OBJECTIVE: Oral lichen planus (OLP) is a mucosal variant of lichen planus. Lichen sclerosus (LS) is an inflammatory disorder with a predilection for genital skin. We aimed to identify the characteristics of patients with both mucosal diagnoses. STUDY DESIGN: This retrospective study included 86 women with both OLP and vulvar LS diagnosed from June 1, 1991 through November 30, 2020 at a Mayo Clinic campus in Rochester, Minnesota; Scottsdale, Arizona; or Jacksonville, Florida. Data included treatments, other cutaneous diagnoses, comorbidities, and information on patch testing and malignant transformation. RESULTS: The median patient age at diagnosis was 64.5 years for OLP and 65.6 years for vulvar LS. A diagnosis of OLP before vulvar LS was most common (50.0%). The most frequently used treatment for both conditions was topical corticosteroids. Oral squamous cell carcinoma (SCC) did not develop in any patient, but vulvar SCC developed in 2 (2.3%). CONCLUSIONS: OLP and vulvar LS may coexist, commonly beginning in the patient's seventh decade. Topical corticosteroids are often used to manage both conditions. The coexistence of both diseases did not seem to portend a greater malignancy risk.
- MeSH
- hormony kůry nadledvin terapeutické užití MeSH
- lichen planus orální * komplikace farmakoterapie patologie MeSH
- lichen planus * komplikace MeSH
- lichen sclerosus vulvy * komplikace farmakoterapie patologie MeSH
- lidé MeSH
- nádory hlavy a krku * komplikace MeSH
- nádory úst * MeSH
- retrospektivní studie MeSH
- spinocelulární karcinom * komplikace patologie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Lichen planus je v klinické praxi poměrně časté a onemocnění, které postihuje nejen kůži a její adnexa, ale i slizniční povrchy. Významné je, že zejména v jejich kontextu pak může nabývat charakteru prekancerózy. Etiopatogeneze onemocnění není do současnosti zcela objasněna, ale předpokládá se, že mnohými rysy se blíží autoimunitním procesům. Onemocnění mívá nejednou chronický průběh a jeho úspěšná terapie může být v některých případech obtížná. Terapie zahrnuje lokální i systémové léky, včetně řady moderních léčiv, a vyžaduje interdisciplinární spolupráci. Vhodně vedená léčba a péče o tyto nemocné je bezpečná a přispívá k udržení dobré kvality života pacienta.
Lichen planus is relatively common in clinical practice and a disease that affects not only the skin and its adnexa, but also mucosal surfaces. It is important that, especially on the mucous membranes, it can become precancerous. The etiopathogenesis of the disease has not been fully elucidated to date, but it is presumed to be related to autoimmune processes in many respects. The disease often has a chronic course and its successful therapy can be difficult in some cases. Therapy includes both local and systemic drugs, including a range of modern drugs, and requires interdisciplinary collaboration. Properly managed treatment and care of these patients is safe and contributes to maintaining a good quality of life for the patient.
- MeSH
- aplikace lokální MeSH
- diferenciální diagnóza MeSH
- glukokortikoidy aplikace a dávkování terapeutické užití MeSH
- imunosupresiva MeSH
- inhibitory kalcineurinu aplikace a dávkování terapeutické užití MeSH
- lichen planus orální * diagnóza farmakoterapie patologie MeSH
- lichen planus * diagnóza farmakoterapie patologie MeSH
- lidé MeSH
- prekancerózy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
Introduction: Oral Lichen planus (OLP) is chronic inflammatory oral mucosal disease of unknown etiology. Basement membrane damage and T‑cell migration in OLP may be mediated by matrix metalloproteinases (MMPs). We examined the expression of matrix metalloproteinase 9 to support this hypothesis. Materials and methods: The study population consisted of 71 patients with OLP and 10 control patients with oral fibromas. Indirect immunohistochemistry was used for detection of MMP 9 expression (polyclonal rabbit anti‑human MMP antibody). Results: In all cases of OLP, the MMP‑9 expression was seen mainly in the area of lymphocytic inflammatory infiltrate in the lamina propria including lymphocytes within the overlying epithelium. In addition, it was observed in the epithelial keratinocytes, particularly in the stratum basale and stratum spinosum with occasional positivity in the superficial layer. Fibroblasts and endothelium of small vessels in the lamina propria showed MMP9 expression as well. In all cases of oral mucosal fibromas, the MMP‑9 expression was seen only in fibroblasts and in endothelium of small vessels with occasional positivity within the overlying epithelium. It remains unclear, whether MMP‑9 is directly connected to OLP pathogenesis.
