Direct immunofluorescence and immune function in patients with oral lichen planus

Background/Purpose

Direct immunofluorescence and immune function and patients with oral lichen planusThe etiology of oral lichen planus (OLP) is unknown, our purpose was to evaluate the diagnostic value of direct immunofluorescence (DIF) and to investigate the immune functions in OLP.

Materials and methods

We enrolled 65 patients with suspected lesions of OLP and 47 controls. In all participants, clinical and serologic testing were conducted. The histopathologic and DIF tests were conducted in 65 patients. The severity of OLP was evaluated by reticular/hyperkeratotic, erosive/erythematous, ulcerative (REU) scoring system.

Results

By hematoxylin and eosin (H&E) staining and DIF examination, 71.2% (42/59) were diagnosed as OLP, 28.8% (17/59) were diagnosed as non-OLP. DIF demonstrated 64.3% positive reactivity with 2 distinct distribution patterns and 8 staining patterns. Compared to the controls, serum IgA in OLP was higher (P < 0.01), and serum CD3+ cells, IgM, IgE, C3 and C4 were lower (P < 0.05). Pearson correlation analysis in OLP revealed correlations between REU score and IgM, IgA of DIF (r = 0.54, P = 0.026; and r = 0.56, P = 0.020, respectively), between serum IgG and IgG of DIF (r = 0.51, P = 0.038), between serum CD4+ and the ratio of CD4+/CD8+, IgM in DIF (r = −0.50, P = 0.048; and r = −0.54, P = 0.031, respectively), between serum CD8+ and IgM, IgA in DIF (r = 0.52, P = 0.038; and r = −0.50, P = 0.047, respectively).

Conclusion

A combination of H&E test and DIF is useful for the diagnosis of OLP. Compared to controls, immune changes happen to patients with OLP. There are significant associations between the OLP lesions and general cellular and humoral immune status, localized humoral immune response.

Evaluation of serum immunoglobulin (IgG, IgM, IgA) in potentially malignant disorders of oral cavity - A case control study

Background

Only few studies have been done to evaluate level of serum immunoglobulins (IgG,IgM,IgA) in patients with Potentially Malignant Disorders (PMD) like Leukoplakia, Oral Submucous Fibrosis (OSMF) and Oral Lichen Planus (OLP) as tumour markers.

Aims and objectives

To estimate the serum immunoglobulins level (IgG, IgM, IgA) in leukoplakia, OSMF and oral lichen planus (OLP) patients and its comparison with levels among control groups and Weather these values can be used to predict severity of disease or not.

Materials and methods

30 patients with different potentially malignant disorders like leukoplakia, OSMF and oral lichen planus and 30 healthy controls were selected at random and subjected for analysis of serum IgG, IgA, IgM. Statistical methods employed were mean, standard deviation and ANOVA test.

Results

We observed significant elevated levels of all the immunoglobulins in leukoplakia, OSMF and oral lichen planus when compared with the control group and levels were increasing with clinical stages of OSMF (p < 0.05).

Conclusions

All these immunoglobulins are indicative of tumour burden or transformation of malignancy in higher stage and might be employed as prognostic indicators in these disorders.

Peripheral T-cell subsets in patients with reticular and atrophic-erosive oral lichen planus

OBJECTIVE

Oral lichen planus (OLP) presents with various clinical forms that can be classified into 2 major types: reticular OLP and atrophic-erosive OLP. Our objective was to investigate immunologic differences between these 2 types.

STUDY DESIGN

We investigated possible immunologic differences between 26 patients with reticular OLP and 26 patients with atrophic-erosive OLP.

RESULTS

No differences were detected in serum Ig levels or complement levels. However, the mean proportions of CD4+CD45RO+ and DR+ lymphocytes were significantly higher in patients with atrophic-erosive OLP than in patients with reticular OLP, whereas the mean proportion of CD8+CD45RA+ lymphocytes was significantly lower in patients with atrophic-erosive OLP.

CONCLUSION

These findings suggest that the 2 clinical types of OLP might have different immunopathogenic mechanisms.

