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Concept: Lichen planus


BACKGROUND: Oral lichen planus (OLP) is seen frequently in patients with hepatitis C virus (HCV) infection. The aim of this study was to evaluate the occurrence of oral candidiasis, other mucosal lesions, and xerostomia during interferon (IFN) therapy for HCV infection. METHODS: Of 124 patients with HCV-infected liver diseases treated with IFN therapy in our hospital, 14 (mean age 56.00 +/- 12.94 years) who attended to receive administration of IFN once a week were identified and examined for Candida infection and other oral lesions and for the measurement of salivary flow. Serological assays also were carried out. RESULTS: Cultures of Candida from the tongue surfaces were positive in 7 (50.0%) of the 14 patients with HCV infection at least once during IFN therapy. C. albicans was the most common species isolated. The incidence of Candida during treatment with IFN did not increase above that before treatment. Additional oral mucosal lesions were observed in 50.0% (7/14) of patients: OLP in three (21.4%), angular cheilitis in three (21.4%) and recurrent aphthous stomatitis in one (7.1%). OLP occurred in one patient before treatment with IFN, in one during treatment and in one at the end of treatment. 85.7% of the oral lesions were treated with topical steroids. We compared the characteristics of the 7 patients in whom Candida was detected at least once during IFN therapy (group 1) and the 7 patients in whom Candida was not detected during IFN therapy (group 2). The prevalence of oral mucosal lesions (P=0.0075) and incidence of external use of steroids (P=0.0308) in group 1 were significantly higher than in group 2. The average body weight of group 1 decreased significantly compared to group 2 (P=0.0088). Salivary flow decreased in all subjects throughout the course of IFN treatment and returned at 6th months after the end of treatment. In group 1, the level of albumin at the beginning of the 6th month of IFN administration was lower than in group 2 (P=0.0550). According to multivariate analysis, one factor, the presence of oral mucosal lesions, was associated with the detection of Candida. The adjusted odds ratio for the factor was 36.00 (95% confidence interval 2.68-1485.94). CONCLUSION: We should pay more attention to oral candidiasis as well as other oral mucosal lesions, in patients with weight loss during IFN treatment.

Concepts: Interferon, Hepatitis C, Candida albicans, Candidiasis, Aphthous ulcer, Oral pathology, Lichen planus, Stomatitis


Current treatments for chronic lichen planus (LP) are often ineffective and may have significant adverse side effects. An alternative safe and effective treatment for recalcitrant LP is needed.

Concepts: Lichen planus


Oral lichen planus (OLP) is a chronic inflammatory disorder. Recently, a case-control study found that lichen planus was associated with dyslipidemia in a large series of patients. However, no data were presented about lipid values in patients and controls.

Concepts: Epidemiology, Lichen planus, Mucosal lichen planus


Oral lichen planus (OLP) is generally accepted to be a T cell-mediated chronic inflammatory disease with an unclear pathogenesis. There have been numerous studies on the proliferation and apoptosis of T cells in situ. In contrast, research on the proliferation and apoptosis of peripheral blood mononuclear cells (PBMCs) in patients with OLP is rare. The aim of the present study was to investigate the proliferation and apoptosis of PBMCs in patients with OLP. PBMCs were isolated from 20 patients with reticular OLP, 20 patients with atrophic-erosive OLP, and 20 healthy volunteers. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyl-2,5-tetrazolium bromide assays were performed to investigate the proliferation of PBMCs, and caspase-3 colorimetric assays were performed to investigate the apoptosis of PBMCs. The proliferation rate of PBMCs in atrophic-erosive OLP subjects was significantly higher than that in both healthy (P < 0.05) and reticular OLP (P < 0.05) subjects. In contrast, the proliferation rate of PBMCs in reticular OLP subjects was significantly lower than that in healthy subjects (P < 0.05). The apoptosis rates of PBMCs in OLP subjects (P < 0.05) and atrophic-erosive OLP subjects (P < 0.05) were significantly lower than the apoptosis rate in the healthy group. Our findings reinforce the view that T cell-mediated immune responses play a critical role in the pathogenesis of OLP. It can reasonably be concluded that these abnormalities are linked to the presence of inflammatory infiltrates.

Concepts: Immune system, Inflammation, White blood cell, Blood, PBMC, Cell-mediated immunity, Lichen planus, Mucosal lichen planus


Oral lichen planus is a common immunologically mediated mucocutaneous disease. These lesions have varied clinical presentations and symptoms, which include reticular, erosive, or erythematous forms. This article reviews the diagnosis and management of oral lichen planus.

