WARNING!

WARNING! THIS SITE HAS PICTURES AND CONTENT OF A MEDICAL NATURE AND MAY NOT BE SUITABLE FOR EVERYONE. VIEW AT YOUR OWN DISCRETION.

Wednesday, January 1, 2014

About Oral Lichen Planus and Cancer: an Abstract

The malignant transformation of oral lichen planus and oral lichenoid lesions
A systematic review

Abstract

Background Determining the potential for malignant transformation of oral lichen planus (OLP) is complicated by difficulties in diagnosis, differentiation from oral lichenoid lesions (OLLs) and the phenomenon of premalignant lesions’ exhibiting lichenoid characteristics. 

The authors of this systematic review evaluated evidence regarding malignant transformation of OLP and characterized transformation prevalence, clinical characteristics of OLP lesions developing into squamous cell carcinoma (SCC) and time to transformation.

Types of Studies Reviewed The authors searched PubMed, Embase and Thomson Reuters Web of Science in a systematic approach. 

They evaluated observational English-language studies involving human participants published in peer-reviewed journals. Inclusion required patients to have the diagnosis of OLP or OLL as confirmed with biopsy results on initial enrollment. 

They excluded all patients who had dysplasia on initial biopsy of OLP or OLL lesions.

Results 

Sixteen studies were eligible. Among 7,806 patients with OLP, 85 developed squamous cell carcinoma (SCC). Among 125 patients with OLL, four developed SCC. 

The rate of transformation in individual studies ranged from 0 to 3.5 percent. The overall rate of transformation was 1.09 percent for OLP; in the solitary study in which investigators evaluated OLL, the rate of transformation was 3.2 percent. 

Patients’ average age at onset of SCC was 60.8 years. The authors noted a slight predominance of female patients among those who experienced malignant transformation. The most common subsite of malignant transformation was the tongue. The average time from diagnosis of OLP or OLL to transformation was 51.4 months.

Practical Implications A small subset of patients with a diagnosis of OLP eventually developed SCC. 

The most common demographic characteristics of patients in this subset were similar to the most common demographic characteristics associated with OLP in general (that is, being female, being older and being affected in areas common to this condition). 

It is prudent for clinicians to pursue continued regular observation and follow-up in patients with these conditions, even in patients who do not fit a traditional high-risk category for oral SCC.

Source: 

The Journal of the American Dental Association 
(January 1, 2014) 145, 45-56
© January 1, 2014 American Dental Association

doi: 10.14219/jada.2013.10

The malignant transformation of oral lichen planus and oral lichenoid lesions
A systematic review

Sarah G. Fitzpatrick, DDS
Dr. Fitzpatrick is an adjunct assistant professor of oral and maxillofacial pathology, Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western Reserve University, 10900 Euclid Ave., Cleveland, Ohio 44106, 

Stanley A. Hirsch, DDS, MS
Dr. Hirsch is an associate professor of oral and maxillofacial pathology, Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, and the director, Dental Clinic Laboratory, School of Dental Medicine, Case Western Reserve University, Cleveland.

Sara C. Gordon, DDS
Dr. Gordon is an associate professor of oral and maxillofacial pathology, Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois at Chicago.

Saturday, July 20, 2013

When OLP is Cured

Is my Oral Lichen Planus cured? I've been asked. I have to say it is "Cleared" instead. More specifically, since I have been taking the Sprycel prescription for my Leukemia the OLP has cleared up and is minimal at best. I seldom think of it anymore. I have no lesions to speak of. Only a slight bit of lacy stuff once in a while that I only happen to notice because I've made a good search of my mouth. As mentioned before, the only time I had a relapse was when I was taking a proton pump inhibitor for my GERD. As soon as I stopped, it disappeared again.

It's been pointed out to me that my blog has been "inactive". Yes, true. But, that's because my OLP is inactive. But that doesn't mean I have forsaken the blog, nor you readers. This blog gets quite a few hits every day. Therefore, I suspect, it still has it's use in the lives of those searching for information on Oral Lichen Planus.

I'm not planning on closing down the blog at all. I want others to know they are not alone in their diagnosis. I want others to have this record and it's photos to be able to share with others in their lives who don't understand what they are going through. Perhaps, too, some will find my journey a refreshing reminder that no matter what they are going through, they can get through this!

I'm not going to bother to post another picture of my mouth, pretty as it is these days. But, here's an updated picture of how happy I am that my OLP journey is behind me.


In the meantime, anyone who is interested, please know that I am still here and all you have to do is make a comment and I will reply (as long as it is not spam). If you wish to share your story, I can create a place for it in this blog as well. Or, better yet... you can set up your own blog. After all, wouldn't it be nice to find something other than medical jibber jabber and fake claims for cure on all those other sites you come across when searching for information on OLP. It's nice to just know that there are others out here dealing with the same issues and how they are doing. You're not alone.

Stay in touch.

Saturday, May 5, 2012

Drug-induced Lichenoid Reactions

A number of drugs may induce development of lesions that clinically and histologically resemble idiopathic lichen planus.


