to the hypothesis that oral lichen planus is a premalignant condition.     

Psychological profile in oral lichen planus

AIM: Oral lichen planus (OLP) is an oral lesion with an enigmatic etiology. To explore the possibility of psycho-somatization, we evaluated the psychological personality profiles of OLP patients. METHODS: Twenty patients with reticular; 20 with erosive form of OLP, and 25 controls were tested with the psychological Minnesota Multiphasic Personality Inventory (MMPI)-202 test. Eight clinical scales (hypochondriasis, depression, hysteria, psychopathic deviate, paranoia, psychasthenia, schizophrenia, and hypomania) as well as cortisol level, CD3, CD4, CD8, and CD16 markers by group were compared. Psychosomatization was evaluated by the use of internalization ratio (IR) Index. RESULTS: A characteristic MMPI profile was noted in the OLP groups with high IR index value. Significant differences among the groups were detected for cortisol, CD4, CD8, and CD16 counts. Mean values for hypochondriasis, depression, and hysteria were all significantly different with significantly higher mean scores for both reticular and erosive OLP subjects compared with controls. CONCLUSIONS: Prolonged emotive stress in many OLP patients may lead to psychosomatization and may contribute to the initiation and clinical expression of this oral disorder. Clinical significance: If additional research involving a larger and more diverse sample of patients confirms these findings, clinical trials will be needed to determine whether adjunctive psychological intervention provides a benefit in treating patients with OLP.     

Clonal expansion of lymphocytes from oral lichen planus lesions

Lymphocytes were extracted from 11 biopsy specimens of oral lichen planus (OLP) by collagenase digestion, and cell lines were expanded with repetitive cycles of stimulation (with phytohaemagglutinin) and rest in media supplemented with interleukin 2. Four OLP lines contained a majority of CD3 + CD4 −CD8 + cells, in six lines the CD4:CD8 ratio was between I and 2, and in one line the CD4:CD8 ratio was 5:1. Limiting dilution of nine lines at 0.3 and 1.0 cells/well resulted in viable wells (putative clones) with plating efficiencies ranging from 0.0 to 18.1 percent and 0.0 to 22.2 percent respectively. The majority of clones were CD3 + CD4–CD8 +αβ+γδ-, although three clones were CD3 + CD4 + CD8 - αβ+γδ - and one clone was CD3 + CD4 - CDS - and expressed the γδ T cell receptor. T cell clones derived from lymphocytes extracted from OLP lesions may be generated and maintained in culture providing opportunity for their further phenotypic and functional characterisation. This strategy may facilitate the identification of a putative oral lichen planus-specific antigen and indicate the frequency of lichen planus-specific T cells within lesions of OLP.     

KLF-6在口腔扁平苔藓恶变中的表达研究

目的 探讨KLF 6在口腔扁平苔藓发病机制及癌变中的作用。方法 分别采用免疫组化和Western blot方法对10例正常口腔黏膜、30例扁平苔藓患者和22例口腔鳞癌患者的上皮组织中KLF 6蛋白进行t检测,比较其在三者之间的差异。SPSS 14.0对数据进行检验。结果 扁平苔藓患者组织中KLF 6蛋白的表达明显低于正常口腔黏膜,两组之间具有显著性差异;口腔鳞癌患者组织中KLF 6蛋白的表达明显低于扁平苔藓组织,两组之间具有显著性差异。结论 KLF 6的表达异常可能在口腔扁平苔藓的发生发展及癌变的过程中起作用。     

EP—CAM在OLP和OSCC组织中的表达及意义

目的：观察上皮细胞黏附分子（Ep—CAM）在口腔正常黏膜、扁平苔癣（OLP）和鳞癌（OSCC）组织中表达的变化,分析Ep—CAM在口腔黏膜疾病及其癌变发病机制中的作用。方法：采用免疫组织化学法检测10例正常口腔黏膜、30例OLP（15例非糜烂型、15例糜烂型）及20例OSCC组织中Ep—CAM的表达变化。结果：Ep—CAM在正常黏膜组织阴性表达,而在非糜烂型OLP、糜烂型OLP及OSCC组织中表达逐渐增强。结论：Ep—CAM在口腔黏膜癌变的发展过程中可能具有一定的指示意义。     

