A retrospective study of 370 patients with oral lichen planus in Turkey

Objectives: Although several detailed studies concerning the patient profile and clinical features of oral lichen planus have been undertaken all over the world in different populations, a similar study has not yet been conducted in a Turkish population. The purpose of this retrospective study was to describe the demographic and clinical characteristics of a group of patients with oral lichen planus in Turkey.Study Design: Charts of 370 patients, from the archive of Oral Diagnosis and Radiology Department of Marmara University Faculty of Dentistry (Istanbul, Turkey), with histologically confirmed clinical diagnosis of oral lichen planus in the period 1990-2010 were retrospectively reviewed.Results: Of the 370 patients, 260 (70.3%) were women and 110 (29.7%) were men. The mean age was 49.84±13.41 years (range of 16-83). The lesions were asymptomatic in 63 patients (17%). Nearly half of the patients (47.6%) had multiple sites of involvement. Predominantly red forms were the most frequent, affecting 60.5% of patients. Approximately 17% of the patients had symptoms of possible extraoral involvement. No evidence suggesting a connection between oral lichen planus and tobacco or alcohol use was found. Only one out of the 370 cases had histologically proven malignant transformation.Conclusions: The patient profile and clinical features of oral lichen planus in Turkey were generally similar to those described in other populations. The preponderance of the red forms and also the fact that majority of patients referred themselves to our clinic highlighted the lack of awareness among Turkish health care providers about lichen planus. Key words:Oral lichen planus, clinical features, patient profile.     

Lack of evidence of hepatic disease in patients with oral lichen planus in Serbia

OBJECTIVE: The reported frequency of chronic liver disease, and particularly, Hepatitis C virus (HCV) infection in patients with oral lichen planus (OLP) shows geographical variation. The aim of this study was to determine the prevalence of chronic hepatic disease, Hepatitis B virus and HCV infection in patients with OLP and control subjects resident in Serbia. PATIENTS AND METHODS: In this prospective study 48 patients with OLP (33 women and 15 men, with a mean age of 49.7 years) and 60 control subjects (38 women and 22 men, with a mean age of 46.7 years) were examined for the presence of serological evidence of chronic hepatic disease, Hepatitis B surface antigen (HBsAg) and anti-HCV seropositivity. RESULTS: All patients with OLP had normal liver function. HBsAg was not found in any of the patients with OLP or control group. None of the patients with OLP or control subjects were HCV seropositive. CONCLUSION: Patients with OLP resident in Serbia do not have evidence of chronic liver disease or infection with HBV or HCV. The exact aetiological role between hepatic disease and OLP remains unclear.     

A clinical study of 674 patients with oral lichen planus in China

BACKGROUND: Oral lichen planus (OLP) is a chronic inflammatory disease with different clinical presentations that can be classified as reticular, atrophic or erosive. Although OLP is a relatively common disorder, the reports comprising large numbers of OLP patients with specific character are lacking in the literature. The purpose of this paper was to describe the clinical characteristics of OLP in 674 Chinese patients. METHODS: A total of 674 charts of patients with histologically confirmed OLP were collected from Stomatological Hospital of Wuhan University between 1963 and 2003. RESULTS: Of the 674 patients, 65.9% were women and 34.1% were men. The most common clinical presentation was the reticular type (51.3%), and symptomatic OLP was noted in 67.5% of the patients, mainly in those with the erosive form. The erosive presentations showed significantly longer duration, more sites affected and a much greater old patients predominance than reticular or atrophic ones. About 90.9% of the patients had multiple oral sites of involvement and isolated lower lip lichen planus were observed in 60 cases (8.9%) and isolated gingiva lichen in only one case (0.2%). Skin involvement of lichen planus was found in 11.4% of patients. No statistically significant differences could be identified between OLP and diabetes, cardiovascular disease, smoking or alcohol use. Precipitating factors that resulted in an exacerbation of the disease were frequently noted and included foods, stress, dental cusp and poor oral hygiene. The transformation of OLP into malignancy was observed in four patients at sites previously diagnosed by clinical examination as erosive or atrophic lichen planus. CONCLUSIONS: Patients with OLP in China usually present with distinctive clinical morphology and characteristic distribution and few may display lesions with a confusing array of forms mimicking other diseases. A long time follow up is of utmost importance to detect its malignant transformation.     