The principal offenders are:
gold
penicillamine
beta-blockers
antimalarials
captopril
lithium
carbamazepine
chlorpromazine
thiazides
methyldopa
INH
PAS
NSAIDs

Can Medications cause OLP?



Oral lichen planus (OLP) can affect up to about 4% people, mostly in middle-aged adults, with women being affected twice as much as males.

Several studies have suggested a possible relationship between OLP and daily intake of medicine.

OLP lesions presumed to be related to long-term drug intake are referred to as lichenoid drug reactions (LDR).

Additionally, it is very difficult to identify the drug associated to LDR based on the patient’s medical history.

The best way to find out is observation that the lesion remits with drug withdrawal and returns on taking it again.

Many types of drugs have been implicated as a causative factor for  lichenoid drug reactions, especially the non-steroidal antiinflammatory drugs. (NSAIDS)

In one study involving 75 patients with OLP, of whom 20 were taking NSAIDS, 7 had a complete resolution of their oral lesions after withdrawal of the drug.

Of these 7 patients, 2 produced a recurrence when later taking the offending drug.

The purpose of the following study was to investigate whether the daily systemic and/or topical medicine used by patients with OLP contributes to the development of their oral lesions.

See the full article here:
http://www.progruda.com/UserFiles/image/ImageBank/Lichen%20Planus.pdf

Sunday, January 29, 2012

OLP and Cancer

Since last I wrote, I have been diagnosed with Chronic Myelogenous Leukemia. No, No. Don't worry! It's not got anything to do with Oral Lichen Planus. It's just a coincidence.

So, that is why I have not posted for a while. I've been a little busy.

What is totally fascinating to me is that I am taking a "chemo" drug. That's a misnomer because it is not a chemically based treatment at all. It's a pill called, Dasatinib (Sprycel) which I take once a day. It's known as a Tyrokinase Inhibitor.

Anyhow, that first month I had started taking it, my OLP had started to diminish. Now it's gone. That's right! My oral lichen planus, from which I have suffered since 2004 has disappeared!

The only disadvantage is I have a bumpy rash. Not too bad. A great trade off. Which would I rather have? Inexplicably permanent Erosive Oral Planus or bumpy rash? I'll settle for the rash. Oh, hell. I forgot the CML. It's not too bad. Really! It's chronic, like diabetes. All I have to do is take the pill for the rest of my life and I will die of something else. CML is the good kind of cancer to have these days.

I wonder what the connection is! I wonder if TKI's could be a treatment for OLP?

At least I don't have that other kind of cancer associated with (RARELY) Oral Lichen Planus.

If you are interested, you can read my journey with CML at The Heart of the Rose

Tuesday, May 17, 2011

Sjogren's and OLP, is there a relationship?

Two years ago I was asked to participate in a Sjogren's research study. I have sometimes been questioned by doctor's if that was an issue for me. I have never tested positive for Sjogren's so I have always said no, though I have often had symptoms.

I received a letter asking me to return to have a follow up appointment for the study. Since it is located at University of California, San Francisco Medical Center, it is a long drive for me, about 90 miles. Because of other medical conditions I have, it can be a daunting trip. So, I was able to have my son pick me up and drive me there. (Thank you, Stellar Son!)

First:
Examination of mouth, which involved spitting into a container for five minutes in order to measure how much saliva is produced. Everyone in the study does this.

I have more saliva than a friend I know who has the Sjogren's diagnosis. She has to carry a container of water around with her to sip, in order to talk. I am aware that if I talk for any length of time, my mouth goes dry and it sometimes makes me cough unless I can close mouth and try to get some moisture.

In five minutes I was able to produce what I would consider a sufficient amount of saliva. It will be analyzed, certain criteria will be looked for, and the DNA will be tested. I won't know the results until they send me a letter. I wont get to know everything, but unlike some studies, I will learn something.

Second:
Visit to the Ophthalmologist. Since it is a teaching hospital I was given two eye exams. Nice Doctors, but I was tense. I don't like those lights pressing into my eyes. I recently had an eye problem and have had more than my share of annoying stuff put in my eyes. I have dry eyes and constantly have to put eye drops in them.

Since I don't have positive blood test results for Sjogren's, one of the tests they did was to stick paper in my eyelid and leave it there to see if I would produce tears. People who have dry eye will not produce much in the way of tears no matter how much it hurts. I produced some tears. But, apparently it still brings me into the Sjogren's spectrum of dryness.

It was incidentally discovered that I have Superior Limbic Keratoconjunctivitis. Ugh! Something else to deal with! I understand it is not related to Sjogren's, or Oral Lichen Planus.

Third:
After that stressed filled appointment, I was given a coupon to go have lunch in the hospital cafeteria. They had a very large selection of any kind of food one could want. But the prices were higher than the five dollars I was allotted. So, I got a juice and a scone. I wasn't very hungry anyways. Too stressed to enjoy a meal.

Besides, at that point I was aware of what I call "the shaky syndrome". The inside of my body feels shaky, even though there is no outward sign of it. It happens when I am physically exhausted or unwell. And, I guess in this case, stressed out.

