Serum and salivary cytokines in patients with oral lichen planus treated with Photobiomodulation.

OBJECTIVES: To evaluate the serum and salivary levels of IL-1ß, IL-6, IL-17A, TNF-α, IL-4, and IL-10 in patients with oral lichen planus (OLP) treated with Photobiomodulation (PBM) and clobetasol propionate 0.05%. MATERIAL AND METHODS: Thirty-four OLP patients were randomized into two groups: Control (clobetasol propionate 0.05%) and PBM (660 nm, 100 mW, 177 J/cm2 , 5 s, 0.5 J per point). Serum and saliva were collected at baseline and at the end of treatment (after 30 days) and evaluated using ELISA. The cytokine results were correlated with pain, clinical subtypes, and clinical scores of OLP. RESULTS: IL-1ß, IL-6, IL-17A, TNF-α, and IL-4 levels were higher in saliva in relation to serum. IL-1ß was the most concentrated cytokine in saliva, and a positive correlation with the severity of OLP was noticed. After treatment with corticosteroid, IL-1ß in saliva decreased significantly. No modulation of all cytokines was observed after PBM. CONCLUSION: IL-1ß appears to be an important cytokine involved in OLP pathogenesis. In addition, the mechanisms of action of PBM do not seem to be linked to the modulation of pro or anti-inflammatory cytokines at the end of treatment. It is possible that this events occurred early during treatment.

CD146 expression in oral lichen planus and oral cancer.

OBJECTIVE: To examine the CD146/METCAM expression on keratinocytes in normal oral mucosa (NOM), oral lichen planus (OLP), oral epithelial dysplasia (OED), and oral squamous cell carcinoma (OSCC). SUBJECTS AND METHODS: Immunohistochemical examination of CD146 was performed on 80 specimens, divided into 20 cases from each group. The number of CD146+ keratinocytes was quantitatively assessed together with the staining intensity. RESULTS: The mean percentage of CD146+ keratinocytes was 19.04±15.32, 59.40±24.48, 60.04±28.87, and 22.13±21.03 in NOM, OLP, OED, and OSCC, respectively. The mean percentages of CD146+ keratinocytes in OLP and OED were significantly higher than those of NOM and OSCC (p≤0.001). Most OED (55%) and OLP (60%) showed strong and moderate staining intensity, respectively, while NOM (50%) and OSCC (45%) predominantly expressed CD146 at mild intensity. CONCLUSIONS: This is the first study to examine CD146 expression in OLP and OED. CD146 is upregulated in OLP and OED but downregulated in OSCC. The alteration in CD146 may be involved in the immunoregulatory response of OLP and the early event of oral carcinogenesis. The loss of this protein may underlie the progression of OED into invasive OSCC. CLINICAL RELEVANCE: Overexpression of CD146 protein may play a role in the pathophysiology of OLP and OED.

Correlation of clinicopathological characteristics and direct immunofluorescence studies in oral lichenoid lesion in Thai patients.

AIM: To investigate the correlation between the clinicopathological characteristics, serum antinuclear antibody (ANA) and direct immunofluorescence (DIF) findings in oral lichen planus (OLP) and oral lichenoid lesion (OLL). METHODS: Fifty three Thai patients with red and white lesions were divided into 3 groups: 17 cases of OLP, 19 cases of OLL and 17 cases of oral lichenoid drug reaction (OLDR), respectively. The medical records, photographs, histopathological evaluation and laboratory ANA and DIF results were analyzed. RESULTS: Atrophic pattern was the most commonly found pattern in the OLDR, OLP and OLL groups. In the OLP group, the DIF interpretation confirmed only 41.2% of cases as OLP, with 23.5% each as lichen planus (LP)/lupus erythematosus (LE) or negative findings. In the OLL group, the most common DIF interpretation (31.6% each) was LP/LE or non-specific finding. In the OLDR group, DIF interpretation was OLP or LP/LE (23.5% each), with 5.9% each of immune complex-mediated disease, compatible with OLP, and mixed connective tissue disease. Interestingly, 1 case in the OLDR group demonstrated mild to moderate dysplasia. There were no significant differences in ANA positivity or patterns between the 3 groups. CONCLUSION: An OLP-like lesion could be diagnosed as OLP, OLP/LE, chronic ulcerative-like lesion, immune-mediated disease or dysplasia.

