Lichen Planus in Four Clinical Forms.

Lichen planus is an autoimmune disorder which comes under lichenoid reactions. It is T-cell mediated cytotoxic reaction directed against antigen expressed by basal cell layer of the oral mucosa. Autoreactive T-lymphocytes may be of primary importance for the development of oral lichen planus. Lichen planus presentations in the oral cavity are in 6 forms: Reticular, papular, plaque, bullous, erythematous and ulcerative. We present a case report of 4 forms in a patient.

Changes in peripheral innervation and nociception in reticular type and erosive type of oral lichen planus.

Background: Oral lichen planus (OLP) is a chronic inflammatory lesion in oral mucosa. Reticular (OLP-R) and erosive (OLP-E) types of OLP are the common forms that have been found in dental clinics. The aim of this investigation is to determine the correlation between neurogenic inflammation and nociception associated with OLP-R and OLP-E. Materials and Methods: The oral mucosal lesions from six patients with OLP-E, four with OLP-R and three with noninflamed oral mucosa, which represent normal mucosa, were identified by morphometric analysis of nerve fibers containing immunoreactive protein gene product (PGP) 9.5. The level of inflammation was measured with hematoxylin and eosin staining and the level of nociception was analyzed with visual analog scale measurement. Results: We found that 1) an increase in peripheral innervation was related to the size of the area of inflammatory cell infiltration from both OLP-R and OLP-E; 2) the pattern of PGP 9.5-immunoreactivity among OLP-R and OLP-E was not significantly different (P=0.23); and 3) the correlation between nociception and an increase in PGP 9.5-immunoreactivity was not found in OLP-E and in OLP-R. Conclusions: Our findings suggest that an increase in peripheral innervation may lead to increased inflammation, which is part of the immunopathogenesis of OLP. Differences in nociception between OLP-R and OLP-E arise from the pathogenesis of each lesion, not from the differences in peripheral innervation.

Líquen plano oral / Oral lichen planus

O líquen plano da mucosa oral (LPO) é afecção relativamente comum, que pode aparecer isolado ou associado ao líquen plano cutâneo, havendo, no entanto, significantes diferenças clínicoevolutivas: o LPO tende a ser crônico, recidivante e de difícil tratamento, levando a importante morbidade, principalmente em sua forma erosiva. Novas formas clínicas agressivas têm sido salientadas na literatura, como a forma gingivo-vulvar. Este artigo revisa a etiopatogenia, as formas clínicas, a diagnose diferencial e laboratorial, a prognose e o tratamento do LPO, além de mencionar, brevemente, a experiência dos autores com esta enfermidade, vivida no Ambulatório de Estomatologia da Divisão de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.

Oral lichen planus (OLP) is a relatively common mucosal disease that can present isolated or associated with cutaneous lichen planus. Contrarily to its cutaneous counterpart, though, OLP tends to be chronic, relapsing, and difficult to treat. Severe morbidity is related to erosive forms, and more aggressive presentations have been described, such as the "gingivo-vulvar syndrome". This article reviews the current knowledge about the pathogenesis, clinical picture, differential and laboratorial diagnosis, prognosis, and treatment of OLP.

Evaluation of salivary cortisol and psychological factors in patients with oral lichen planus.

Background and Objectives: Lichen planus is a relatively common chronic inflammatory disease of oral mucosa and skin. Cortisol, also called as "stress hormone", has been used as an indicator in various stress evaluation studies. Salivary cortisol measurement is an indicator of free cortisol or biologically active cortisol in human serum and provides noninvasive and easy technique. Recent studies have been conflicting, and hence, in the present study, evaluation of salivary cortisol levels and psychosocial factors in oral lichen planus (OLP) patients was done. Materials and Methods: A total of 30 patients with clinically and histopathologically proven cases of OLP, along with the age and sex-matched healthy controls were included in the study. Samples of stimulated saliva were collected, centrifuged and analyzed for the level of cortisol with cortisol enzyme linked immunosorbent assay. Psychosocial factors of study and control groups were measured by depression anxiety and stress scale. Student's t-test was used to compare the psychological factors and salivary cortisol levels between patients with the OLP and the control group. Results: Irrespective of sex, significantly higher depression (83.4 ± 15.4%), anxiety (80.5 ± 11.3%), and stress (94.2 ± 6.2%) scores were observed in OLP patients compared to controls. Increased cortisol levels were observed among 17 (56.6%) OLP patients in the study group. A positive correlation was found between psychological factors and salivary cortisol levels in the OLP patients. The values of Pearson's correlation coefficient "r", between depression, anxiety, and stress with salivary cortisol was: +0.42,S; +0.27,NS; and +0.65,HS, respectively among the study group.