口腔粘膜扁平苔藓患者丙型肝炎病毒感染的初步研究

目的：了解ＯＬＰ患者ＨＣＶ感染情况,探讨ＨＣＶ感染与ＯＬＰ之间的关系。方法：用全自动生化检测仪,酶联免疫测定及ＰＣＲ法分别测定４１名ＯＬＰ患者和３８名对照者外周血ＳＧＰＴ、ＳＧＯＴ、抗－ＨＣＶ和ＨＣＶ－ＲＮＡ。结果：４１名ＯＬＰ患者中,１５人（３６．６％）有肝酶异常升高、１２人（２９．３％）抗－ＨＣＶ阳性,１０人（２４．４％）ＨＣＶ－ＲＮＡ阳性;而３８名对照组中,６人（１５．８％）有肝酶异常升高,３人（７．９％）抗－ＨＣＶ阳性,３人（７．９％）ＨＣＶ－ＲＮＡ阳性,ＯＬＰ组的上述三项指标均较对照组为高（Ｐ＜０．０５、Ｐ＜０．０１、Ｐ＜０．０５）,两组存在明显的差异。结论：国人ＯＬＰ患者存在较高的ＨＣＶ感染率,表明有相当部份的ＯＬＰ患者体内有ＨＣＶ存在与复制,ＯＬＰ的发病可能与此有一定的关系。     

The magnitude of the association between hepatitis C virus infection and oral lichen planus: meta-analysis and case control study

Although hepatitis C virus (HCV) infection is associated with oral lichen planus (OLP), a case–control study and a meta-analysis were designed to investigate the magnitude of such an association. A total of 413 presumptive OLP patients (18–75 years) who referred to a dental clinic in Rasht (Iran) were consecutively selected. OLP was diagnosed clinically (typical forms) and histologically (atypical forms) by a calibrated examiner. A total of 487 adults (20–77 years) attending the same dental clinic were the controls. The two groups were homogeneous in terms of age, gender and occupation. Subjects were tested for anti-HCV antibodies. The odds ratio (OR) for OLP attributable to HCV infection was non-significant [OR 1.2, 95% confidence interval (95CI) 0.3–4.8], suggesting that the association between HCV and OLP was weak in the Iranian context. Meta-analysis of observational studies characteristics of primary studies were that cases were diagnosed clinically (only typical forms) and histologically and exposure was assessed through anti-HCV antibodies. Exposed/unexposed cases/controls were extracted and zero values were appropriately transformed. As much as 44 studies, including the present, were located. Publication bias could not be totally excluded. The pooled OR, estimated using the random-effect model, was 2.8 (95CI 2.4–3.2). Sensitivity analysis confirmed the robustness of results. Subgroup analysis showed non-significant differences between American/European and Asian/African studies. The fraction of global OLP cases associated with HCV (population attributable fraction) was 2.1% (95CI 1.9–2.2%). Although HCV and OLP were significantly associated, the majority of OLP patients were not affected by HCV.     

口腔扁平苔藓与肝病关系的病例对照研究

目的：探讨口腔扁平苔藓与慢性肝病的关系。方法：回顾性分析４７６例口腔扁平苔藓的肝病、肝功能异常发生情况，并与年龄、性别配对的４７６例其它口腔粘膜病及１７１１名健康人比较。结果：口腔扁平苔藓患者慢性肝病发生率６５％，１项肝功能异常发生率为２３．９％，二项或二项以上为５．３％。上述指标均较疾病对照组和正常对照组为高（Ｐ＜０．０１），其中尤以反映间质反应的指标如血清蛋白、ＴＴＴ、ＺｎＴＴ的异常改变较为明显。结论：口腔扁平苔藓与肝病有一定的关系，其所伴发的肝病以慢性肝病疾患为主。     

A clinical study of 205 patients with oral lichen planus.