Thank heavens! After I returned from my meal, I had to wait in the office comfortably seated in the dental chair with my feet up. That was relaxing, and I got some of my composure back.

Fourth:
The mouth doctors returned to test my saliva production in another way. This was to ascertain, how my salivary glands functioned after a meal.

Two little suction devices were attached to the inside of my cheeks high up beside my upper back teeth. I sat there while we waited for saliva to travel down two tubes into a container held by my chin. Occasionally some lemon juice was painted on my tongue in order to stimulate production.

I mentioned how I like to put lemon in my tea and squeeze it on my food. Apparently I was instinctively self treating to get my mouth to be less dry. It was beginning to look as though I do have Sjogren's. But, I'm guessing according to what was said, it is a mild case.

Fifth
Then there was an examination by a Rheumatologist Nurse Practitioner. That was the least intrusive part of the day. And the most relaxing. Since it had already been determined and documented that I have osteoarthritis, we discussed self care. I also learned some techniques for taking better care of myself. I was told that lowering my stress level is top priority. I wanted so bad to roll my eyes!

Sixth:
Then, a visit from my Oral Lichen Planus doctor. She was not at all pleased with how my mouth looks. It was so well cleared up and healthy looking at our last visit. But now it looks "angry". I really didn't think it was too bad as it has not been hurting very much lately or burning much, and at least I don't see the raw ulcers that I used to have.

The one thing that has bothered me is the lower back tooth where there is a permanent "pocket" where food gathers and I can't get a toothbrush in there. This was caused by the scar tissue of the OLP building up and growing around that tooth.

It gets filled with pus sometimes. I have to clean the area with a Q tip. One day recently, it was really bad and I dug at it until all the pus was gone and it was bleeding. I was able to get my regular doctor to order antibiotics that time.

You may think, "Why doesn't she go to a dentist to take care of this?"

I have no dental insurance. Because of my disabilities, I do not have funds for going in for treatment. That is why I self treat.

We discussed my flared up mouth and bad tooth "pocket" at length. I have to return in two weeks. I was surprised she considered it that serious. But, after all these years of seeing her, I will be there for my appointment. Thank heavens I have coverage for this.

In the meantime, I will be swishing and gargling with Chlorhexidene daily, as a substitute for an antibiotic. I will need to carefully brush the "angry" area of my mouth near that tooth pocket. Now, that will be a problem, because I cannot fit a toothbrush, even a baby toothbrush into that area. Still, I will try. Plus, my handy-dandy Q-tips will be put to good use. I am to apply Clobetasol ointment to the area as well to use in place of a steroid. It will also be a problem because now that my mouth has been messed with my pain level is at the screaming level and I know it's going to take days to calm it down.

Seventh:
One of the research doctors came back in with her camera and a student to teach, and she took pictures of the top of my tongue because "the scar formation is so interesting". I just had to laugh!

Truly, this did not bother me, as some have asked me. I am glad to help out science so to speak. Maybe someone will learn something from me that can help others. That is why I signed up for the study! If what I have been through can help just one person, it is all worth it.


Then, many vials of blood were drawn for the research. Some of it will be frozen and placed in storage for future biomedical research.

Eighth:
Then it was time to do the biopsy. I've had one in the tongue before. It's no picnic. So this one on the back of my lip down by the bottom of my teeth was a piece of cake, comparatively. That area was numbed with Novocaine before pieces of salivary glands were removed for the study.

I was totally exhausted. I had been there from 10 A.M. until 4 P.M. Thank heavens I could call my son to pick me up and take me home.

Saturday, April 23, 2011

Oral Lichen Planus Three Year Comparison





Please note: The top photo was taken in 2008 when I had a very bad flare up of Erosive OLP ulcers. I was in bad pain at the time and could barely swallow water. If you ever get like that, pay attention to your water intake so that you don't get dehydrated.
The second photo was taken in January of this year. My OLP was much improved at that time, after having been taking Cellcept for over a year. My mouth was almost completely clear when I went off the Cellcept. After this little bout in January, it cleared up again. I continue to use Clobetasol ointment.

Sunday, April 17, 2011

Update on Oral Luchen Planus - Abstract and Link

Update on oral lichen planus: etiopathogenesis and management.
  
Abstract
Lichen planus (LP) is a relatively common disorder of the stratified squamous epithelia, which is, in many ways, an enigma.

This paper is the consensus outcome of a workshop held in Switzerland in 1995, involving a selection of clinicians and scientists with an interest in the condition and its management.

The oral (OLP) eruptions usually have a distinct clinical morphology and characteristic distribution, but OLP may also present a confusing array of patterns and forms, and other disorders may clinically simulate OLP. Lesions may affect other mucosae and/or skin. 

Lichen planus is probably of multifactorial origin, sometimes induced by drugs or dental materials, often idiopathic, and with an immunopathogenesis involving T-cells in particular. 

The etiopathogenesis appears to be complex, with interactions between and among genetic, environmental, and lifestyle factors, but much has now been clarified about the mechanisms involved, and interesting new associations, such as with liver disease, have emerged. 