OBJECTIVE: Oral lichen planus (OLP) is one of the commonest diseases of the oral mucosa. The etiology of the disease is unknown. Our goal was to determine frequencies of functionally important alleles which determine the metabolic rate (phenotype) of individuals with OLP and to compare drug utilization, with focus on CYP2D6, with that of a control group. MATERIAL AND METHODS: The study population consisted of 46 patients with OLP, 60 sex- and age-matched control subjects for drug utilization evaluation and 223 healthy non-medicated controls for genotype comparison. DNA analysis was done using polymerase chain reaction and restriction fragment length polymorphism. The gene CYP2D6 was analyzed for the alleles CYP2D6*3,*4,*5,*6 and gene duplication. Drug utilization was evaluated according to Anatomical Therapeutic Chemical code, liver drug metabolism pathway and mono- or polytherapy. RESULTS: Intake of drugs was significantly higher in the group of OLP patients in comparison with control subjects. The use of CYP2D6 substrates, inhibitors or inducers did not differ between OLP patients and controls. Predicted phenotype frequencies in OLP patients and healthy controls, respectively were as follows: ultrarapid metabolizers 2% and 5.8%, extensive metabolizers 52% and 49.8%, intermediate metabolizers 39% and 37.7% and poor metabolizers 7% and 6.7%. CONCLUSIONS: We did not find a statistically significant difference in the frequency of CYP2D6 alleles between OLP patients and healthy controls. OLP patients used more medication than age- and sex-matched controls.
- MeSH
- alely MeSH
- cytochrom P-450 CYP2D6 genetika metabolismus MeSH
- duplikace genu MeSH
- játra enzymologie MeSH
- lichen planus orální enzymologie genetika patologie MeSH
- lidé MeSH
- polymerázová řetězová reakce MeSH
- polymorfismus délky restrikčních fragmentů MeSH
- polypharmacy MeSH
- senioři MeSH
- spotřeba léčiv MeSH
- studie případů a kontrol MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Orální lichen planus (OLP) patří spolu s recidivujícími aftami k nejčastějším onemocněním ústní sliznice. Epidemiologické studie prokazují výskyt OLP u 1-2 % dospělých obyvatel. Onemocnění je věnováno mnoho odborných sdělení, přesto zůstává etiologie onemocnění neobjasněna. Podařil se částečný průlom v pochopení patogeneze. Změny postihující oblast bazální membrány se vysvětlují apoptózou keratinocytů, která vzniká působením CD8+T-lymfocytů (buněk zabíječů). Tyto buňky jsou aktivovány TNF? (tumor necrosis factor). Odumřelé keratinocyty narušují pevnost bazální membrány, která se rozrušuje (štěpí). Do procesu rozrušování bazální membrány se zapojuje matrixová metaloproteináza 9 (MMP 9). Získané poznatky zatím nelze využít terapeuticky, protože není znám etiologický spoušťový mechanismus celého patogenetického procesu.
Oral lichen planus (OLP) and recurrent aphtous stomatitis are the most frequent diseases of oral mucosa. Epidemiologic studies are demonstrating the frequency of 1-2 % in adult population. OLP is very frequently discussed in scientific literature. However, the etiology remains still unclear. Pathogenetic processes of OLP are partly elucidated. Changes involving the region of basal membrane are suggested to be the result of the apoptosis of keratinocytes. Apoptosis of keratinocytes is caused by CD8+Tlymphocytes. These cells are activated by TNF?. After the death of keratinocytes the stability of the basal membrane is changed, the basal membrane is splitted (teared). MMP 9 is involved in enhacing the process. Actually it is impossible to explore this knowledge in the treatment of OLP because the initial factor of the pathogenetic process is unknown.
To evaluate the efficacy of 1% pimecrolimus cream in treating oral erosive lichen planus and to assess its tolerance. DESIGN: Double-blind randomized trial with placebo control. SETTING: Outpatients of the Department of Dermatology, University Hospital of Nice, from December 21, 2004, to April 19, 2005. PATIENTS: Fourteen consecutive patients with oral erosive lichen planus confirmed by histological examination and with a clinical score superior to 3. Of the 14 patients, 2 did not meet the inclusion criteria and 12 were enrolled in the trial. INTERVENTION: The intervention was 1% pimecrolimus cream or its vehicle, which was applied on ulcerated lesions twice a day for 4 weeks. MAIN OUTCOME MEASURES: The efficacy of the treatment was quantified using a 12-point clinical score. The blood level of pimecrolimus was analyzed on days 0 (baseline), 14, and 28. RESULTS: In the placebo group, the mean score was 4.67 on day 0 vs 3.33 on day 28 (P = .22). In the pimecrolimus group, the mean score was 6.83 on day 0 vs 3.33 on day 28 (P = .04). In the pimecrolimus group, blood concentrations of pimecrolimus were always above the threshold (mean value, 2.84 ng/mL; extreme values, 0-6.19 ng/mL). Pimecrolimus cream was well tolerated, and only transient burning sensations were reported by some subjects. Each of the patients in the pimecrolimus group whose condition improved subsequently relapsed when assessed 1 month after treatment. CONCLUSIONS: The 1% pimecrolimus cream seems to be an effective and well-tolerated treatment for oral erosive lichen planus. The finding of systemic levels of pimecrolimus after mucosal applications necessitates long-term study because it seems that long-term application is required to maintain clinical improvement.