A Review of the Effectiveness and Side-Effects of Fluocinolone Acetonide 0.1% in the Treatment of Oral Mucosal Diseases.

Topical steroids have been widely used in the treatment of symptomatic oral lesions to reduce pain and inflammation. Potent topical steroids such as clobetasol propionate, fluocinolone acetonide (FA), and fluocinonide have been widely used in the treatment of severe oral mucosal lesions. Many reports have demonstrated that these steroids were effective in treating oral lesions with only minor side-effects. This review describes the effectiveness and side-effects of using FA 0.1% in the treatment of symptomatic oral lichen planus (OLP), oral lichenoid drug reaction (OLDR), oral pemphigus, and herpes associated erythema multiforme (HAEM). FA 0.1% was effective and safe in the treatment of patients with multiple systemic diseases and a pregnant patient with HAEM. Moreover, this topical steroid rapidly reduced pain, inflammation, and enhanced lesion healing with no serious side-effects other than pseudomembranous candidiasis, which is easily treated. In some cases, a long-term treatment with FA 0.1% resulted in hyperpigmentation at the areas of previously healed oral lesions; however, this hyperpigmentation was gradually resolved after discontinuing topical steroid treatment.

Serum antinuclear antibody in adult Thais.

OBJECTIVE: This study investigated the presence of antinuclear antibody (ANA) in older Thais compared with middle-age and younger participants. BACKGROUND: Antinuclear antibody represents the first step in the diagnostic testing for lupus erythematosus (LE) and other autoimmune diseases. Due to the lack of reference ANA levels in older, middle-age and younger Thais healthy participants, this study will be useful for determining the proper diagnostic and treatment criteria. METHODS: There were 28 older (60-76 years), 17 middle-age (41-59 years) and 13 younger (24-40 years) participants in this study. Immunofluorescence was performed to analyse the ANA staining pattern and titre levels in the participants' blood samples. RESULTS: The presence of serum ANA was found in 18 of 28 cases (64.3%), four of 17 (23.5%) and one of 13 cases (7.7%) of the older, middle-age and younger participants, respectively. The difference in the number of serum ANA-positive participants between the older, middle-age and younger groups was statistically significant (p < 0.05). Interestingly, the ANA positive in older participants presented more than one staining pattern. The speckled pattern was the most commonly detected ANA staining pattern in the older group, being found in 12 cases followed by cytoplasmic pattern (10 cases), homogeneous pattern (nine cases) and nucleolar pattern (five cases). In the middle-age group, the speckled pattern was found in four cases, whereas one younger participant presented a nucleolar pattern. CONCLUSION: Serum ANA positive was significantly higher in the older group compared with the middle-age and younger groups. There were variations of the serum ANA staining patterns in the older group.

Treatment of a Pregnant Patient with Herpes Associated Erythema Multiforme (HAEM): A case report.

Erythema Multiforme, (EM) is an uncommon, acute inflammatory disease of the skin and mucous membranes characterized by ulcerations caused by hypersensitivity to drugs, microbial agents or other allergens. An EM outbreak can result in more severe forms of EM involving the skin, and there are several types of EM manifestations. A hemorrhagic crust on the lip is a pathognomonic sign of this disease. Target lesions may or may not be present in EM cases. When target lesions are not present on the skin, it is very difficult to make a differential diagnosis of EM. Herpes associated erythema multiforme (HAEM) is an uncommon lesion caused by herpes simplex virus infection. A case of severe painful lesions in a 28-year-old pregnant patient with HAEM is presented here. HAEM is rarely found in pregnant women, and its clinical findings, diagnosis and treatment have not previously been reported.

Glycerin Borax Treatment of Exfoliative Cheilitis Induced by Sodium Lauryl Sulfate: a Case Report.