The management of lichen planus is still not totally satisfactory, and there is as yet no definitive treatment, but there have been advances in the control of the condition. 

There is no curative treatment available; immunomodulation, however, can control the condition. Based on the observed increased risk of malignant development, OLP patients should be offered regular follow-up examination from two to four times annually and asked to report any changes in their lesions and/or symptoms. 

Follow-up may be particularly important in patients with atrophic/ulcerative/erosive affections of the tongue, the gingiva, or the buccal mucosa. 

Much more research is required into the genetic and environmental aspects of lichen planus, into the premalignant potential, and into the possible associations with chronic liver, and other disorders. 

More clinical studies are required into the possible efficacy of immunomodulatory drugs such as pentoxifylline and thalidomide.

Click on this link for full PDF article
Note: it's a little slow to upload so be patient

From:
Critical reviews in oral biology and medicine
1998;9(1):86-122.

Eastman Dental Institute for Oral Health Care Sciences,
University of London,
United Kingdom.

Authors:
Scully C, Beyli M, Ferreiro MC, Ficarra G, Gill Y, Griffiths M, Holmstrup P, Mutlu S, Porter S, Wray D.


Please note: although this article was published in 1998, I think the information is still valuable for gaining understanding. ~~~Elizabeth Munroz

Thursday, April 14, 2011

Lichen Planus and Eyes

Isolated lichen planus of the conjunctiva





Abstract:
 
Lichen planus is an autoimmune condition of unknown aetiology affecting the skin and mucous membranes. 

Classic lesions appear as recurrent, small, discrete, polygonal, flat topped, violaceous, pruritic papules distributed symmetrically on the flexor surfaces of the extremities and trunk. 

These lesions are often accompanied by lesions of the oral, genital, and rarely, ocular mucosa. 

Conjunctival lichen planus can lead to irreversible damage to the ocular surface and loss of vision from corneal scarring.

We report two patients with isolated lichen planus of the conjunctiva. 

The referring ophthalmologists had attributed these ocular findings to a severe dry eye state. 

The correct diagnosis was made by conjunctival biopsy.

Treatment with topical ciclosporin A resulted in suppression of the inflammation and arrest of the progressive cicatrisation. 

From:
British Journal of Ophthalmology  
2006;90:1325-1326  
doi:10.1136/bjo.2006.096263
  1. M Pakravan,
  2. T R Klesert,
  3. E K Akpek
+ Author Affiliations
  1. The Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA

Correspondence to:
Esen Karamursel Akpek MD, Director 
Ocular Surface Diseases and Dry Eye Clinic
The Wilmer Eye Institute
600 North Wolfe Street
Maumenee Building No 321
Baltimore, MD 21287-9238, USA




Palate Oral Lichen Planus

Distribution of mucosal pH on the bucca, tongue, lips and palate.
A study in healthy volunteers and patients with lichen planus, Behçet's disease and burning mouth syndrome.

Abstract

Saliva coating all oral surfaces has a buffering capacity that neutralizes bacterial and cariogenic acids.

The aim of our study was to determine the surface pH in different regions of the oral cavity in healthy volunteers and in patients with diseases affecting the oral mucosa.

Oral pH was measured with a flat glass electrode on the anterior third of the ventral surface of the tongue, middle hard palate, buccal mucosa and inner lips in 32 healthy volunteers, 12 patients with Behçet's disease, 23 patients with oral lichen planus, and 11 patients with burning mouth syndrome. The present study showed that there was an uneven distribution of oral surface pH. The palate had a higher pH than most other sites in all groups, and in patients with lichen planus, the palate pH was higher than that in healthy controls.

Those with dentures had lower pH values in the hard palate than dentate patients. The relatively high pH in the palate region in all patient groups as well as healthy volunteers needs to be further studied to clarify its mechanisms and clinical relevance.

Acta Derm Venereol. 
2001 Jun-Jul;81(3):178-80.

Yosipovitch G, Kaplan I, Calderon S, David M, Chan YH, Weinberger A.

Department of Dermatology,
Rabin Medical Center,
Petah Tiqva, Israel.
gil@nsc.gov.sg

PMID: 11558872 [PubMed - indexed for MEDLINE]

NOTE: The complete article can be found by clicking here.

Wednesday, April 13, 2011

Lichen Planus and Oral Cancer Study



    * Are you a patient with oral cancer or Oral Lichen Planus?
    * If so, you may be eligible for a research study!


What is the purpose of the study?

This study is to explore the possibility of using saliva in an early cancer detection method for certain patients who may be at risk for developing oral cancer.

We will need to collect saliva samples from two types of people; those who have oral squamous cell carcinoma and those who have lichen planus. Analysis of the saliva samples for several particular proteins and chemicals will be performed and the results will be compared among these two groups and a group of normal controls (people who have neither oral cancer nor lichen planus).

For the rest of this information click here.

NOTE: The photo DOES NOT represent oral cancer

Monday, April 11, 2011

Do Medications cause Oral Lichen Planus?


