Factors associated with clinical characteristics and symptoms in a case series of oral lichen planus

Oral Lichen Planus: A Narrative Review Navigating Etiologies, Clinical Manifestations, Diagnostics, and Therapeutic Approaches

Background/Objectives: Oral Lichen Planus (OLP) is a common immune-mediated inflammatory disorder affecting the oral mucosa, impacting 0.5% to 2% of the global population, primarily middle-aged women. Immunological dysregulation is a key factor in OLP's pathogenesis, involving CD4+ T helper and CD8+ T cytotoxic cells. The World Health Organization (WHO) classifies OLP as a potentially malignant disorder, with a risk of oral squamous cell carcinoma (OSCC) developing in up to 2% of lesions. This narrative review aims to provide a comprehensive overview of the etiopathogenesis, clinical manifestations, diagnostic criteria, and therapeutic strategies for OLP, informing clinical practice and guiding future research. Methods: A review of the literature from the PubMed and Google Scholar databases was conducted up to December 2023, focusing on studies addressing the etiopathogenesis, diagnosis, clinical manifestations, and treatment of OLP. Results: OLP's pathogenesis is driven by immune dysregulation, with CD4+ and CD8+ cells playing crucial roles. Clinically, OLP presents as reticular, erosive, bullous, and plaque-like lesions. Diagnosis relies on clinical examination, histopathology, and direct immunofluorescence. Recent advancements in diagnostic markers and imaging techniques have improved detection and monitoring. Treatment primarily involves corticosteroids, but novel therapies such as curcumin, retinoids, and laser therapy are increasingly used for their effectiveness and reduced side effects. These treatments show promise in symptom reduction and recurrence prevention, although long-term data are needed. Conclusions: Regular screenings and biopsies are essential due to OLP's likelihood of malignant transformation. This study urges further investigation into long-term results, improved diagnostic techniques, and evidence-based treatment regimens.

Oral Lesions of Immune-Mediated and Autoimmune Diseases: A 12-year Experience at a Single Brazilian Referral Center

BACKGROUND

Oral lesions of immune-mediated and autoimmune diseases have been well-documented, but studies from Brazil are limited. The varied spectrum of oral lesions within this demographic group poses challenges to clinicians, particularly when they occur in isolation. This study aimed to evaluate the occurrence, clinical characteristics, and management of patients with oral lesions of immune-mediated and autoimmune diseases at a single center in Brazil.

METHODS

A retrospective cross-sectional study was conducted from 2010 to 2022. Clinicodemographic data, histopathological features, and treatment modalities were analyzed descriptively and analytically.

RESULTS

Of the 3,790 oral and maxillofacial lesions diagnosed, 160 (4.2%) were confirmed as immune-mediated or autoimmune diseases. The population surveyed predominantly consisted of women (73.7%), with a mean age of 60.2 years. Oral lichen planus (51.3%), mucous membrane pemphigoid (MMP) (23.7%), and pemphigus vulgaris (PV) (19.4%) were the most prevalent lesions. The buccal mucosa (59.4%) was predominantly affected, with pain reported in 46.2% of cases, notably in individuals with PV and MMP. The average time to disease stabilization post-local and/or systemic corticosteroid therapy was 15.8 months for systemic lupus erythematosus, 8.7 months for MMP, and 6.5 months for PV.

CONCLUSION

Although oral lesions related to immune-mediated and autoimmune diseases are uncommon, their diverse clinicopathological aspects require multidisciplinary management.

