Oral Manifestations of Dermatologic Disease: A Focus on Lichenoid Lesions

Lichenoid changes in the oral mucosa can be encountered in a wide range of lesions with varied etiologies including immune-mediated disorders, reactions to systemic medications and to dental materials. Dysplasia of the oral cavity can exhibit a lichenoid histology, which may mask the potentially cancerous component. Another unusual clinical disease, proliferative verrucous leukoplakia, can often mimic oral lichen planus clinically requiring careful correlation of the clinical and pathologic features.     

Oral erosive lichen planus regression after thymoma resection

Thymomas are neoplasms known to be frequently associated with autoimmune disorders. Oral lichen planus is an immunologically based, chronic inflammatory oral mucosal disease of undetermined cause. We describe a 79-year-old patient with a 6-month history of generalized oral erosive lichen planus in whom a chest roentgenogram led to the discovery of an anterior mediastinal mass consistent with thymoma. Transsternal complete thymoma resection achieved erosive oral lichen planus regression. The clinical correlations between erosive oral lichen planus and thymoma are presented.     

Oral lichen planus part II: therapy and malignant transformation

Oral lichen planus lesions can cause discomfort, pain, and a burning sensation. Therefore, all professionals who deal with the oral cavity must be aware of all the therapeutic options for it. This article presents a review of the literature on oral lichen planus, focusing on its treatment, and also discusses the important and controversial potential for the evolution of oral lichen planus into epidermoid carcinoma.     

Esophageal lichen planus: case report and review of the literature

Involvement of the esophagus by lichen planus is a rarely reported condition. The histologic features of esophageal lichen planus, which may differ from those of cutaneous disease, have only rarely been illustrated. We describe a 58-year-old woman with skin and oral lichen planus who presented with dysphagia and an esophageal stricture that were ultimately diagnosed as esophageal lichen planus. Multiple esophageal biopsies demonstrated a lichenoid, T cell-rich lymphocytic infiltrate, along with degeneration of the basal epithelium and Civatte bodies. Correct diagnosis of esophageal lichen planus is critical because of its prognostic and therapeutic distinction from other more common causes of esophagitis and stricture formation.     

参苓白术汤治疗糜烂型口腔扁平苔藓的效果与安全性分析

目的：比较不同治疗法治疗糜烂型口腔扁平苔藓患者的疗效与安全性。方法对80例糜烂型口腔扁平苔藓患者,采用随机分组的方法,分成对照组40例与观察组40例。分别进行常规西药治疗与参苓白术汤进行治疗,比较两组疗效、不良反应。结果观察组总有效率为90.00%,显著高于对照组的60.00%,差异有统计学意义（P＜0.05）。观察组治疗后的TNF-ɑ、IL-6及IgE水平均显著低于对照组,差异有统计学意义（P＜0.05）。结论在使用常规西药治疗的基础上,使用中药治疗糜烂型口腔扁平苔藓患者,能够有效提高临床治疗效果,而且安全性较高。     

Validation of instruments to measure the symptoms and signs of oral lichen planus.

OBJECTIVE: The aim of this study was to validate the visual analog scale (VAS), numeric rating scale (NRS), and change in symptoms scale (CSS) in measuring symptoms of oral lichen planus, and the modified oral mucositis index (MOMI) in measuring the signs of oral lichen planus. STUDY DESIGN: Criterion validity, construct validity, and internal consistency reliability were evaluated using data from a randomized, double blind, placebo-controlled clinical trial of curcuminoids in oral lichen planus. RESULTS: Moderate to high correlations were found between VAS, NRS, and CSS. Correlations of symptom scores with clinical signs ranged from minimal to high. Correlation of NRS with clinical signs was stronger than that of VAS with clinical signs. Significant changes from baseline at each follow-up in NRS, VAS, and MOMI scores were seen. The Cronbach alpha for erythema and ulceration scores from the MOMI were 0.66. CONCLUSIONS: This study gives some evidence of the validity of NRS, VAS, CSS, and MOMI for use in oral lichen planus. The NRS has better construct validity than VAS, based on higher correlations with clinical signs. Erythema plus ulceration is a better measure than ulceration alone.     