Abstract
Objectives: To investigate whether daily systemic and/or topical medication contributes to the development of oral
lichen planus (OLP) lesions.

Study Design:
The study involved 110 OLP patients and 76 control subjects, matched by age, race and sex. The analyzed data included medical records, drug intake and topical medication.

Results:
No statistical difference was found between the two groups in terms of systemic diseases, number of medicated individuals in the categories of mono- and polypharmacy,

Regarding the clinical forms and site of involvement, a statistically significant difference was only found for the clinical erosive form of OLP

Conclusions:
It seems that the use of systemic medication does not lead to a significant increase in the incidence of OLP lesions. For their part, lichenoid drug reactions are likely to occur only in a very low percentage of patients.

Please note: I have paraphrased this abstract. To see the complete article, go here.

Successful Treatment of Erosive Lichen Planus



I came across this medical article called, Successful Treatment of Erosive Lichen Planus With Topical Tacrolimus

It was co-published by researchers through Northwestern University Medical School and Mayo Clinic

There was a patient who had Oral Lichen Planus but also had some other diseases that made treating her with steroids not a good idea, so they tried out Tacrolimus on her and after a year she had good results.

I didn't have such good results with the Tacrolimus. For me, it intensified the burning sensations in my mouth the instant I used it, so I was reluctant to use it long enough to get good results. I'm am sure everyone has their own experience.

Click HERE for the article.

Note: The photo above was not taken recently. I show it here for educational purposes.

Friday, April 1, 2011

674 patients with oral lichen planus

These are notes from an abstract to see the full abstract go here.

Oral lichen planus (OLP) is a chronic inflammatory disease with different clinical presentations that can be classified as:

reticular
atrophic
erosive

Although OLP is a relatively common disorder, the reports comprising large numbers of OLP patients with specific character are lacking in the literature. 

Of the 674 patients, 65% were women and 34% were men. The most common clinical presentation was the reticular type, and symptomatic OLP was noted in 67% of the patients, mainly in those with the erosive form. 

The erosive presentations showed significantly longer duration, more sites affected and a much greater older patients predominance than reticular or atrophic ones.

No statistically significant differences could be identified between OLP and diabetes, cardiovascular disease, smoking or alcohol use. 

Precipitating factors that resulted in an exacerbation of the disease were frequently noted and included: 


foods
stress
dental cusp (biting surfaces of the teeth)
poor oral hygiene. 

The transformation of OLP into malignancy was observed in four patients at sites previously diagnosed by clinical examination as erosive or atrophic lichen planus.

A long time follow up is of utmost importance to detect its malignant transformation.

From: 
 

A clinical study of 674 patients with oral lichen planus in China.

Journal of Oral Pathol Med. 2005 Sep;34(8):467-72.

Xue JL, Fan MW, Wang SZ, Chen XM, Li Y, Wang L.

Source

Key Lab for Oral Biochemical Engineering 
Ministry of Education, 
Stomatological College of Wuhan University, 
Luoyu Road 65, 430079 Wuhan, Hubei, China.
PMID:
16091113
[PubMed - indexed for MEDLINE]

Friday, January 21, 2011

Over Active Immune System and Oral Lichen Planus

When our immune system encounters something foreign, it responds by mounting an attack on it such as when one has a virus or infection. In order for our immune system to do do it's job to help us get well from the foreign substance, it has to recognize that the object is foreign, and not part of itself.

Usually, the immune system recognizes what is and what is not 'self.'

In autoimmune diseases, the immune system is unable to recognize some part of itself, and will attack it.

This could happen with one organ, a particular part of the body, or the entire body. There are many kinds of autoimmune diseases, which most people are unfamiliar with. Though it is not a common condition, Lupus is the one most people recognize as an autoimmune disease.

In my case my body has an autoimmune condition called Oral Lichen Planus. If you have been reading parts of this blog, you already know that. If you are new to the blog, you may be surprised to learn that Lichen Planus is a type of autoimmune condition. Previously in medical papers it has been referred to as an inflammatory condition, which it is. But, more recent research has shown it to me more than that.


Please note: picture does not represent present condition of my mouth, but is from 2004 and placed here for educational purposes.

Thursday, January 20, 2011

Oral Lichen Planus Caused by Allergy to Dental Fillings?

Objectives
To determine contact allergies in patients with oral lichen planus and to monitor the effect of partial or complete replacement of amalgam fillings following a positive patch test reaction to ammoniated mercury, metallic mercury, or amalgam.

Design
In group A (20 patients), the oral lesions were confined to areas in close contact with amalgam fillings.

In group B (20 patients), the lesions extended 1 cm beyond the area of contact with amalgam fillings.

In group C (20 patients), the oral lesions had no topographic relationship with amalgam fillings.

Partial or complete replacement of amalgam fillings was recommended if there was a positive patch test reaction to ammoniated mercurymetallic mercury,  or amalgam.

Control group D (20 patients) had signs of allergic contact dermatitis.

Results
Amalgam fillings were replaced in 13 patients of group A, with significant improvement.

Dental amalgam was replaced in 8 patients of group B, with significant improvement.