Bidirectional Association between Lichen Planus and Hepatitis C-An Update Systematic Review and Meta-Analysis

Lichen planus (LP) is a chronic, inflammatory mucocutaneous disorder associated with systemic diseases such as hepatitis C (HCV). The objective of this study is to evaluate the association between LP and HCV bidirectionally through a systematic review and meta-analysis. A comprehensive search of studies published was performed in the databases of PubMed, Embase, and Web of Science. Out of 18,491 articles, 192 studies were included. The global prevalence of HCV positive (HCV+) in LP patients registered from 143 studies was 9.42% [95% confidence interval (CI), 7.27-11.58%], and from these, 84 studies showed HCV+ 4-fold more frequent in LP than a control group (OR, 4.48; 95% CI, 3.48-5.77). The global prevalence of LP in patients HCV+ recorded from 49 studies was 7.05% (95% CI, 4.85-9.26%), and from these, 15 registered a 3-fold more LP in HCV (OR, 3.65; 95% CI, 2.14-6.24). HCV+ in LP patients showed great geographic variability (OR, 2.7 to 8.57), and the predominantly cutaneous location was higher (OR, 5.95) than the oral location (OR, 3.49). LP in HCV+ patients was more frequent in the Eastern Mediterranean (OR, 5.51; 95% CI, 1.40-15.57). There is a higher prevalence of HCV+ in LP and vice versa than in the control group, especially in certain geographical areas that should be taken into consideration when doing screening in countries with an upper prevalence of HCV among the general population.

Oral Lichen Planus: Associations Between Histomorphometric Characteristics and White and Red Lesions

Histomorphometry seems to provide more rigid quantitative elements for histological analysis and to bring less subjectivity to the diagnosis of oral lichen planus lesions (OLP). This study aimed to verify the association between white and red lesions and histomorphometric characteristics of OLP lesions. This retrospective cross-sectional study assessed 48 hematoxylin- and eosin-stained histological sections from incisional biopsies obtained from OLP cases. A single previously calibrated evaluator performed the light microscopy analyses to evaluate morphological and morphometric parameters. Analyses of associations among variables were performed using the Fisher's exact test. Morphometric variables were assessed using the Mann-Whitney non-parametric test. Comparisons among the three groups (age range) were performed using the Kruskal-Wallis test. In this study, 81.2% of the participants were women aged < 50 years. Keratosis, acanthosis, and inflammatory infiltrates were noted in 10.4, 10.4, and 37.5% of moderate/severe cases, respectively. Inflammatory infiltrate (52.1%), papillary projections (54.2%), saw teeth (12.5%), basal layer degeneration (39.6%), and Civatte bodies (68.8%) were also observed. There was no significant association between lesion type and clinicopathological variables (p > 0.05) or between lesion type and histological (p > 0.05) and morphometric variables (p > 0.05). Furthermore, the morphometric variables analyzed did not differ between white and red lesions (p > 0.05) or in their associations with clinicopathological variables (p > 0.05). The results of this investigation showed no associations between white and red OLP lesions and the histomorphometric characteristics evaluated.

Clinical features of oral lichen planus and oral lichenoid lesions: an oral pathologist's perspective

The clinicopathological features that precisely characterize oral lichen planus (OLP) and oral lichenoid lesions (OLL) still represent a challenge. The aim of the present study was to analyze, from an oral pathologist perspective, the clinical features from OLP and OLL. Specimens fullfilling the histological criteria for OLP and OLL, and also compatible with OLP (OLP-C), were selected and clinical information was retrieved from the laboratory forms. The final sample was composed by 221 cases, including 119 OLP (53.8%), 65 OLP-C (29.4%) and 37 OLL (16.7%). Females were more affected in the three groups, but the number of males was higher in OLL. Mean age was lower in OLP (52.3 years) in comparison with OLL (57.9 years) (p=0.020). Buccal mucosa and tongue involvement was more frequent in OLP; gingival involvement was uncommon in OLL. The reticular pattern was more frequently found in OLP, while the association of reticular and atrophic/erosive/ulcerated patterns was more common in OLP-C and OLL (p=0.025). In conclusion, gender and mean age of the patients, and anatomical location and clinical manifestation of OLL are different from OLP, and could help to better characterize this group of conditions. Specimens diagnosed as OLP-C showed clinical parameters close to OLP.