Full thickness,split thickness and culture epithelium as a treatment for ulcerative lichen planus

Summary Ulcerative lichen planus is a rare and chronic form of lichen planus. The disease affects mainly the feet and the oral cavity. This form is not only extremely painful and disabling, but carries the hazards of malignant transformation. Only nine patients described in the literature had excision and skin grafting of their lesions, with good short and long-term results. We present a case report of a patient with 27 years history of ulcerative lichen planus and multiple skin grafting and recurrencies. We present an alternative method of treatment with culture epithelium allograft as a temporary measure.     

Oral lichen planus part I: epidemiology, clinics, etiology, immunopathogeny, and diagnosis

This article presents a review of the literature on oral lichen planus, focusing on important aspects of its epidemiology, etiopathogeny, and clinical manifestations. The oral form is an important clinical presentation of lichen planus. It may precede or accompany the skin lesions, or it may be the only manifestation of the disease. Dermatologists, dentists, otorhinolaryngologists, and other specialists who deal with the oral cavity must be aware of this disease so they can diagnose, treat, and keep these patients under observation.     

Efficacy of Intralesional Bacillus Calmette-Guérin Polysaccharide Nucleic Acid and Vitamin D Injections in the Treatment of Lichen Planus

BACKGROUND: Lichen planus is a multifactorial chronic inflammatory disease with diverse clinical manifestations involving the skin, hair, nails, and mucous membranes. OBJECTIVE: We evaluated the clinical efficacy and adverse effects of Bacillus Calmette-Guérin polysaccharide nucleic acid (BCG-PSN) injection, vitamin D injection, and the combination of both in the treatment of different types of lichen planus. METHODS: Thirty patients ranging in age from 12 to 70 years with clinically diagnosed lichen planus were enrolled in this study and divided into three groups according to treatment regimen. RESULTS: A partial therapeutic response in three patients and no improvement in seven patients were achieved in the intramuscular vitamin D injection group. Meanwhile, the intralesional injection of BCG-PSN was associated with complete response in three patients, partial response in three patients, and no response in four patients. The combination of both intralesional injection of BCG-PSN and intramuscular injection of vitamin D was associated with complete response in two patients, partial response in four patients, and no response in four patients. CONCLUSION: BCG-PSN alone appears to be efficacious in the treatment of lichen planus, and vitamin D in combination with BCG-PSN had no effect on cutaneous lichen planus.     

Submucosal Fibrotic Bands in Oral Lichen Planus: A Clinico-Pathological Investigation of a Newly Described Phenomenon

Fibrosis is a recognized complication of chronic inflammatory conditions, which has not yet been described in oral lichen planus. To describe characteristics of submucosal fibrotic bands in oral lichen planus. Prospective study. Patients with biopsy confirmed lichen planus were included. Clinical examination recorded fibrotic bands, mouth opening, vestibular depth loss, gingival recessions adjacent to band, lichen subtypes, areas of affected mucosa, extra-oral manifestations. Patients completed the Chronic Oral Mucosal Disease Questionnaire, with additional questions regarding stiffness, restricted opening, symptom frequency, time from diagnosis of lichen, co-existing medical conditions. 73 patients were included, 14 M, 59 F, age 28–84 (mean 61) years. Buccal fibrous bands were palpated in 22 (30.1%), 13 (59%) were bilateral. Self-reported restricted opening/stiffness were significantly associated with fibrous bands (36% Vs. 11% in controls, p = 0.02). Mouth opening less than 40 mm was recorded in only 2 (9%) with bands, none in controls. Reduced vestibular depth was significantly associated with bands (11 (50%) Vs 3 (6%) in controls, p = 0.0001).Gingival recessions adjacent to bands were recorded in 3 (13.6%). No association was demonstrated between fibrous bands and erosive lesions, extra oral involvement, smoking, age, visual analogue scale, quality of life questionaire and disease duration. Histological evaluation of one case each with and without band and control showed increased mean width of connective tissue. Submucous fibrous band is first described in the present study. It is common in oral lichen planus, may lead to feeling restricted mouth opening, stiffness, loss of vestibular depth and adjacent gingival recession.     

