Verruciform xanthoma associated with lichen planus

Verruciform xanthoma (VX) is a rare benign lesion of unknown etiology, with a rough or papillary aspect, painless, sessile, well-defined, most lesions do not exceed 2 cm in their largest diameter, the degree of keratinization of the surface influences color, varying white to red, affecting mainly the gingiva and alveolar mucosa, and can also be seen in skin and genital. Herein, we present a report a clinical case of oral verruciform xanthoma in the buccal mucosa associated with the lichen planus lesion, as well as the morphological and immunohistochemical characteristics of the lesion. The clinical diagnostic hypothesis of oral lichen planus of the white reticular lesions on the buccal mucosa and on the tongue was confirmed by histopathology before a subepithelial connective tissue exhibiting intense inflammatory infiltrate in a predominantly lymphocytic band. In contrast, the hypothesis of the verrucous lesion in the left buccal mucosa was leukoplakia, with histopathological evidence showing exophytic and digitiform proliferations with parakeratin plugs between the papillary projections. Subepithelial connective tissue was characterized by macrophages with foamy cytoplasm (xanthoma cells). An immunohistochemical examination was performed, showing positivity for CD68, a macrophage marker, in addition to testing by Schiff's periodic acid (PAS) with diastasis, which was detected the presence of lipids inside these macrophages. The patient is free of recurrences of verruciform xanthoma and is being monitored due to the presence of lesions of oral lichen planus.

Immune mechanisms involved in the coexistence of oral lichen planus and autoimmune thyroid diseases / 浙江大学学报·医学版

Oral lichen planus (OLP) is a chronic inflammatory oral mucosal disease with unclear etiology. Autoimmune thyroid diseases (AITD) is a type of autoimmune disease characterized by increased thyroid-specific antibodies. In recent years, more and more studies have found that the incidence of AITD is increased in OLP patients. The occurrence and development of OLP and AITD may be related to the expression of thyroid autoantigen in oral keratinocytes, the imbalance of thyroid hormone （Th）1/Th2 and Th17/Treg cell subsets, the abnormal quantity and function of follicular helper T cells and chemokines and the specific killing ability of CD8 T cells to target cells. In this article, the possible immune mechanisms involved in the coexistence of OLP and AITD are reviewed to provide insights for the diagnosis, treatment and prevention of these two diseases from the perspective of immunology.

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.

Increased salivary aldehyde dehydrogenase 1 in non-reticular oral lichen planus

Abstract: Background: Oral lichen planus is a potentially malignant disorder. One of the malignant transformation markers is cancer stem cells. One of the proposed marker for the detection of cancer stem cells's in head and neck cancer is aldehyde dehydrogenase. Recently it is shown that aldehyde dehydrogenase 1 expression in tissue samples is associated with oral lichen planus malignant transformation. Objective: This study evaluates salivary aldehyde dehydrogenase 1 in oral lichen planus. Method: Thirty patients and 30 age and sex-matched healthy volunteers were recruited. Oral lichen planus was diagnosed based on the modified World Health Organization criteria. Subjects in the case group were divided into reticular and non-reticular forms. Unstimulated salivary samples were collected at 10-12 AM. Saliva concentrations of aldehyde dehydrogenase 1 were measured by ELISA. Results: The differences between aldehyde dehydrogenase levels in the oral lichen planus group compared with the control group were not significant but aldehyde dehydrogenase in non-reticular oral lichen planus was significantly higher than that of the reticular form. Limitations of the study: This is a cross-sectional study, thus longitudinal studies in oral lichen planus may present similar or different results. Conclusions: The mechanism of malignant transformation in oral lichen planus is not defined. Previous analyses revealed that the aldehyde dehydrogenase 1 expression is significantly correlated with increased risk of transformation. This finding is consistent with our results because in the erosive and ulcerative forms of oral lichen planus, which have an increased risk of transformation, salivary aldehyde dehydrogenase 1 was overexpressed. A higher salivary aldehyde dehydrogenase level in non-reticular oral lichen planus can be a defensive mechanism against higher oxidative stress in these groups. Aldehyde dehydrogenase may be one of the malignant transformation markers in oral lichen planus. Further studies are needed for introducing aldehyde dehydrogenase as a prognostic indicator in certain lesions.