Prevalence and risk of chronic kidney disease in oral lichen planus: a large cross-sectional study from eastern China

Background

Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disease which is frequently associated with comorbidities such as diabetes and cardiovascular diseases. However, little is known about the association of OLP with impaired kidney function. To elucidate the possible association of chronic kidney disease (CKD) with OLP and its severity, this study investigated the prevalence of CKD as well as its risk factors in patients with OLP.

Methods

A large prospective cross-sectional study of 1,021 patients with OLP was carried out using questionnaires and laboratory tests available from an oral medicine clinic at a university in eastern China. According to the Kidney Disease: Improving Global Outcomes (KDIGO) diagnostic guideline, CKD was classified based on the estimated glomerular filtration rate (eGFR, <60 mL/min/1.73 m²) or urinary albumin to creatinine ratio (UACR, >30 mg/g).

Results

The prevalence of CKD in the patients with OLP in this study was 14.3% (95% CI, 12.3–16.6%), which was higher than that in the general Chinese population (10.8%; 95% CI, 10.2–11.3%). The mean values of serum creatinine, eGFR, UACR, and urine N-acetyl-β-D-glucosidase in patients with CKD were significantly higher than those in patients without CKD (all P<0.01). Pearson’s correlation analysis revealed that CKD stage and UACR were positively correlated with the severity of OLP (both P<0.001). Importantly, multivariate regression analysis revealed that age ≥58 years old, female sex, and hypertension were independent risk factors for incident CKD and abnormal UACR (>30 mg/g) in patients with OLP (all P<0.01).

Conclusions

This study has reported for the first time that CKD is a comorbidity in patients with OLP. The occurrence and staging of incident CKD are associated with OLP and its severity.

Oral lichen planus: a novel staging and algorithmic approach and all that is essential to know

Lichen planus (LP) is a chronic autoimmune disease. Oral lesions may occur in isolation or in combination with other affected muco-cutaneous sites. Oral LP (OLP) may present as one of the various manifestations of LP or may present as a disease sui generis with a broad range of severity. Despite this disease targeting the oral mucosa, its great impact on quality of life is underrated. In this article, we provide an updated review of the pathophysiology and epidemiology of OLP and offer guidance for its diagnosis and management. We also propose an algorithmic approach to the clinical forms of OLP and a novel staging system to facilitate management decisions.

Clinicopathologic data of individuals with oral lichen planus: A Brazilian case series

Background

The aim of the present series was to analyze the sociodemographic characteristics, clinicopathologic features, and oral health-related quality of life of 41 individuals with oral lichen planus (OLP).

Material and Methods

In a retrospective analysis (1998-2018), individuals with a clinical diagnosis of OLP from a referral service of Oral Medicine of Brazil were invited for follow-up. The individuals were assessed using the Oral Health Impact Profile-14 (OHIP-14) form. Histopathological data were reviewed according to the latest criteria proposed by the American Academy of Oral and Maxillofacial Pathology (AAOMP/2016).

Results

This series mainly consisted of females (70.7%) in their forties (31.7%). The buccal mucosa (68.2%) was the most commonly affected site. Reticular (56.1%) and erosive (34.3%) appearances were the most frequent. According to OHIP-14, individuals with OLP at multiple sites in the oral cavity showed worse values in the handicap domain and those who did not respond to corticosteroids showed a higher score on the psychological discomfort domain.

Conclusions

The findings of the present study, using the AAOMP/2016 criteria, agree with case series and retrospective studies reported in the literature. Besides, OLP in its more severe clinical forms had an influence on patient quality of life.

Key words:Diagnosis, epidemiology, oral lichen planus, oral mucosa, quality of life.

Inflammatory Markers and Incidence of other Autoimmune Diseases in Patients with Oral Lichen Planus

INTRODUCTION

Oral lichen planus (OLP) is a chronic immune, inflammatory disease of the oral cavity of a still unknown etiology.