Two hundred and five patients with oral lichen planus were divided into two groups: those with only reticular lesions (group 1) and those with atrophic-erosive lesions with or without concomitant reticular lesions (group 2). A comparative study of the two groups showed that the most commonly affected oral location in both was the buccal mucosa. Lesions of the tongue, gingiva, lip, and palate predominated in group 2. Likewise, chronic liver disease and diabetes were more common in the second group, as was extension of the oral lesions (P less than .001).     

A multicenter study of oral lichen planus in Thai patients

Abstract Aim: Oral lichen planus is an oral mucosal disease that affects middle‐aged patients. The characteristics of oral lichen planus in Thai patients from a multicenter were studied. Methods: Data of 533 patients from the oral medicine clinics at Chulalongkorn and Mahidol (central Thailand), Chiang Mai (northern Thailand), and Khon Kaen (northeastern Thailand) universities during 2002–2007 were analyzed. The diagnosis of patients with oral lichen planus was clinically and/or histopathologically confirmed. Results: There was a greater number of female patients than males (4:1). There were significant differences in age, sex, and some systemic diseases among the oral lichen planus patients from the three centers. Burning sensation was the most common symptom (72.9%), followed by pain (26.5%), roughness (6.4%), and then no other symptoms (7.9%). The most common site of lesions was found at the buccal mucosa (87.1%). Atrophic oral lichen planus was common in Thai patients. There were significant differences in the types of oral lichen planus, including reticular, atrophic, and ulcerative oral lichen planus among these patients from the three centers (P = 0.000). Nine cases (1.7%) showed dysplasia, but one case (0.2%) developed squamous cell carcinoma. Conclusion: Patients with oral lichen planus from the central, northern, and northeastern parts of Thailand presented with distinct characteristics. The malignant transformation of oral lichen planus was low in Thai patients.     

Implant treatment in patients with oral lichen planus: a prospective-controlled study

Objectives: The main aim of this prospective‐controlled study was to evaluate the implant survival rate in patients diagnosed with oral lichen planus (OLP). The secondary goals were to analyze the presence of implant‐ and patient‐dependent variables. Material and methods: Two groups, including 18 patients diagnosed with OLP and 18 controls, received 56 and 62 implants during the years 2003–2008. Pain and wound healing were evaluated after the procedure. After a mean follow‐up of 53.5 and 52.3 months, clinical and radiographic assessments were used to evaluate implant survival and patient‐ and implant‐dependent parameters. Results: The implant survival rate was 100% for the OLP group. Immediate postsurgical complications were similar in both groups. Peri‐implant mucositis (PIM) was detected in 44.6% of the implants and 66.6% of the patients with OLP. The presence of desquamative gingivitis (DG) was associated with a higher rate of PIM on those implants of the OLP group (P=0.004). Peri‐implantitis (PI) appeared in 10.7% of the implants and 27.7% of the patients with OLP (P=NS). Conclusion: Despite the limitations of the small sample size, it seems that lichen planus is not a prominent local player in the genesis of implant failure. Patients with DG should be carefully examined during follow‐up care.     

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.     