This paper reports on the results of a case study of a 19-year-old female who presented to the Oral Medicine clinic with a chief complaint of scaly and peeling lips. The lesions had persisted on her lips for more than 7 years and were refractory to previous treatment. Her physician's diagnosis was contact dermatitis. We diagnosed this patient as having exfoliative cheilitis (EC). A patch test using the toothpaste containing sodium lauryl sulfate (SLS) was positive and the patient discontinued using it. Instead, she started using a toothpaste not containing SLS. One year after treating her lesions with hydrogen peroxide mouthwash 1% and glycerin borax, a gradual improvement was observed until returning to normal. Glycerin borax was safe, low cost and simple to use in treatment of refractory exfoliative cheilitis. SLS may have been a precipitating factor in EC in this case.

Correlation of serum ANA and direct immunofluorescence studies in elderly Thai patients with red and white oral lesions.

OBJECTIVES: This study investigated the presence of serum antinuclear antibodies (ANA) profile and direct immunofluorescence (DIF) evaluation in elderly Thai patients with red and white oral lesions. MATERIALS AND METHODS: Thirty-two patients with red and white oral lesions were divided into two groups: group I consisted of 10 cases not taking medications, while group II consisted of 12 cases taking medications, and 30 healthy subjects as a control group. Blood samples were used to determine the ANA profile. DIF was investigated in the lesion containing groups. RESULTS: Serum ANA was found in six cases (60%) in group I, eight cases (66.7%) in group II, and 19 cases (63.3%) in the control group. There were no significant differences between group I and group II and the control group (P > 0.05). Serum ANA was most commonly found in patients taking hypolipidemics (80%), followed by antihypertensives (71.4%), NSAIDs (50%), hypoglycemics (50%), and others (66.7%). The anticytoplasmic staining frequency in group II was higher compared with group I and the control group. Anti-dsDNA antibodies were not found in any group. CONCLUSIONS: Elderly patients with red and white oral lesions who were taking medications had a higher serum ANA frequency than group I and the control group.

Oral medicine (stomatology) across the globe: birth, growth, and future.

Oral medicine (stomatology) is a recognized and increasingly important dental specialty in many parts of the world that recognizes and fosters the interplay between medical health and oral health. Its dental activities rely greatly on the underlying biology of disease and evidence-based outcomes. However, full recognition of the importance of oral medicine to patient care, research, and education is not yet totally universally acknowledged. To address these shortcomings, we outline the birth, growth, and future of oral medicine globally, and record identifiable past contributions to the development of the specialty, providing an accurate, unique, and valuable resource on oral medicine. Although it was challenging to gather the data, we present this information as a review that endeavors to summarize the salient points about oral medicine, based on MEDLINE, other internet searches, communication with oral medicine and stomatological societies across the world, the web page http://en.wikipedia.org/wiki/List_of_dental_organizations, and discussions with a wide range of key senior persons in the specialty.

Folate and Vitamin B12 Levels in Thai Patients with Oral Lichenoid Related Drug.

BACKGROUND: Medications have been increasingly used by patients for the treatment of their systemic diseases. However, many drugs are reported to induce oral lichenoid lesions (OLL). AIM: The aim of our study was to investigate the relationship between OLL, medications, and folate and vitamin B12 levels. MATERIAL AND METHODS: Twenty Thai patients who were diagnosed with OLL by clinical and histopathological examination were included in this study. These subjects were compared with 24 healthy control subjects. Complete blood counts, hemoglobin typing, serum and red cell folate, and serum vitamin B12 levels were investigated. The medications taken and the systemic diseases of the Thai patients with OLL were recorded and analyzed. RESULTS: Our results showed that only 1/20 patients with OLL (5%) had low red cell folate and only 1 case showed a low level of serum folate. Vitamin B12 levels were within normal range in both groups. There were no significant differences in red cell folate, serum folate, or vitamin B12 levels between the patients with OLL and the control group (p>0.05). Four cases in OLL and 3 cases in the control group had low hematocrit less than 36% and they were defined as anemic. CONCLUSION: Antihypertensives and hypolipidemics were the most common medications taken by patients with OLL; however, these drugs had no effect on red cell folate, serum folate, or vitamin B12 levels. Since the patients were taking multiple drugs and we could not confirm the diagnosis of OLDR by withdrawal of the drugs, we used the term OLL related drug instead.