The autoimmune background in lichen planus

Fifty-four patients with lichen planus (LP) and 54 age- and sex-matched controls were studied. No increase in the incidence of autoimmune disease was found in the patients with LP or their relatives. There was no increase in the frequency of autoantibodies in the LP group and serum immunoglobulin levels were not altered significantly. In the majority of cases, LP is not part of a generalized autoimmune disturbance.

Lichen planus: review and update on pathogenesis

Lichen planus (LP) is a common oral disorder which may represent the manifestation of a mucosal reaction to a variety of aetiological factors. Of the many immunological changes described in LP several may be epiphenomena although a cell-mediated immune response to unidentified antigens or antigenic changes clearly is involved. Associations with drugs or systemic disorders are well-defined in some patients but may, in others, be aleatoric. Finally, the prognosis of oral LP not only differs from that of cutaneous LP but there is little doubt that in a few instances LP is a premalignant condition.

Serum immunoglobulins and autoantibodies in patients with oral lichen planus

A qualitative and quantitative determination of serum immunoglobulins was made in 34 patients (27 female, 7 male) with histologically verified oral lichen planus (OLP). The subjects ranged in age from 33 to 80 years and 28 of the cases had OLP changes of atrophic-erosive type. The possible presence of rheumatoid factors (RF), antinuclear antibodies (ANA) or antibodies to mitochondrias, renal glomeruli and smooth muscles was studied in 30 of the patients. The investigation also comprised a control group of 23 patients (17 female, 6 male) without mucosal changes. Immunoelectrophoresis showed an abnormal pattern in 10 OLP cases (29%), the most common change being a polyclonal increase of IgG in 8 persons. Elevated levels of serum IgG (greater than 15 g/l) were seen in a total of 9 OLP patients (26%), but only in 1 of the control cases (4%). The mean IgG value was significantly higher in the OLP than in the control group, 13.4 and 10.3 g/l, respectively. Regarding levels of IgA and IgM, no difference was noted between the groups. Autoantibodies were registered in 27% of the OLP patients and in 9% of the controls. The immune changes could be correlated in some respect to positive fungal cultures, allergies and decreased unstimulated saliva, but not to age, endocrine disorders or joint diseases.

Glucocorticosteroids and oral medicine

The article deals with the use of glucocorticosteroids in the treatment of the oral manifestations of Systemic Lupus Erythematosus (SLE), Discoid Lupus Erythematosus (DLE), Rheumatoid Arthritis (RA) in the temporomandibular joint, Pemphigus Vulgaris, Pemphigoid, Erythema Multiforme Exudativum (EME), Lichen Planus (LP), and Recurrent Aphthous Ulcerations (RAU). The benefit from steroids is discussed on the basis of current knowledge of etiology and pathogenesis of the various disorders. All of them are characterized by inflammation which appears secondary to a hypersensitivity reaction against autocomponents. Glucocorticoids do not interfere with the primary disease mechanisms. But it is concluded from the literature, that because of anti-inflammatory and immunosuppressive effects of the hormones, it seems reasonable to profit from steroids as palliatives in acute phases of the diseases and/or as long-term suppressors of the general host defense.

Serum immunoglobulins and complement (C'3) in oral lichen planus

Serum immunoglobulins and complement (C'3) were determined by single radial immunodiffusion according to the method of Mancini and co-workers in fifty patients with oral lichen planus and twenty persons with clinically normal oral mucosa. Significantly increased levels of serum IgG (p less than 0.05) and a significant reduction of serum IgA concentration (p less than 0.05) in the experimental group as compared with normal controls were observed. Mean serum IgM and complement (C'3) levels were similar in patients and controls. No correlation between disease variety or extensiveness and immunoglobulin or complement levels was noticed. These results suggest that patients with oral lichen planus may have a generalized immunologic disorder in which humoral immunity is disturbed. Whether humoral immunity is of etiologic significance, contributes to the disease process, or, finally, represents an event secondary to the pathologic changes seen in the disease remains to be determined.

beta 2 Microglobulin in lichen planus

The aim of the present study was to examine idiopathic lichen planus for possible changes in the serum concentration of the immunological marker beta 2 microglobulin (beta 2m), a component of HLA antigens. It was shown that serum levels of beta 2m were not different in lichen planus from those in controls. Although these findings do not support major systemic immunopathological changes in lichen planus, they do not exclude the involvement of local immune mechanisms.