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目的 探讨糖尿病与口腔扁平苔藓（OLP）的相关性。方法 应用国内外数据库检索相关文献,将纳入文献分为A、B两组：A组是OLP患者中糖尿病患病为结局指标的文献;B组是糖尿病患者中OLP患病为结局指标的文献。采用RevMan5.1软件分别对A、B组相关数据进行Meta分析,评价糖尿病与OLP之间的相关性。结果 共纳入15项研究,其中A组8项研究,病例1123例,正常对照1292例;B组7项研究,病例3652例,正常对照2618例。A组糖尿病患病合并OR值及95%CI为1.83（1.24,2.69）,OLP组糖尿病患病率明显高于对照组,且差异有统计学意义（P = 0.0002）;B组OLP患病合并OR值及95%CI为2.25（1.34,3.78）,糖尿病组OLP的患病率明显高于对照组,且差异有统计学意义（P = 0.002）。结论 糖尿病与OLP之间存在明显关联。在治疗OLP时需关注患者是否患有糖尿病,同期治疗糖尿病对OLP的疗效有重要作用。对于糖尿病患者,加强口腔宣教,定期进行口腔检查,及时发现并治疗OLP十分必要。     

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口腔扁平苔藓(orallichenplanus,OLP)是一种累及口腔黏膜且可反复发作的慢性炎症疾病,患病率为0.51%,在口腔黏膜疾病中居第2位,属常见病。皮肤和黏膜可单独或同时发病,病理表现相似:主要以口腔黏膜不同程度的角化异常、基底层细胞液化变性、上皮下结缔组织中淋巴细胞呈带状浸润为典型表现。     

中西医结合三步法治疗口腔扁平苔藓的临床研究

目的　观察中西医结合三步法治疗口腔扁平苔藓的临床疗效。方法　 39例口腔扁平苔藓患者随机分为 2组 ,治疗组 2 0例 ,对照组 19例 ,分别采用中西医结合三步法和单纯西药疗法 ,观察疗效 ,并采用流式细胞术测定治疗前后T细胞亚群及NK细胞 ,观察患者免疫功能变化情况。结果　治疗组痊愈率 45 .0 0 % ,总有效率95 .0 0 % ;对照组痊愈率 10 .5 3% ,总有效率 6 8.42 %。治疗组疗效显著高于对照组 (P <0 .0 5 )。治疗组治疗后CD8+ %较治疗前明显降低 (P <0 .0 1) ,CD4 + /CD8+ 比值明显升高 (P <0 .0 1) ,NK %亦有升高 (P <0 .0 5 ) ,CD4 + %治疗前后差异无显著性 (P >0 .0 5 )。对照组治疗后CD8+ %较治疗前降低 (P <0 .0 5 ) ,CD4 + %、CD4 + /CD8+ 及NK %较治疗前均无显著变化 (P >0 .0 5 )。结论　中西医结合三步法治疗口腔扁平苔藓疗效高、疗程短、复发率低、无明显副作用 ,能快速有效地改善口腔扁平苔藓患者免疫功能     

Th1 cytokines in oral lichen planus

BACKGROUND: Cell-mediated immune responses in oral lichen planus (OLP) may be regulated by cytokines and their receptors. METHODS: In situ cytokine expression and in vitro cytokine secretion in OLP were determined by immunohistochemistry and ELISA. RESULTS: The majority of subepithelial and intraepithelial mononuclear cells in OLP were CD8+. In some cases, intraepithelial CD8+ cells were adjacent to degenerating keratinocytes. CD4+ cells were observed mainly in the deep lamina propria with occasional CD4+ cells close to basal keratinocytes. Mononuclear cells expressed IFN-gamma in the superficial lamina propria and TNF-alpha adjacent to basal keratinocytes. Basal keratinocytes expressed TNF-alpha as a continuous band. TNF R1 was expressed by mononuclear cells and basal and suprabasal keratinocytes. There was variable expression of TGF-beta1 in the subepithelial infiltrate while all intraepithelial mononuclear cells were TGF-beta1-. Keratinocytes in OLP stained weakly for TGF-beta1. Unstimulated OLP lesional T cells secreted IFN-gamma in vitro. TNF-alpha stimulation down-regulated IFN-gamma secretion and up-regulated TNF-alpha secretion. IL-4, IL-10 and TGF-beta1 secretion were not detected. CONCLUSIONS: These data suggest the development of a T helper 1 immune response that may promote CD8+ cytotoxic T-cell activity in OLP.