In situ carcinoma developed over oral lichen planus: a case report with analysis of BUB3, p16, p53, Ki67 and SOX4 expression

AbstractOral lichen planus (OLP) represents a common mucocutaneous disease. Various authors have suggested that OLP has malignant potential; however, the mechanisms involved in malignant transformation have not yet been elucidated. A 79-year-old man presented a white lesion for five months in the buccal mucosa diagnosed as OLP. After two months using 0.05% clobetasol ointment for treatment, the lesion became ulcerated. A new biopsy of the same lesion was performed, and histological analysis showed an in situ oral carcinoma (ISOC). An immunohistochemistry panel was performed, and p16 expression was negative in OLP, however, it showed weak cytoplasmic staining in ISOC. There was strong nuclear BUB3 staining in both OLP and ISOC areas. p53 showed less intense nuclear staining in both regions. Ki67 was negative in OLP area, but showed nuclear staining in the ISOC. SOX4 was negative in both studied areas. BUB3 expression, first reported in this case, and the p16 expression may suggest some influence of these genes on pathogenesis or malignant potential of OLP.

Oral lichen planus: study of 21 cases

Abstract BACKGROUND: Lichen planus is considered to be the most common dermatological disease involving the oral mucosa. OBJECTIVE: To investigate the profile, clinical features, and the presence of dysplasia and candidiasis in patients with oral lichen planus. METHODS: A total of 21 patients were selected from 258 patients at risk for oral cancer development. RESULTS: Most of the patients were white (76,2%), female (66,6%), with mean age of 58.8 years. Eight were smokers and seven were alcohol consumers. The buccal mucosa was the most affected site, followed by the tongue and the gingiva. The reticular pattern was the most common appearance. Histopathology depicted dysplasia in nine cases and cytopathology was positive for Candida in eight cases in the first appointment. CONCLUSION: Our data are similar to the literature. Cytopathology was important for the diagnosis of candidiasis. Although the presence of dysplasia was verified, further studies are necessary to clarify the importance of this finding. .

Syndrome in Question

Multiple autoimmune syndrome is a rare condition, described by Humbert and Dupond in 1988. It is defined by the association of at least 3 autoimmune diseases in the same patient. Vitiligo is the most common skin condition in this syndrome. This article presents the case of a 31-year-old male with vitiligo, alopecia areata, Crohn's disease, psoriasis vulgaris and oral lichen planus. The rarity of this case is highlighted by the coexistence of four autoimmune skin diseases in association with Crohn's disease, never described in the literature.

Papel da apoptose no infiltrado inflamatório do Líquen Plano Bucal / Inflammatory infiltrate of oral lichen planus of erosive and reticular types

O Liquen Plano Bucal (LPB) é uma doença inflamatória crônica auto-imune, cujas formas clínicas mais comuns são os tipos reticular e erosivo. A persistência do infiltrado inflamatório é importante para a patogênese do LPB, mas os mecanismos envolvidos neste processo ainda precisam ser mais onvestigados. A deficiência de apoptose pode contribuir para essa persistência do infiltrado subepitelial, que é composto predominantemente por linfócitos T CD4+ e CD8+. É sabido que o alvo das células CD8+ (LT citotóxicos) são ceratinócitos no LPB. O objetivo deste estudo foi avaliar se há bloqueio da apoptose nos linfócitos subepiteliais, elucidar as vias apoptóticas envolvidas, bem como quantificar os linfócitos T CD8+ nas lesões de LPB dos tipos reticular e erosivo...

Liquen plano oral y su relación con el desarrollo de carcinomas. Revisión bibliográfica: reporte de un caso / Oral lichen planus and its relation with the development of carcinomas. Review of the literature: a clinical case report

Se realizó la búsqueda bibliográfica de la incidencia del liquen plano oral y su relación con el desarrollo de carcinomas verrugoso y espinocelular en Sudamérica, que varía en relación con otras latitudes. Su mayor incidencia es en el sexo femenino, fuera de factores de riesgo, pero con un componente psicológico evidente. El caso clínico del presente trabajo es sobre una paciente de género femenino de 52 años de edad, diabética tipo dos e hipertensa compensada, quien presentaba dos lesiones de liquen plano que fueron biopsiadas, obteniéndose como resultado anatomopatológico carcinoma verrugoso y espinocelular.