口腔扁平苔藓的临床治疗分析

目的采用中西医结合方法调节患者免疫功能,探讨口腔扁平苔藓的治疗效果。方法根据患者临床表现,辨证施治,并结合西医方法联合治疗。结果治疗2年后,69例患者中,治愈23例,好转27例,总有效率达72.4%。结论口腔扁平苔藓是一种病因复杂且不确定的疾病,与患者免疫失衡有关,利用中药对机体免疫功能的双向调节作用,免疫平衡得以恢复,并取得较好的临床疗效。     

Carcinoma verrucoso de pene desarrollado sobre un liquen plano. ¿una auténtica lesión preneoplásica?

Introductionup to 30% of squamous cell carcinomas of the penis arise from a lichen sclerosus, but very few reports in which lichen planus was the preexisting lesion have been published. We report a male with verrucous carcinoma of penis that developed in an area of lichen planus.Clinical casea 53-year-old male presented with an exophytic tumor on the glans penis that had been present for about 6 months. The lesion developed in a previously biopsied area of lichen planus hypertrophicus. After excision, histological diagnosis was verrucous carcinoma.Commentthe development of any subtype of squamous cell carcinoma of penis in a lichen planus can be coincidental, or a neoplastic transformation of lichen planus can take place.     

Expression of p63 and 14-3-3σ in normal and hyperdifferentiated mucosa of the upper aerodigestive tract

Objective: Our goal was to analyze p63 and 14-3-3σ expression in normal and hyperdifferentiated head and neck mucosa. Study Design: Compare the in vivo expression of p63 and 14-3-3σ by immunohistochemistry in normal mucosa and oral lichen planus, a benign mucosal lesion marked by hyperdifferentiation and apoptosis. Results and Conclusion: p63 is underexpressed and 14-3-3σ is overexpressed in lichen planus on immunohistochemical analysis. Significance: The findings support the hypothesis that p63 plays an antidifferentiation role, whereas 14-3-3σ plays a prodifferentiation role in the upper aerodigestive tract epithelium. Lichen planus is a valuable model for the study of p63, 14-3-3σ, and mucosal differentiation. p63 and 14-3-3σ may be molecular markers for oral lichen planus. (Otolaryngol Head Neck Surg 2002;126:598-601.)     

A randomized controlled trial to compare steroid with cyclosporine for the topical treatment of oral lichen planus.

OBJECTIVE: To compare the effectiveness of cyclosporine solution versus triamcinolone acetonide in orabase in the treatment of oral lichen planus (OLP) in reducing signs and symptoms. STUDY DESIGN: One hundred thirty-nine biopsy-proven OLP patients were randomly assigned to cyclosporine (68) or steroid (71) applied onto the target lesion and affected areas. Assessments were at weeks 0, 2, 4, 8 by clinical scoring and grid measurement of the target lesion (reticulation, erythema, ulceration). Patients ranked severity of pain and burning sensation using visual analog scales. RESULTS: Although clinical response, pain, burning sensation, area of reticulation, erythema, and ulceration at week 4 were all worse in patients receiving cyclosporine than in those receiving steroid, the differences were not statistically significant. Large patient-to-patient variability was evident over the observation period, with little evidence of marked changes in levels over time in both treatment groups. CONCLUSION: Topical cyclosporine appears no more effective than steroid in the treatment of oral lichen planus.     

Assessment of the peripheral immunocompetent cells in patients with reticular and atrophic-erosive lichen planus.

OBJECTIVE: To assess the cellular and humoral immunity in patients with reticular and atrophic-erosive oral lichen planus (OLP). STUDY DESIGN: Lymphocyte phenotype analysis of 50 patients with OLP and 16 control subjects was performed by means of flow cytometry. The results were analyzed by the Mann-Whitney U test. RESULTS: In the patient group the percentage of na?ve helper T cells was significantly decreased, while that of memory cells was increased, resulting in a significantly higher ratio of memory to na?ve cells in the OLP group than in the control group. In the group of patients with atrophic-erosive OLP, the percentages of cytotoxic/suppressor T cells and cytotoxic/suppressor na?ve T cells were found to be slightly decreased. CONCLUSIONS: The results indicate that the relative ratio of immunocompetent cells in the peripheral blood is altered in patients with lichen planus and that the exact character of these disturbances depends on OLP form. Some of the alterations observed in these patients are typical to autoimmune diseases, thus promoting the concept of autoimmune etiopathogenesis of lichen planus.     