Concepts: Lichen planus, Mucosal lichen planus


OBJECTIVE: The aim of this study is to assess whether C1772T and G1790A hypoxia-inducible factor-1 (HIF-1)α polymorphisms are associated with risk of oral lichen planus (OLP). MATERIAL AND METHODS: Restriction fragment length polymorphism analysis was used to investigate HIF-1α C1779T and G1790A polymorphisms in 32 OLP and 88 individuals without OLP. RESULTS: The frequency of the CC, TT, GA, and AA genotypes was higher in patients with OLP. Notably, individuals carrying the C and A, and T and A haplotypes showed a significant association OLP risk. CONCLUSIONS: Our study demonstrated that the C1772T and G1790A polymorphisms of HIF-1α gene increased the risk of OLP. C1772T and G1790A polymorphisms of HIF-1α gene had differing patterns of allelic imbalance in the normal samples and subsequent chronic lesions. Further studies are necessary to elucidate the HIF-1α pathway in OLP, which would facilitate the development of novel therapeutic strategies for the prevention and treatment of OLP. CLINICAL RELEVANCE: These results, in conjunction with previous studies, suggest that HIF-1α may play important roles in the chronicity of oral mucosa lesions of OLP patients. Taken together, we suggest that HIF-1α polymorphisms enhance its target genes, thereby altering the microenvironment and supporting sequential release of inflammatory mediators or cellular events in OLP. It appears unlikely that inhibition of a single proinflammatory mediator will prove useful in clinical practice, but several ways to reprogram mediators engaged in a wide array of roles simultaneously are encouraging.

Concepts: Inflammation, DNA, Gene, Genetics, Genotype, Allele, Restriction fragment length polymorphism, Lichen planus


ObjectiveTo compare the efficacy, relapse, and adverse effects between intralesional injection and mouth rinse of triamcinolone acetonide (TA) in patients with oral lichen planus (OLP).Study DesignA randomized controlled study.SettingCollege medical center.Subjects and MethodsForty consecutive patients, who had been diagnosed with OLP, were recruited. Participants were randomly divided into 2 groups using intralesional injection or mouth rinse of TA. The severity of pain and burning sensation on a 10-cm visual analog scale (VAS) and the Oral Health Impact Profile-14 (OHIP-14) were assessed at weeks 0, 1, 2, 3, 4, and 6. The signs of OLP were quantified using a special scoring system for OLP. The rate of relapse and the adverse effects were compared between both groups.ResultsThe VAS scores for pain and burning mouth sensation and objective scoring for OLP were significantly improved at 1, 2, 3, 4, and 6 weeks in both groups. The changes in the VAS for burning mouth sensation, OHIP-14, and objective scoring for OLP were similar between both groups. The change in the VAS for pain from baseline to week 1 in the intralesional injection group was significantly higher than in the mouth rinse group. The rate of adverse effects was significantly higher in the mouth rinse group than in the intralesional injection group (44.4% vs 5.0%).ConclusionThe efficacies of both treatments were similar. The rate of adverse effects was significantly lower for intralesional injection of TA than mouth rinse of TA.

Concepts: Randomized controlled trial, Randomness, Eczema, Triamcinolone acetonide, Lichen planus, Mucosal lichen planus


Oral lichen planus is a chronic immune-mediated disease with an estimated prevalence of 0.5-2.5% in the general population. Patients with oral lichen planus are often emotionally unstable and anxious and may develop concomitant systemic disorders. The objective of this study was to evaluate emotional characteristics of patients with oral lichen planus.

Concepts: Psychology, Disease, Medical terms, Emotion, Emotional intelligence, Lichen planus, Mucosal lichen planus


Oral premalignant and malignant lesions may mimic oral lichen planus (OLP) clinically and microscopically. OLP often shows basement membrane fibrinogen positivity on direct immunofluorescence testing (DIF). This study examined fibrinogen positivity in oral premalignant lesions and squamous cell carcinoma.

Concepts: Cancer, Lung cancer, Anatomical pathology, Types of cancer, Carcinoma, Squamous cell carcinoma, Squamous epithelium, Lichen planus


Palmoplantar lichen planus (PPL) is an uncommon type of lichen planus (LP) that exclusively affects the palms and soles. We report a case of a 50-year-old man who had palmoplantar hyperkeratotic papules and plaques. The patient was diagnosed as a case of PPL by skin biopsy, and treated with acitretin. He showed a good response to acitretin within 2 months. Clinical appearance and some features of PPL may differ from classic LP. Acitretin may be a favourable treatment option for PPL.

Concepts: Patient, Biopsy, Skin biopsy, Lichen planus