In group C, amalgam replacement in 2 patients resulted in improvement in 1 patient.

These results were evaluated after 3 months.

No positive patch test reactions to mercury compounds were found in patients with concomitant cutaneous lichen planus and in group D.

Conclusions
Contact allergy to mercury compounds is important in the pathogenesis of oral lichen planus, especially if there is close contact with amalgam fillings and if no concomitant cutaneous lichen planus is present.

In cases of positive patch test reactions to mercury compounds, partial or complete replacement of amalgam fillings will lead to a significant improvement in nearly all patients.

See full free article by clicking on the following link:
Oral Lichen Planus and Allergy to Dental Amalgam Restorations

Authors:
Laeijendecker R, Dekker SK, Burger PM, Mulder PG, Van Joost T, Neumann MH.

Department of Dermatology
Albert Schweitzer Hospital
Dordrecht, The Netherlands

R.Laeijendecker@asz.nl

Arch Dermatol.
2004;140:1434-1438.

See also:

Lichenoid amalgam reaction

Tuesday, January 18, 2011

Oral Lichen Planus Support Group

Less than two percent of the general population suffers from oral lichen planus, an uncomfortable and chronic condition characterized by lesions that form in the mouth and skin. Its not unusual for lichen planus sufferers to know no one else with the disease.

That's one reason for the popularity of Texas A&M Health Science Center Baylor College of Dentistry's online International Oral Lichen Planus Support Group, a web-based support group that brings together sufferers from throughout the world. The on-line organization serves as a resource for patients, family members and practitioners.

The site also features periodic live online discussions that link lichen planus sufferers with faculty in HSC-BCDs Stomatology Center and guest faculty from other dental schools around the world.

Saturday, January 15, 2011

Have You been Tested for Liver Problems with Oral Lichen Planus?

Lichen planus is fairly common skin disorder that last for months to years. Lichen planus affects about 1 or 2% of the U.S. population (approximate six million) and usually affects people between the ages of 30 and 70 years old and is slightly more prevalent in women than in men.

The exact cause of lichen planus is unknown, but it seems to be triggered by stress, genetics, allergic reactions to medicines, and by viral infections such as Hepatitis C.

The onset may be gradual or quick. There have been studies that have found a prevalence of Hepatitis C Virus in people with lichen planus from 3.5% to 60%. For this reason, it has been recommended that people with lichen planus (especially with elevated liver enzymes) should be tested for Hepatitis C Virus.

See the rest of this article free in PDF

Tuesday, January 11, 2011

Laser Versus Topical in Oral Lichen Planus



A Comparative Pilot Study of Low Intensity Laser versus Topical Corticosteroids in the Treatment of Erosive-Atrophic Oral Lichen Planus


Abstract

Background and objective:
Treatment of oral lichen planus (OLP) remains a great challenge for clinicians. The aim of our study was to compare the effect of low intensity laser therapy (LILT) with topical corticosteroids in the treatment of oral erosive and atrophic lichen planus.

Materials and Methods:
Thirty patients with erosive-atrophic OLP were randomly allocated into two groups.

The experimental group consisted of patients treated with the 630nm diode laser. The control group consisted of patients who used Dexamethason mouth wash.

Response rate was defined based on changes in the appearance score and pain score (Visual Analogue Scale) of the lesions before and after each treatment.

Results:
Appearance score, pain score, and lesion severity was reduced in both groups. No significant differences were found between the treatment groups regarding the response rate and relapse.

Conclusion:
Our study demonstrated that LILT was as effective as topical corticosteroid therapy without any adverse effects and it may be considered as an alternative treatment for erosive-atrophic OLP in the future.

From:
Photomedicine and Laser Surgery

A Comparative Pilot Study of Low Intensity Laser versus Topical Corticosteroids in the Treatment of Erosive-Atrophic Oral Lichen Planus

Hasan Hoseinpour Jajarm, D.D.S., M.Sc.,1
Farnaz Falaki, D.D.S., M.Sc.,1 and
Omid Mahdavi, D.D.S., M.Sc.2
1Department of Oral Medicine and Dental Research Center,
Faculty of Dentistry,
Mashhad, Iran.

2Department of Oral Medicine and Dental Research Center,
Faculty of Dentistry,
Yazd, Iran.

Address correspondence to:
Dr. Farnaz Falaki
Department of Oral Medicine
Faculty of Dentistry and Dental, Research Center
Mashhad University of Medical Sciences
P.O. Box 91735-984
Mashhad
Iran
E-mail: farnazfalaki@yahoo.com

Online Ahead of Print: January 8, 2011

Monday, January 10, 2011

Oral lichen planus in childhood: A rare case report

Oral lichen planus is a cell-mediated immune condition and is infrequently encountered in children, with a prevalence of about 0.03 percent in childhood.

Reports of oral lichen planus affecting children are scarce in the literature.

The purpose of this article is to present a rare case of oral lichen planus affecting a seven-year-old child without concomitant cutaneous lesions.

