Probable Association Between Oral Lichen Planus and presence of Helicobacter Pylori: a Preliminary Study in a Chilean Population / Probable Asociación entre Liquen plano Oral y la presencia de Helicobacter pylori: estudio Preliminar en Chile

ABSTRACT: Oral Lichen planus (OLP) is one of the main inflammatory diseases of the oral mucosa that is considered as a potentially malignant disorder. The exact pathogenesis of OLP remains to be completely understood. However, presence of bacteria has been associated to the inflammatory response observed in OLP. Particularly, Helicobacter pylori a major etiological agent of gastrointestinal inflammatory diseases and risk factor for gastric cancer, has been associated to Lichen planus. Here we studied a group of Chilean patients if there is any association between the presence of Helicobacter pylori and the clinical manifestation of OLP. We found a significant difference between the patients positive for H. pylori and the age of OLP diagnosis, suggesting that oral H. pylori might induce the disease at an earlier age. However, we could not confirm a statistically significance between the presence of the bacteria and OLP.

RESUMEN: Liquen Plano Oral (LPO) es una enfermedad inflamatoria de la mucosa oral considerada como desorden potencialmente maligno. La patogénesis exacta de LPO es desconocida. Sin embargo, se ha asociado la presencia de bacterias como responsables de la inflamación observada en LPO. Particularmente, Helicobacter pylori (H. pylori), agente etiológico principal de enfermedades inflamatorias gastrointestinales y factor de riesgo de cáncer gástrico, ha sido asociado con LPO. Se estudió la posible asociación entre H. pylori y manifestaciones clínicas de LPO en un grupo de pacientes Chilenos. Se encontró diferencia significativa entre los pacientes positivos para H. pylori y la edad de diagnóstico de LPO, sugiriendo que H. pylori podría inducir la enfermedad a temprana edad. Sin embargo, no se pudo confirmar significancia estadística entre la presencia de esta bacteria y la presencia de displasia en LPO.

Psychopathological profile and quality of life of patients with oral lichen planus

Abstract Objectives Oral lichen planus (OLP) is a chronic, multifocal, sometimes painful, inflammatory disease of the oral mucosa. OLP can predispose development of psycho-emotional disorders. Until now, the relationship between the severity of lichen planus and the psychological profile of patients (psychological well-being, perceived stress and pain coping strategies) has never been studied. Material and Methods Study was conducted on 42 OLP patients. Number of sites involved, severity and activity score of OLP were evaluated. Psychological tests were used to evaluate patients' psycho-emotional condition. The mean duration time of symptomatic OLP was 43 months. Results We detected that the longer the duration of subjective symptoms, the poorer the quality of life and the higher the level of perceived stress (PSS). Also, the higher the PSS results, the greater the anxiety and depression on Hospital Anxiety and Depression Scale (HADS). Likewise, higher level of depression in HADS was strongly correlated with worse quality of life. (p≤0.05). Conclusions In this study, we detected a relationship between duration of the disease, level of perceived stress and quality of life. The longer the disease lasts, the higher it tends to catastrophize. This may influence development or increase of the anxiety and depression and may decrease patients' quality of life.

Association of Oral Lichen Planus and Electrocardiographic P-Wave Dispersion - An Original Research

Abstract Lichen planus (LP) is considered to be a T-cell-mediated inflammatory disorder. Inflammation is considered to produce disturbances of lipid metabolism which may affect the myocardium. Increased P-Wave Dispersion (PWD) is demonstrated as an independent risk factor for developing atrial fibrillation (AF). Hence the present study has been conducted to explore the possible relationship of oral lichen planus (OLP) with AF by the evaluation of PWD. Twelve-lead electrocardiographs (ECG) were obtained from 45 OLP patients and 45 age and gender-matched healthy controls. The P-wave durations (Pmax and Pmin) were calculated in all 12 leads. The difference between Pmax and Pmin was defined as P-Wave Dispersion (PWD). After the PWD was recorded, the results were statistically analyzed. The study showed that PWD increased on surface ECG measurements in OLP patients who were otherwise asymptomatic in relation to cardiac conditions. The p value obtained was <0.001 which was highly significant. The present study suggests a highly statistically significant association of OLP with increased P-wave dispersion. Hence the patients with OLP should undergo cardiac evaluation and follow up for early detection of atrial fibrillation.

Resumo O líquen plano oral (LPO) é considerado um distúrbio inflamatório mediado por células T. Acredita-se que a inflamação produza distúrbios do metabolismo lipídico que podem afetar o miocárdio. Uma dispersão de onda-P (DOP) aumentada é demonstrada como um fator de risco independente para o desenvolvimento de fibrilação atrial. Assim, o presente estudo foi conduzido para explorar a possível relação de LPO com fibrilação atrial pela avaliação por meio de DOP. Eletrocardiogramas (ECG) de 12 derivações foram obtidos de 45 pacientes com LPO e 45 controles saudáveis com idade e sexo equiparados. As durações das ondas P (Pmax e Pmin) foram calculadas em todas as 12 derivações. A diferença entre Pmax e Pmin foi definida como DOP e os valores analisados estatisticamente. O estudo mostrou que DOP aumentada nos ECG de superfície dos pacientes com OLP que eram assintomáticos em relação a condições cardíacas. O valor p obtido foi <0,001, altamente significativo. O presente estudo sugere uma associação altamente significativa estatisticamente entre OLP a DOP aumentada. Assim, os pacientes com OLP devem ser submetidos a avaliação cardíaca e acompanhamento para detecção precoce da fibrilação atrial.