MATERIALS AND METHODS

The study involved 63 subjects diagnosed with oral lichen planus and 63 subjects without pathologic changes in the oral mucosa who were classified as controls. All subjects were given a detailed medical history at first screening. The medical history of the presence of other autoimmune disease in all subjects was supported by medical records. A sample of venous blood was taken from each subject in order to determine sedimentation rate (SE) and leukocyte count (L) using standard laboratory procedures, and serum C-reactive protein (CRP) concentration values ​​were determined as well.

STATISTICAL ANALYSIS

The methods of descriptive statistics, χ2-test, the Fisher's exact test, and the Student's t-test were used in the statistical processing of the results. The results were interpreted at a significance level of P <0.05.

RESULTS

For all three measured inflammatory markers, there were no statistically significant differences in the number of subjects with elevated values ​​between the test and control groups (P = 0.364 for SE; P = 1.000 for CRP and P = 0.219 for L). The prevalence of other autoimmune disease in the OLP group was higher than in the control group, with statistical significance, and the most common was cutaneous lichen in nine subjects (14.29%) with OLP and celiac disease seven subjects (11.11%).

CONCLUSIONS

The results showed that there was no significant difference in the average values of the investigated inflammatory markers in blood (SE, CRP and L) between patients with OLP and control subjects, while a significantly higher incidence of other autoimmune diseases in patients with OLP was demonstrated.

Lichen planus and diabetes mellitus: Systematic review and meta-analysis

OBJECTIVE

The aim of this study was to perform a systematic review and meta-analysis answering the following questions: (a) "What is the prevalence and risk of oral lichen planus among patients with diabetes mellitus?" and (b) "What is the prevalence and risk of diabetes mellitus among patients with oral lichen planus?".

MATERIAL AND METHODS

A bibliographic search was conducted in PubMed/Medline and Scopus database from 1966 to March 2018, using the following terms: "Lichen planus" AND "Diabetes mellitus" AND "Prevalence" AND "Oral mucosal lesions".

RESULTS

Twenty-two studies were included in this review. Twelve studies assessed the prevalence of diabetes mellitus among patients with lichen planus. The prevalence reported ranges from 1.6% to 37.7% with a relative risk of 2.432. Ten studies assessed the prevalence of lichen planus among patients with diabetes mellitus which showed a prevalence of lichen planus ranging from 0.5% to 6.1% with a relative risk of 1.4.

CONCLUSIONS

Contradictory results were found when analyzing the relationship between lichen planus and diabetes mellitus. Diverse factors should be considered when studying this association for a correct interpretation of results. Diabetes mellitus has high prevalence and morbidity, which is why new case-control studies are needed to further investigate this association.

Hepatitis C virus infections in oral lichen planus: a systematic review and meta-analysis

BACKGROUND

A role for hepatitis C virus in oral lichen planus has been postulated. This systematic review and meta-analysis of the existing epidemiological studies was conducted to determine if there is a correlation between oral lichen planus and hepatitis C virus infection.

METHODS

We examined the association between hepatitis C virus and oral lichen planus by conducting a systematic review and meta-analysis of case-control studies that examined the prevalence of anti-HCV antibodies in the serum of cases and controls. We searched PubMed, Embase and The Cochrane Library databases from 2005 to January 2015. Associations were measured using random-effect odds ratios (ORs) combined with 95% confidence intervals.

RESULTS

Nineteen eligible studies, encompassing 1807 cases of OLP and 2519 controls, were retrieved and included in this review. The summary estimate OR for all studies was 6.07 (95% CI: 2.73-13.48), showing a statistically significant difference in the proportion of HCV seropositivity among oral lichen planus patients, compared with controls and substantial heterogeneity between studies (I(2) = 65%) as a result of a variety of geographical distributions.

CONCLUSIONS

The association of hepatitis C virus infection with oral lichen planus emphasizes the importance of hepatitis C virus screening in oral lichen planus patients.