Intraoral lesions and associated mild discomfort treated with topical corticosteroid therapy and a plaque control regime resulted in a favorable result.

continue to read full article here>>>




From:
Dermatology Online Journal
Volume 16 Number 8
August 2010

Oral lichen planus in childhood: A rare case report

M GunaShekhar MDS,
Reddy Sudhakar MDS,
Mohammad Shahul MDS,
John Tenny MDS,
Manyam Ravikanth MDS,
N Manikyakumar BDS

Vishnu Dental College & Hospital,
NTRUHS, India

Sunday, January 9, 2011

The Pathogenesis of Oral Lichen Planus

Abstract

Both antigen-specific and non-specific mechanisms may be involved in the pathogenesis of oral lichen planus (OLP). Antigen-specific mechanisms in OLP include antigen presentation by basal keratinocytes and antigen-specific keratinocyte killing by CD8+ cytotoxic T-cells.

Non-specific mechanisms include mast cell degranulation and matrix metalloproteinase (MMP) activation in OLP lesions.

These mechanisms may combine to cause T-cell accumulation in the superficial lamina propria, basement membrane disruption, intra-epithelial T-cell migration, and keratinocyte apoptosis in OLP.

OLP chronicity may be due, in part, to deficient antigen-specific TGF-β1-mediated immunosuppression.

The normal oral mucosa may be an immune privileged site (similar to the eye, testis, and placenta), and breakdown of immune privilege could result in OLP and possibly other autoimmune oral mucosal diseases.

Recent findings in mucocutaneous graft-versus-host disease, a clinical and histological correlate of lichen planus, suggest the involvement of TNF-α, CD40, Fas, MMPs, and mast cell degranulation in disease pathogenesis.

Potential roles for oral Langerhans cells and the regional lymphatics in OLP lesion formation and chronicity are discussed. Carcinogenesis in OLP may be regulated by the integrated signal from various tumor inhibitors (TGF-β1, TNF-α, IFN-γ, IL-12) and promoters (MIF, MMP-9).

We present our recent data implicating antigen-specific and non-specific mechanisms in the pathogenesis of OLP and propose a unifying hypothesis suggesting that both may be involved in lesion development.

The initial event in OLP lesion formation and the factors that determine OLP susceptibility are unknown.

The complete free article is available 

From:
Critical Reviews of Oral Biology and Medicine 
July 2002 vol. 13 no. 4 350-365

P.B. Sugerman  
N.W. Savage
L.J. Walsh
Z.Z. Zhao
X.J. Zhou
A. Khan
G.J. Seymour
M. Bigby

AstraZeneca R&D Boston,
35 Gatehouse Drive,
Waltham, MA 02451, USA     

Oral Biology and Pathology,
The University of Queensland,
St Lucia, Brisbane,
Queensland, Australia,

Department of Dermatology,
Beth Israel Deaconess Medical Center,
Brookline, MA, USA

Peripheral sensory neuropathy associated with short-term oral acitretin therapy

A 57-year-old female patient with widespread chronic plaque psoriasis and a 32-year-old male patient with severe oral lichen planus are reported, who developed sensory symptoms in the extremities 3 and 4 months after the onset of oral acitretin (trade name Soriatane) therapy, respectively. 


Both patients showed clinical and electrophysiological evidence of a sensory peripheral neuropathy, which completely resolved 2 and 2.5 years after discontinuation of oral acitretin administration, respectively.
From:
2003 Jan-Feb;16(1):46-9.

Department of Dermatology, 
University of Patras, 
Greece. 
tsambaos@med.upatras.gr