Líquen plano oral (LPO): diagnóstico clínico e complementar / Oral lichen planus (OLP): clinical and complementary diagnosis

O líquen plano é uma desordem comum do epitélio escamoso estratificado que acomete as mucosas oral e genital, a pele, as unhas e o couro cabeludo. O líquen plano oral (LPO) afeta mulheres de meiaidade e apresenta padrões e distribuição característicos, como estriações brancas, pápulas ou placas brancas, eritema, erosões e bolhas, que podem estar associadas a medicações e/ou materiais dentários no paciente. O diagnóstico clínico somente poderá ser feito se a doença apresentar padrões clássicos, como lesões concomitantes na mucosa oral e na pele. O diagnóstico laboratorial por meio do exame histopatológico se caracteriza pela presença de projeções do epitélio em forma de dentes de serra e corpos de Civatte, e possibilita excluir condições de displasia e malignidade. A imunofluorescência direta é utilizada em suspeita de outras doenças, como pênfigo e penfigoide. O LPO é tratado com agentes anti-inflamatórios, principalmente, corticosteroides tópicos, e novos agentes e técnicas têm-se demonstrado eficazes. A transformação maligna do LPO e sua incidência exata permanecem controversas. Este trabalho tem como objetivo apresentar, com base na revisão da literatura, a etiopatogenia, o diagnóstico clínico, exames complementares e complicações do LPO.

Lichen planus is a common disorder of the stratified squamous epithelium that affects oral and genital mucous membranes, skin, nails, and scalp. Oral Lichen Planus (OLP) affects middle-aged women and shows distribution patterns and characteristics such as white striations, white plaques or papules, erythema, blisters and erosions, and may be associated with medication and/or dental materials used by the patient. The clinical diagnosis can only be made if the disease presents classical patterns such as concomitant lesions in the oral mucosa and skin. The laboratory diagnosis is histopathologically characterized by the presence of projections of the epithelium in the form of sawtooth and Civatte bodies and allows the exclusion of dysplasia and malignancy. Direct immunofluorescence is used when there is suspicion of other diseases, such as pemphigus and pemphigoid. OLP is treated with anti-inflammatory agents, particularly topical corticosteroids; new agents and techniques have proved effective. The malignant transformation of OLP and its exact incidence remain controversial. This work aims at presenting, through literature review, the etiopathogenesis, clinical diagnosis, laboratory tests, and complications of OLP.

Síndrome de Cushing como complicação do tratamento de líquen plano oral erosivo / Cushing´s Syndrome as a complication of treatment of oral lichen planus

O líquen plano oral (LPO) é uma doença mucocutânea inflamatória crônica relacionada com alterações na imunidade mediada por células T. Diversos medicamentos têm sido utilizados no tratamento desta doença, especialmente nas formas erosivas e ulcerativas, com resultados variados. O objetivo deste trabalho é descrever e discutir um caso clínico de líquen plano oral erosivo tratado com corticóide sistêmico que resultou em Síndrome de Cushing, que se manteve com o uso de corticóide tópico.

Oral lichen planus (OLP) is a chronic mucocutaneous inflammatory disease involving T cells-mediated immunity. Several drugs have been used to treat OLP, specially the erosive and ulcerative forms, with varying results. The aim of this paper was to describe and discuss one clinical case of erosive oral lichen planus treated with systemic corticosteroids that resulted in Cushing´s syndrome that maintained with topical corticosteroid.

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.

Líquen plano bucal: considerações clínicas e histopatológicas: [revisão] / Oral lichen planus: clinical and histopathological considerations: [review]

O líquen plano é uma das doenças dermatológicas mais comuns que acometem a cavidade bucal, com prevalência de 1 por cento a 2 por cento na população geral. Contudo, apesar de relativamente freqüente, o líquen plano bucal é alvo de muita controvérsia, especialmente em relação ao seu potencial de malignização. OBJETIVO: O presente trabalho tem como objetivo tecer considerações clínicas e histopatológicas a respeito do líquen plano bucal, favorecendo seu entendimento por parte dos profissionais da saúde e, conseqüentemente, reforçando a importância do acompanhamento a longo prazo dos pacientes acometidos pela doença. CONCLUSÃO: A possibilidade da lesão sofrer transformação maligna justifica a importância do acompanhamento a longo prazo dos pacientes com a doença.

Oral lichen planus is one of the most common dermatological diseases presenting in the oral cavity; the prevalence in the general population is 1 percent to 2 percent. Although relatively frequent, oral lichen planus is the target of much controversy, especially in relation to its potential for malignancy. AIM: This study aimed to make clinical and histopathological considerations regarding oral lichen planus to increase the level of knowledge about this condition among health professionals, underlining the importance of long-term follow-up of these patients. CONCLUSION: The possibility of this lesion to turn malignant justifies the importance of long term follow up for patients with such disease.

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

Transformación maligna del liquen plano bucal vs. displasia liquenoide: presentación de caso clínico / Malignant transformation of oral lichen planus vs. lichenoid dysplasia: report of a clinical case

Se presenta una revisión bibliográfica acompañada de un caso clínico, donde se plantea la importante polémica que se discute actualmente, en cuanto a la posibilidad de malignización de las lesiones de liquen plano bucal.