Oral lichenoid lesions and serum antinuclear antibodies in Thai patients.

OBJECTIVES: The aim of this study was to investigate the presence of serum antinuclear antibodies (ANA) in Thai oral lichenoid drug reaction (OLDR) and oral lichen planus (OLP) patients. MATERIALS AND METHODS: This study comprised 20 patients diagnosed with OLDR, 23 patients with OLP, and 24 healthy control subjects. Participants' blood samples were assayed for ANA staining patterns and serum ANA titer levels by immunofluorescence using human epithelial type 2 (HEp-2) as a substrate. The serum ANA titer levels were defined as low (1:40-1:80), medium (1:160-1:320), and high (>1:640). RESULTS: Serum ANA were detected in 73.9%, 70%, and 25% of OLP, OLDR, and control subjects, respectively. There was a statistically significant difference between the number of serum-ANA-positive subjects in the OLP or OLDR groups and the control group (P < 0.01), but no significant difference between the OLP and OLDR groups. The speckled pattern was the most commonly found staining pattern, present in 60.9%, 55.0%, and 20.8% of the OLP, OLDR, and control subjects, respectively. The number of subjects with low ANA titers in the OLP and OLDR groups was significantly higher than that of the control group (P < 0.01). Medium ANA titers were found in 15%, 4.4%, and 4.2% of the OLDR, OLP, and control subjects, respectively, while high ANA titers were not found in any group. CONCLUSIONS: The number of serum-ANA-positive OLP and OLDR patients was significantly higher than the control group. Speckled pattern and low titer levels were the most common findings in both OLP and OLDR groups.

Pyoderma gangrenosum-like oral ulcerations in an elderly patient.

OBJECTIVE: To present a case of pyoderma gangrenosum (PG)-like oral ulcerations in an elderly patient. BACKGROUND: PG is an uncommon idiopathic, ulcerative, chronic inflammatory cutaneous disorder of unknown etiology, which is associated with systemic diseases found in more than 50% of patients. Oral lesions of PG are extremely rare and have not been previously reported on chronic leukemia patient. CLINICAL REPORT: This report presents the first case of a 73 year-old man who had PG-like oral ulcerations which offered the possibility of an initial finding of chronic myeloid leukemia. CONCLUSION: Clinicians should always take into consideration that PG in the oral mucosa is a recalcitrant ulcer and can precede the development of underlying clonal malignancy.

Topical Steroids and CO2 Laser in the Treatment of Refractory Oral Lichenoid Drug Reaction and Lichenoid Contact Lesion: a Case Report.

A 54-year-old female presented with severe pain on the gingiva and buccal mucosa. Oral findings revealed generalized fiery red gingiva, ulcerative with white striae covered by pseudo-membranes on both buccal mucosae. She had hypertension, dyslipidemia, subclinical hypothyroidism and arthritis. She was treated with atorvastatin, hydrochlorothiazide, valsartan, levothyroxine and non-steroidal anti-inflammatory drug (NSAIDs). Her oral lesions were a slight improvement from a previous treatment with pimecrolimus cream, triamcinolone acetonide 0.1% orabase and injection. After diclofenac was replaced with tenoxicam and oral lesions were treated with various topical steroids, the lesions showed marked improvement. The biopsy from the buccal mucosa revealed oral lichen planus. Patch test showed positivity to mercury, gold sodium thiosulfate and palladium. One year later the left buccal mucosa showed red, round papillomatous-like lesions. The histopathological report showed a non-specific ulcer with chronic inflammation. The lesions flared up after replacing amalgam with crowns. After CO2 laser treatment, the lesions showed some improvement. Direct and indirect immunofluorescence of the lesions proved to be negative. This first case report showed that the palliative treatment of refractory oral lichenoid lesions with potent topical steroids for 7 years had no side-effects. CO2 laser can be an alternative treatment of refractory lesion in this case.