Deposits of immunoglobulins, complement, and fibrinogen in oral lupus erythematosus, lichen planus, and leukoplakia

Direct immunofluorescent staining (IF) for detection of deposits of IgG, IgM, IgA, complement C3, and fibrinogen at the basement membrane zone has been performed on a total of 279 biopsy specimens from oral lesions and clinically normal oral mucosa from the following groups of patients: fourty-five discoid lupus erythematosus (DLE), including sixteen patients without skin lesions, seven systemic lupus erythematosus (SLE); fourty-five lichen planus (LP); thirty leukoplakia (Leuk.); twenty patients with uncertain diagnosis, termed DLE? LP?; and twenty-three healthy persons. Deposits of immunoglobulins (lg) occurred in 73 percent of oral lesions in DLE and in 100 percent of the oral lesions in SLE, whereas lg deposits occurred in 3 to 30 percent in the other groups, the differences being significant (P less than 0.05). It is concluded that lg deposits are a characteristic feature of oral lesions of DLE and SLE and only rarely occur in oral lesions of LP and Leuk., which are the most important differential diagnoses. A direct immunofluorescence test on oral lesions suspected to be LE should be regarded as positive only if lg deposits are present, since C3 occurs frequently in oral lesions other than LE. Consideration can be given to the inclusion of lg deposits in the diagnostic criteria for oral LE lesions.

Cutaneous manifestations in rats with advanced vitamin A deficiency

Specific-pathogen-free rats kept on a vitamin A-deficient diet for approximately 5 months developed cutaneous alterations, especially in the periorbital and eyelid skin. These lesions were characterized grossly by erythema, partial alopecia, and crusting, and histologically by hyperorthokeratinization, acanthosis, and a three-fold increase in incorporation of labeled DNA precursors into the epidermal basal layer. Electron microscopy showed an increased number of Langerhans cells with and without Birbeck granules, as well as the presence of cytoplasmic dense bodies of probable lipid nature in keratinocytes of all epidermal strata. The similarities of these ultrastructural alterations with some features of vitamin A-sensitive human dermatoses point to probable common mechanisms in the pathogenesis of these skin diseases.

Histochemical identification of T cells in oral lichen planus

Lysosomal activity was demonstrated in the majority of the lymphocytes forming the mononuclear cell infiltrate in oral lichen planus. Staining for acid phosphatase, N-acetyl-beta-D-glucosaminidase, nonspecific esterase, and beta-glucuronidase was present in these cells in tissue sections, indicating their T cell origin. Small numbers of enzyme-negative lymphocytes were also present. Macrophages showing stronger staining were found scattered through the infiltrates in large numbers. These observations indicate roles for T cells and macrophages in the pathogenesis of lichen planus.

Epithelial differentiation patterns in buccal mucosa affected by lichen planus

The epithelium derived from buccal mucosa affected by lichen planus reticularis was subjected to histometric and stereologic analysis. Point counting procedures were employed to analyse a total of 2,220 electron micrographs sampled from 5 epithelial strata in 9 biopsies, 7 with distinct and 2 with faint Wickham's striae. Histologically the reticular elements presented an atrophy of the entire epithelium which had altered its differentiation pattern from that of normal buccal epithelium. The epithelium of faintly striated lichen planus differed from that of distinctly striated lichens in regard to a series of cytoplasmic organelles representing key features of stratified epithelia, i.e. the volume densities of glycogen, membrane coating granules, keratohyalin granules, cytoplasmic filaments and the cytoplasmic ground substance. The data emphasize that the clinically discernable features of reticular lichen planus of the buccal mucosa are produced by at least two different stages in the deviation of the epithelial differentiation pattern from normality, one stage (distinct striae) being more drastically altered than the other (faint straie).

Studies on oral lichen planus. III. Clinical and histologic correlations in 213 patients

Two hundred thirteen adults in whom oral lichen planus had been diagnosed were studied in order to compare clinical and microscopic findings. In spite of considerable variabilities in both aspects, there was clinical and histologic agreement in 96 per cent. Alertness on the part of the clinician and pathologist is essential for diagnosis of atypical cases.