Oral lichen planus in childhood: a case series

BACKGROUND

Although the exact incidence of pediatric oral lichen planus (OLP) is unknown, the oral mucosa seems to be less commonly involved, and the clinical presentation is often atypical. The aim of the study is to present a case series of OLP in childhood.

METHODS

From our database, we retrospectively selected and analyzed the clinical data of OLP patients under the age of 18 where the diagnosis had been confirmed by histopathological analysis.

RESULTS

The case series from our database shows eight patients, four males and four females. The mean (±SD) age at the time of diagnosis of the disease was 13.5 (±2.73) years, ranging in age from 9 to 17. Clinically, a reticular pattern was present in six patients (75%), and the tongue was the most commonly involved oral site (six cases, 75%). We also report the first case of OLP in a 9-year-old girl affected by autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy.

CONCLUSIONS

We report the largest case series of pediatric OLP published in literature thus far. Differences in the disease between adults and pediatric patients have been detected, but further investigation and a larger case series are needed to establish any detailed differences in clinical outcomes.

Clinical characteristics and analysis of familial oral lichen planus in eight Chinese families

Oral lichen planus (OLP) is one of the most common oral mucosa diseases; however, familial OLP is uncommon. The present study reported and analyzed patients with familial OLP (n=18) in eight different Chinese families between January 1, 2012 and December 31, 2013. Parameters analyzed include gender, age at diagnosis, lesion distribution and lesion type. The follow-up period for each patient was a minimum of 1 year. In this survey, 18/88 individuals in the eight families were affected. Females were more frequently affected, and the female to male ratio for familial OLP (2.2:1) was higher compared with that previously reported for nonfamilial OLP (1.4:1). The age at diagnosis, lesion distribution and lesion type showed consistency with reports concerning nonfamilial OLP, with the exception of family VI, in which 4/5 children had OLP/LP lesions and were of an early age at diagnosis. There were two families in which three generations had been affected by OLP. In addition, it appeared that patients of the same generation in the same family were of a similar age at diagnosis. No malignant or premalignant lesion was identified in the 18 individuals diagnosed with OLP from the eight families. The present study supports the hypothesis that genetic predisposition may serve a role in the etiology of OLP.

Direct Immunofluorescence in Oral Lichen Planus

INTRODUCTION

Oral lichen planus (OLP) is a common immune-mediated oral mucosal disease. Diagnosis of OLP depends mainly on both clinical and histopathological features. Direct immunofluorescence (DIF) is a useful investigation method to distinguish between similar lesions and to confirm diagnosis in cases of uncharacterized features.

AIM

The purpose of this study was to evaluate the prevalence and pattern of DIF in a group of Thai patients with OLP.

MATERIALS AND METHODS

Records of clinically and histologically diagnosed OLP patients attending the Oral Medicine Clinic, Faculty of Dentistry, Mahidol University, Bangkok, Thailand were consecutively reviewed for DIF results. The DIF patterns in these patients were analysed.

RESULTS

There were 82 atrophic and/or erosive OLP patients with a mean age of 51.6 years. Male to female ratio was 1:5. Of these, 82.9% showed positive DIF. Buccal mucosa was superior to the gingiva and palate in terms of sensitivity for DIF. All specimens except one (98.5%) demonstrated deposition of fibrinogen at the basement membrane zone (BMZ) in a shaggy pattern. The most common DIF pattern was shaggy fibrinogen at BMZ with IgM deposition on the colloid bodies (CB) (35.3%) followed by shaggy fibrinogen along BMZ (27.9%).

CONCLUSION

The prevalence of positive DIF in Thai OLP patients was 82.9%. The most common finding was shaggy fibrinogen at BMZ. The typical pattern was shaggy fibrinogen along BMZ with or without positive IgM at CB. DIF pattern could be evaluated for the diagnosis of OLP lacking clinical and/or histopathological characteristic features.