Pemphigus, discoid lupus erythematosus, and dermatomyositis during an 8-year follow-up period: a case report.

A 36-year-old Thai woman presented with a painful, burning sensation in the gingiva and desquamative gingivitis. Findings from histopathologic and direct immunofluorescence examination of the maxillary gingiva confirmed a diagnosis of pemphigus. Two months later, she developed a round erythematous lesion on her face, and findings from a skin biopsy were consistent with lupus erythematosus. Four years after initial presentation, the patient developed amyotrophic dermatomyositis. Seven years after initial presentation, she developed joint pain and tenositis of the neck, shoulders, knees and ankles, which was diagnosed as asymmetric polyarthritis and multiple enthesopathy. There are no previous reports of pemphigus, discoid lupus erythematosus, and dermatomyositis in a Thai patient.Fluocinolone acetonide 0.1% in Orabase and systemic steroid were effective in treating oral PV in this patient. The gingiva showed complete remission after 10 months of treatment and remission with recession at 8.5 years of follow-up.

Oral lichen planus in thai patients has a low prevalence of human papillomavirus.

Background. Oral lichen planus (OLP) is a common chronic inflammatory immune-mediated disease, with an etiopathogenesis associated with cell-mediated immunological dysfunction. Viral infection has been hypothesized as a predisposing factor in the pathogenesis of this disease. Viruses may alter host cell function by inducing the abnormal expression of cellular proteins leading to disease development. However, reports on the relationship between human papillomavirus (HPV) and OLP are inconclusive. Objective. To explore the association between HPV and OLP in Thai patients. Materials and Methods. DNA was extracted from thirty-seven fresh-frozen tissue biopsy specimens from OLP lesions, and polymerase chain reaction assay for the L1 and E1 genes covering 32 types of high- and low-risk HPV was performed. Results. HPV DNA was detected in one tissue biopsy from an atrophic-type OLP lesion. All control samples were negative. Genomic sequencing of the E1 gene PCR product demonstrated that the HPV-type 16 found in the lesion is closely related to the East Asian type. Conclusion. Our data indicate a low prevalence of HPV infection in OLP lesions in Thai patients.

Novel therapies for oral lichen planus.

Oral lichen planus (OLP) is a chronic mucocutaneous disorder commonly found in middle-aged women. Despite the progress in research and advance in knowledge on OLP, a successful management is still difficult to achieve. The main aim of OLP treatment is to control the symptoms of the affected patients. Steroids and other immunosuppressive drugs have been recommended and widely used in the treatment of OLP. Topical corticosteroids are the mainstay of OLP treatment, but strong evidence on their effectiveness is lacking. The effectiveness of alternative ways of managing OLP has been recently reported. Topical aloe vera, topical pimecrolimus and oral curcuminoids are the most promising of the new treatment modalities. Other interesting modalities are topically applied thalidomide and amlexanox. Nevertheless, the careful assessment between the risks and benefits of these drugs is crucial and larger and well-conducted trials need to confirm the above encouraging results.

Interventions for treating oral lichen planus.