P53 and bcl-2 immunoexpression in patients with oral lichen planus and oral squamous cell carcinoma

Objective: The aim of this study was to determine by immunohistochemistry the presence and significance of p53 and bcl-2 proteins in oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC). Study Design: We used 21 cases diagnosed as OLP 16 diagnosed as OSCC and four normal gingival biopsies taken from healthy patients were used as controls. Slides were processed for immunohistochemistry using anti-p53 and anti-bcl-2 monoclonal antibodies. Results: We found p53 immunoexpression in 71.4% OLP cases and 68.7% OSCC cases, with no immunoexpression in control cases. Bcl-2 was negative for all OLP and OSCC cases, and mild positivity was observed in normal tissue. We found significant correlation among p53 expression and OSCC malignancy. Conclusions: Our results suggest that TP53 system mainly promotes a hyperproliferative state by cell cycle arrest of the OLP epithelial cells for repairing damaged DNA nor apoptosis and that anti-apoptotic action of bcl-2 is not important in this disease. Key words:Oral lichen planus, oral squamous cell carcinoma, p53, Bcl-2, carcinogenesis, malignant transformation.     

Candida in patients with oral lichen planus

The presence of yeasts in oral lichen planus (OLP) lesions was studied in cultivations from 41 OLP patients and by histological examination in 39 of these cases. The histological features of OLP were also recorded. The cultivation results were compared with those of a randomly selected, age- and sex-matched control group without mucosal changes. The extent of growth was recorded as "sparse" (1-10 colonies), "model-rate" (11-40 colonies), or "heavy" (greater than 40 colonies). Yeasts were found to be present on cultures or histologic sections from a total of 19 OLP patients (46%). "Moderate-heavy" growth was obtained in 29% of the OLP cases but in only 7% of the control group. Candida albicans accounted for over 80% of the yeasts. The histological examination revealed only 3 cases of invasive fungal growth. Regarding the criteria of OLP, hyperortho- or hyperparakeratosis and a band-shaped subepithelial infiltration of lymphocytes were present in all specimens, basilar liquefaction degeneration in 87% and an eosinophilic zone in 77%. Local treatment with amphotericin B (Fungizone) in 18 OLP patients with positive findings resulted in subjective relief of symptoms in 89% of the patients. Clinical improvement was seen in 94%. The presence of Candida was significantly correlated to low secretion rate in unstimulated saliva.     

Periodontal status in patients with oral lichen planus: a study of 90 cases

OBJECTIVE: This study was carried out to relate periodontal status to the oral lesions in patients with oral lichen planus (OLP). MATERIALS AND METHODS: Periodontal status was evaluated in 90 patients with OLP and in 52 controls, in terms of the plaque index (PII), simplified calculus index (CIS) and periodontal disease index (PDI). RESULTS: No significant differences were observed between the two groups as regards the different periodontal indices. The plaque and calculus indices were higher in the more extensive forms of OLP (P = 0.02 and P = 0.012, respectively), and in the presence of gingival involvement (P = 0.004 and P = 0.04). A significant association was also observed between the presence of atrophic-erosive lesions and increased periodontal deterioration (P = 0.037). CONCLUSIONS: Increased plaque and calculus deposits are associated to a significantly higher incidence of atrophic-erosive gingival lesions in patients with OLP.     

A retrospective clinicopathological study on oral lichen planus and malignant transformation: Analysis of 518 cases

Objective: To investigate the epidemiological and clinical characteristics of a relatively large cohort of patients with oral lichen planus (OLP) from eastern China. Study design: A total of 518 patients with histologically confirmed OLP in a long-term follow-up period (6 months-21.5 years) were retrospectively reviewed in our clinic. Results: Of the 518 patients, 353 females and 165 males were identified. The average age at diagnosis was 46.3 years (range 9-81 years) with the buccal mucosa being the most common site (87.8%). At initial presentation, white lichen and red lichen was seen in 52.3% and 47.7% patients, respectively. Of these, 5 (0.96%) patients previously diagnosed clinically and histopathologically as OLP developed oral cancer. All of them were the females with no a history of smoking or alcohol use. Conclusions: Clinical features of eastern Chinese OLP patients were elucidated. Notably, approximately 1% of OLP developed into cancer, which provides further evidence of potentially malignant nature of OLP. Key words:Oral lichen planus, clinical features, malignant transformation, oral cancer.