Familial oral lichen planus: presentation of six families.

OBJECTIVE: To present a series of 13 different cases of oral lichen planus (OLP) in 6 different families. STUDY DESIGN: From 249 lichen planus cases, we found 13 that could be considered to be family related. A study of these 13 cases of OLP was carried out across the various generations, and the means of presentation, placement, and injuries were studied, as well as signs and symptoms. RESULTS: The predominant affectation was in the women; only 2 patients were male. The mothers showed predominance toward erythematous OLP with greater symptoms, and in their children, symptom-free white OLP was predominant. CONCLUSIONS: It seems there may be some genetic predisposition toward OLP.     

Oral lichen planus

Lichen planus is a mucocutaneous dermatological disorder, with intraoral manifestation. Skin lesions prevail with oral mucosal lesions. Prevalence of lichen planus, as an oral pre-malignant lesion, is 1-2% population. Lateral border, dorsal tongue, gingiva, hard palate and vermilion border are common sites and lesions appear as reticular, plaque-like and papular intraoral types. Skin presents with pururitic, polygonal papules. Atrophic and erosive are the known intraoral pre-malignant types. A case report is presented, which responded well to steroid therapy.     

Dermatoscopy of Nail Lichen Planus: A Boon for Early Diagnosis

BackgroundLichen planus is an immune-mediated disorder affecting the skin, mucous membranes, scalp, and nails.ObjectiveWe sought to evaluate dermatoscopic nail patterns in patients with lichen planus.MethodsThis was a cross-sectional, observational study performed in the outpatient dermatology department of a tertiary care hospital. Thirty-one patients with skin biopsy-proven lichen planus with nail changes were included. An evaluation of clinical nail patterns and dermoscopic assessment of nail patterns were performed.ResultsLongitudinal ridging with splitting, longitudinal melanonychia and splinter hemorrhages were the most commonly found nail patterns in patients with lichen planus. Pterygium has been found to be most pathognomic feature of nail lichen planus.ConclusionDermatoscopy has been demonstrated to be a valuable, noninvasive tool to identify subsurface nail bed changes and subclinical surface findings to facilitate early diagnosis and timely management of lichen planus to avoid long-term sequelae.     

Severe recurrent oral ulceration secondary to erosive lichen planus

A case of recurrent progressively severe ulceration secondary to erosive lichen planus is reported. The patient developed marked malnutrition as a result of extensive involvement of the oral cavity. In addition to the oral ulcerations, she also had violaceous spots present over her forearm. Treatment administered in view of histopathological report and clinical presentation, resulted in marked improvement in symptoms and weight gain.     

Evaluation of Botulinum Toxin Type A Injection in the Treatment of Localized Chronic Pruritus

BACKGROUND: Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum that causes a flaccid muscle paralysis. It is currently used for aesthetic procedures and to treat focal hyperhidrosis. The botulinum toxin has also been used experimentally in many other dermatological conditions with positive results. OBJECTIVE: We sought to evaluate the efficacy and safety of intradermal injection of botulinum toxin A in the treatment of localized recalcitrant chronic pruritus in lichen simplex, inverse psoriasis, post-burn itching, lichen planus (hypertrophic), and postherpetic neuralgia. METHODS: This was a clinical trial study of 32 patients (12 with lichen simplex chronicus [LSC], 4 with inverse psoriasis, 4 with post-burning itch, 4 with lichen planus, 4 with hypertrophic lichen planus, and 4 with post-herpetic neuralgia). We used 2 to 3mL of unpreserved saline to dilute each vial (50 units) of botulinum toxin A. This led to a final concentration of 2 to 2.5U/0.1cc; injections were typically made into the dermis. RESULTS: The ages of patients in the group studied ranged from 13 to 85 years, with a mean of 37.38 years, and 59.4 percent were female. There were statistical reductions in visual analog scale in all the studied cases. CONCLUSION: Botulinum toxin A appears to be a safe and effective therapy for the improvement of localized recalcitrant itching in LSC, inverse psoriasis, burns, hypertrophic lichen planus, lichen planus, and symptoms of postherpetic neuralgia.