BACKGROUND: Oral lichen planus (OLP) is a common chronic autoimmune disease associated with cell-mediated immunological dysfunction. Symptomatic OLP is painful and complete healing is rare. OBJECTIVES: To assess the effectiveness and safety of any form of therapy for symptomatic OLP. SEARCH STRATEGY: The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 26 January 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), MEDLINE via OVID (1950 to 26 January 2011) and EMBASE via OVID (1980 to 26 January 2011). There were no restrictions regarding language or date of publication. SELECTION CRITERIA: All randomised controlled clinical trials (RCTs) of therapy for symptomatic OLP which compared treatment with a placebo or between treatments or no intervention were considered in this review. DATA COLLECTION AND ANALYSIS: The titles and abstracts of all reports identified were scanned independently by two review authors. All studies meeting the inclusion criteria were assessed for risk of bias and data were extracted. For dichotomous outcomes, the estimates of effects of an intervention were expressed as risk ratios (RR) together with 95% confidence intervals. For continuous outcomes, mean differences (MD) and 95% confidence intervals were used to summarise the data for each group. The statistical unit was the patient. Meta-analyses were done only with studies of similar comparisons reporting the same outcome measures. MAIN RESULTS: 28 trials were included in this review. Pain is the primary outcome of this review because it is the indication for treatment of OLP, and therefore this review indicates as effective, only those treatments which significantly reduce pain. Although topical steroids are considered first line treatment for symptomatic OLP, we identified no RCTs that compared steroids with placebo. There is no evidence from the three trials of pimecrolimus that this treatment is better than placebo in reducing pain from OLP. There is weak evidence from two trials, at unclear and high risk of bias respectively, that aloe vera may be associated with a reduction in pain compared to placebo, but it was not possible to pool the pain data from these trials. There is weak and unreliable evidence from two small trials, at high risk of bias, that cyclosporin may reduce pain and clinical signs of OLP, but meta-analysis of these trials was not possible.There were five trials that compared steroids with calcineurin inhibitors, each evaluating a different pair of interventions. There is no evidence from these trials that there is a difference between treatment with steroids compared to calcineurin inhibitors with regard to reducing pain associated with OLP. From six trials there is no evidence that any specific steroid therapy is more or less effective at reducing pain compared to another type or dose of steroid. AUTHORS' CONCLUSIONS: Although topical steroids are considered to be first line treatment, we identified no RCTs that compared steroids with placebo in patients with symptomatic OLP. From the trials in this review there is no evidence that one steroid is any more effective than another. There is weak evidence that aloe vera may reduce the pain of OLP and improve the clinical signs of disease compared to placebo. There is weak and unreliable evidence that cyclosporin may reduce pain and clinical signs of OLP. There is no evidence that other calcineurin inhibitors reduce pain compared to either steroids or placebo. From the 28 trials included in this systematic review, the wide range of interventions compared means there is insufficient evidence to support the effectiveness of any specific treatment as being superior.

Antiretroviral Drug-Associated Oral Lichenoid Reaction in HIV Patient: A Case Report.

Antiretroviral therapy has changed the course of HIV disease and improved quality of life in HIV patients. Incidence of an oral lichenoid drug reaction induced by zidovudine is not common. Once it occurs, it affects a patient's well being, in particular their oral functions. Here we report the first case of a 34-year-old Thai man with painful erosive lesions involving the lip and buccal mucosa. Treatment with topical fluocinolone acetonide 0.1% alleviated the patient's oral pain, but it was not until the subsequent withdrawal of zidovudine that the patient showed improvement and resolution of the lesions. Long-term follow-up was useful in the management of this patient, and no recurrence of the lesion was found during 21-month follow-up in this patient.

A multicenter study of oral lichen planus in Thai patients.

AIM: Oral lichen planus is an oral mucosal disease that affects middle-aged patients. The characteristics of oral lichen planus in Thai patients from a multicenter were studied. METHODS: Data of 533 patients from the oral medicine clinics at Chulalongkorn and Mahidol (central Thailand), Chiang Mai (northern Thailand), and Khon Kaen (northeastern Thailand) universities during 2002-2007 were analyzed. The diagnosis of patients with oral lichen planus was clinically and/or histopathologically confirmed. RESULTS: There was a greater number of female patients than males (4:1). There were significant differences in age, sex, and some systemic diseases among the oral lichen planus patients from the three centers. Burning sensation was the most common symptom (72.9%), followed by pain (26.5%), roughness (6.4%), and then no other symptoms (7.9%). The most common site of lesions was found at the buccal mucosa (87.1%). Atrophic oral lichen planus was common in Thai patients. There were significant differences in the types of oral lichen planus, including reticular, atrophic, and ulcerative oral lichen planus among these patients from the three centers (P = 0.000). Nine cases (1.7%) showed dysplasia, but one case (0.2%) developed squamous cell carcinoma. CONCLUSION: Patients with oral lichen planus from the central, northern, and northeastern parts of Thailand presented with distinct characteristics. The malignant transformation of oral lichen planus was low in Thai patients.