Apoptosis y liquen plano oral: revisión de la literatura / Apoptosis and oral lichen planus: a review of the literature

En los últimos años se han producido grandes avances en el diagnóstico y tratamiento del Liquen Plano Oral (LPO). Sin embargo, sigue siendo una entidad con muchos interrogantes para la estomatología, sobre todo referidos a su proceso de aparición y a su tratamiento. El propósito de este trabajo es realizar una revisión bibliográfica actualizada del LPO y su relación con la apoptosis, tema de gran interés para la investigación científica. La apoptosis por su parte adquiere gran relevancia debido al rol que cumple este mecanismo: regulación en la morfogénesis, homeostasis de las poblaciones celulares y carcinogénesis en relación a la tendencia y potencial capacidad de transformación maligna de algunas variantes de LPO en sus formas atípicas.

In recent years, there have been major advances in the diagnosis and treatment of Oral Lichen Planus (OLP). However, it remains an entity with many questions for stomatology, especially referred to the process of occurrence and treatment. The purpose of this work is to conduct a literature review updated LPO and its relationship with apoptosis, topic of great interest for scientific research. The apoptosis meanwhile acquires great importance because of the role that this mechanism regulating morphogenesis, homeostasis of cell populations and carcinogenesis in relation to the trend and potential ability of malignant transformation of some variants of LPO in their atypical forms.

A comparative study of apoptosis in reticular and erosive oral lichen planus

The oral lichen planus (OLP) is a chronic inflammatory disease, probably autoimmune, with different clinical forms. The most common types are the reticular and the erosive ones. Apoptosis participates in the destruction of basal keratinocytes, but its role in the perpetuation of the subepithelial lymphocytic infiltrates was not yet investigated. To evaluate the involvement of apoptosis in the epithelium and in subepithelial lymphocytic infiltrates, 15 samples of reticular and erosive OLP and 10 samples of healthy oral mucosa were collected and processed histologically. Apoptosis was quantified in the epithelium and in inflammatory cell infiltrates. TUNEL reaction was used to measure apoptosis in the infiltrates. Erosive OLP showed more intense epithelial apoptosis than reticular OLP and controls. In contrast, apoptosis in the inflammatory cell infiltrates was more frequent in reticular than in erosive OLP. Lymphocytes were the predominant cells within the inflammatory cell infiltrates and were more frequent in erosive OLP than in reticular type. These results suggest that different apoptotic levels are involved in the erosive/reticular switch in OLP, determining different clinical presentations. In conclusion, decreased apoptosis in inflammatory infiltrates may contribute to the persistence of T lymphocytes, worsening the attack to the epithelium in erosive OLP.

O líquen plano oral (LPO) é uma doença crônica inflamatória, provavelmente auto-imune, com diferentes formas clínicas. Os tipos mais comuns são o reticular e o erosivo. A apoptose participa da destruição dos ceratinócitos basais, no entanto o seu papel na perpetuação do infiltrado linfocitário subepitelial ainda não foi investigado. Para avaliar o envolvimento da apoptose no epitélio e no infiltrado linfocitário subepitelial, quinze amostras de LPO reticular, quinze de LPO erosivo e dez amostras de mucosa oral saudável foram coletadas e processadas histologicamente. A apoptose foi quantificada no epitélio e nas células do infiltrado inflamatório. A reação de TUNEL foi usada para mensurar a apoptose no infiltrado. A intensidade da apoptose no epitélio mostrou ser maior no LPO erosivo que no LPO reticular e estes foram maiores que no controle. Em contraste, a apoptose nas células do infiltrado inflamatório foi mais freqüente no LPO reticular que no LPO erosivo. Os linfócitos foram as células predominantes dentro do infiltrado inflamatório e foram mais freqüentes no tipo erosivo de LPO que no tipo reticular. Estes resultados sugerem que diferentes níveis de apoptose estão envolvidos no tipo erosivo e reticular de LPO, determinando as diferenças nas apresentações clínicas. Em conclusão, a diminuição da apoptose no infiltrado inflamatório pode contribuir para a persistência dos linfócitos T, piorando o ataque ao epitélio no LPO erosivo.

Correlation of " in vivo" microcirculation and degeneration of the basal cells of the epithelium in lingual lichen planus.

Background: Oral lichen planus is an inflammatory chronic disease with an autimmune pathogenesis and unknown etiology that affects oral mucosa, with or without the involvement of the skin and other mucous membranes. The principal histological characteristics are the degeneration of the basal cell layer and the abnormal infiltration of inflammatory cells into the subepithelial layer of connective tissue. Objectives: This study is aimed to appraise if lingual lichen planus (LLP) is sustained by alteration of the oral microcirculation and if this abnormal vascularisation increases the degeneration of basal keratinocytes and the disruption of the basement membrane. Materials and Methods: Fifteen patients with a histological diagnosis of LLP with higher degree of degeneration of the basement membrane, fifteen LLP patients with lower degree of basement membrane (BM) degeneration and fifteen healthy patients were included in the study. The microcirculation of the left margin of the lingual mucosa of all the patients and subjects was analysed with the videocapillaroscopy. The following parameters were analyzed on each capillaroscopic image: c0 apillary loop length, loop diameter, and capillary density. The results obtained by videocapillaroscopy software were subjected to statistical analysis using Mann Whitney U-test (P < 0.001). Statistical analysis was performed using PAST software, v. 1.53. Results: Capillary density, loop length, and total diameter showed statistically significant differences between LLP patients with histologically lower degree of BM degeneration and healthy subjects and a meaningful significant difference between LLP patients with higher degree of BM degeneration. Conclusions: A remarkable increase in capillary density was showed by videocapillaroscopic exam. The increased value of the density could be associated with angiogenesis mechanism and it could be an indicator of the evolutionary condition of LLP. Videocapillaroscopy may be useful for the evaluation of the evolution or regression of the disease.