Role of apoptosis in erosive and reticular oral lichen planus exhibiting variable epithelial thickness

Oral lichen planus (OLP) is a chronic inflammatory disease with different clinical types. Reticular and erosive forms are the most common. Although the cause of OLP remains speculative, many findings suggest auto-immune involvement, mediated by T lymphocytes against the basal keratinocytes. Inflammation, mechanical trauma or toxic agents can affect the epithelial homeostasia. Increased apoptosis may cause a decrease in epithelial thickness reflecting in the activity of the lesion. The objective of this study was to evaluate the occurrence of apoptosis and epithelial thickness in reticular and erosive forms of OLP. 15 samples of OLP each type (reticular and erosive) plus 10 of healthy mucosa were collected and processed. After morphometry, the apoptotic index and epitelial thickness were obtained. TUNEL and M30 CytoDEATH immunohistochemical assay were used to validate the morphologic criteria used. Apoptosis in the erosive OLP was significantly more intense than in the reticular type and both forms of OLP presented more apoptosis than the healthy oral mucosa. Healthy oral mucosa was thicker than both OLP forms and thicker in OLP reticular form than in the erosive one. The clinical differences between reticular and erosive forms of OLP are related to variations in epithelial thickness and in intensity of apoptosis.

O líquen plano oral (LPO) é uma doença inflamatória crônica com diferentes tipos clínicos. As mais comuns são as formas reticular e erosiva. Embora a causa do LPO permaneça no campo especulativo, muitos achados sugerem tratar-se de uma doença auto-imune, mediada por linfócitos T que têm como alvo os ceratinócitos basais. Inflamação, trauma mecânico ou agentes tóxicos podem afetar a homeostasia epitelial. O aumento da apoptose pode levar a uma diminuição da espessura epitelial e isto refletir na atividade da doença. O objetivo deste estudo foi avaliar a ocorrência de apoptose e a espessura epitelial nas formas reticular e erosiva de LPO. 15 amostras de LPO de cada tipo reticular e erosivo, além de 10 amostras de mucosa saudável foram coletadas e processadas. Depois da morfometria, o índice apoptótico (IA) e a espessura do epitélio foram obtidas. Reação de TUNEL e imunohistoquímica do M30 CytoDeath foram usadas para validação dos critérios morfológicos. A apoptose no LPO erosivo foi significativamente maior que no tipo reticular e ambas as formas de LPO apresentaram mais apoptose que a mucosa oral normal. A mucosa oral normal foi mais espessa que ambas as formas de LPO, sendo que, a forma reticular foi mais espessa que o tipo erosivo. As diferenças clínicas entre as formas reticular e erosiva de LPO têm relação com as variações na espessura epitelial e na intensidade da apoptose.

Actualización en liquen plano oral / Update in oral lichen planus

El liquen plano LP es un desorden inflamatorio del epitelio escamoso estratificado relativamente común. Las lesiones pueden afectar la piel y membranas mucosas. El Liquen Plano Oral LPO, usualmente, presenta una morfología y distribución característica, pudiendo mostrar una disposición confusa de patrones y formas de tal manera que otros desórdenes pueden simularlo clínicamente. El LP es probablemente de origen multifactorial, algunas veces es inducido por drogas o materiales dentales, a menudo idiopático y con una inmunopatogénesis que involucra a las células T en particular. La etiopatogénesis parece ser compleja con interaccioes entre factores genéticos, ambientales y de estilo de vida, aunque en la actualidad se han aclarado varios aspectros acerca de los mecanismos involucrados y han surgido nuevas asociaciones interesantes con otras enfermedades. El manejo del LP aún no es satisfactorio, pues hasta ahora no existe un tratamiento definitivo y aunque no hay método curativo disponible, la inmunomodulación puede controlar la condición. Clásicamente se ha considerado como una entidad premaligna, pero estudios recientes sugieren que existe una condición conocida como displasia liquenoide que requiere diagnóstico diferencial con el LP. Se precisa más investigación en los aspectos genéticos, ambientales, potencial maligno, asociación con otros desórdenes y más estudios clínicos acerca de su terapia