Copyright 2003 S. Karger AG, Basel
PMID: 12566828 [PubMed - indexed for MEDLINE] 

~~~~~~~~~~~~~
Note: 
The full free article is supposed to be available through Karger, but I could not find it.


Wednesday, January 5, 2011

Resolution of Oral Lichen Planus

It has been nearly two months since I went off the Cellcept and I still have very little signs of Oral Lichen Planus. The cold that I had stayed for a very long time, though, and eventually because it aggravated my asthma, I needed to take some Prednisone to get it under control. Presently, the cold is gone, my asthma is under control and I am titering down from the Prednisone.

Still no sign of the Oral Lichen Planus. The few times in this last six weeks that I thought I might have some signs, I have used my Clobetasol ointment, and it has been enough. Let it be understood that my mouth is not entirely perfect looking. I still have some redness, a little bit of lace appearance on the inside of the cheeks, and some thinning of the tissue on top of the tongue, but the pain is gone and I am able to consume most foods that I would have eaten in the past before the OLP with the exception of highly spiced foods. I still have some permanent scarring inside, and swelling on the outside edge of my chin.

I have now been able to appropriately take care of my dental health. I am using a sonic toothbrush and Biotene toothpaste. I can floss well, though I do not use a mint or cinnamon flavored floss. Mint and cinnamon are not recommended for people with Oral Lichen Planus. I also use a Waterpik. All of these methods for good oral health were difficult to perform when my mouth was so flared up in the past.

Needless to say, I am very happy!

Saturday, November 13, 2010

Going Off Cellcept

A week or so ago, I called my UCSF oral clinic doctor and updated her on a few things that have been going on with me medically unrelated to Oral Lichen Planus. We discussed when my next appointment is scheduled and she mentioned maybe we would discuss going off the Cellcept at that time. I told her I didn't see how that was going to be possible considering that even if I forget to take it for a day or two, my mouth gets all flared up again. But, still I am open to discussing it in the future.

In the meantime, because I am taking Cellcept to knock down my immune system, I am susceptible to viruses and bacterial infections and who knows what all. The changes are observable in my blood test results, usually with a lower than normal lymphocyte count in particular. There have been a few times when I have felt a little sickly, but nothing I could point a finger at and say what was the diagnosis.

But, this last week, starting last Friday night I noticed a sore throat coming on. Then, Saturday and Sunday, I felt feverish, fatigued, and full blown cold symptoms. I have had plenty of colds in my life, but never one quite so fulminate as this one. I felt like I was hit by a sledge hammer. Since I have had my flu shots, I am sure it is not the flu. Needless to say, my significant other also came down with the cold but was well enough in a day to go to work, while I was bedridden.

I went to see my new primary physician on Monday. (My old one retired.) I have been feeling pretty unsure of him so far. Aside from the OLP, I have a number of other medical problems to deal with, and my last doctor did a superior job of helping me keep a decent balance in my care. Yet, he asked the right questions about my symptoms and immediately ordered anti-biotics. This is the same thing my old doctor would have done under the circumstances, simply because the Cellcept might encourage the cold to turn into an infection, as I mentioned.

What surprised me, though was that he suggested I go off the Cellcept while I am sick with this cold to give my body a chance to fight it off, so I can get well.

I admit I was hesitant to consider it. After all that pain and suffering for so many years, then the best treatment for me came along and the Cellcept has put my OLP to rest quite well and made life more tolerable. Do I want to go back to that? I really struggled with the idea.

However, in the past, I have had some terrible infections for other reasons, and weighing out my options, it was clear to me to go ahead with the plan.

Oddly enough, I have now been completely off the Cellcept (no titering down) since Monday. So, here I am going on the sixth day and have no signs of an increase of my OLP symptoms. Everything is as clear as it was before I got sick.

I wonder if my body is so busy fighting off the cold that it can't be bothered with attacking my mouth. Or is it just a coincidence and this is one of those "naturally occurring remissions" I've been reading about that others seem to have.

I am including a picture here of one of the times that my mouth was flared up.

Tuesday, November 9, 2010

Stress and Oral Lichen Planus

Oftentimes, patients are told that OLP is caused by or aggravated by stress. I understand where this idea comes from when I look at medical articles that say the same thing.

It has been a source of major frustration for me to accept the idea that stress is a cause or contributor to OLP. After all, there are plenty of times life is stressful for all of us and it does not bring on OLP. There have been plenty of times when I've gone through major stress and not have a flare up of OLP. In fact, I have found the stress in my life increases when I have an outbreak of uncontrolled OLP.

Not too long ago I realized that the kind of stress that might trigger an episode of OLP in those predisposed to it, would be of a physiological nature.


Picture shows OLP involvement in the soft palate, the tonsil, uvula, and the retromolar pad. This was very painful to endure at the time.

Here is an abstract of a new article I found interestingon the relationship of "oxidative stress" to Oral Lichen Planus.



Evaluation of oxidative stress and antioxidant profile in patients with oral lichen planus

Objective:
The aim of this study was to assess oxidative stress and antioxidant profile in patients with oral lichen planus (OLP) using serum and salivary samples and to compare these biomarkers in a group of healthy subjects.

Patients and methods:
Twenty-one recently diagnosed patients with OLP and 20 healthy controls with matched periodontal status were recruited to the study. Total antioxidant activity (TAA) and lipid peroxidation product malondialdehyde (MDA) in both serum and saliva were determined. Univariate comparisons between the two groups were made for quantitative and categorical variables to determine any significant differences.

Results:
In OLP patients, total antioxidant defense (TAA) was significantly lower than that in healthy subjects in their serum samples (P?=?0.01). Salivary MDA levels were significantly higher in the OLP group compared with healthy subjects (P?=?0.03). A significant correlation was found between serum and saliva TAA estimates in patients with OLP (r?=?0.714 and P?=?0.0001) and in the control group (r?=?0.69 and P?=?0.001). Significant correlation was also found between serum and saliva MDA values in control group (r?=?0.464 and P?=?0.04). A significant inverse correlation was found between salivary MDA and TAA values in the control group (r?=?-0.598 and P?=?0.005).

Conclusions:
The findings of this study suggest an increased oxidative stress and imbalance in the antioxidant defense system in biological fluids of patients with OLP. These findings may reflect the disease phenomenon of OLP rather than a causal effect and their role in pathogenesis and transformation of OLP to cancer, if any, needs further elucidation.

PMID: 21039889

Medline AbstractJ Oral Pathol Med (2010)


Evaluation of oxidative stress and antioxidant profile in patients with oral lichen planus.
S Ergun, SC Trosala,
S Warnakulasuriya,
S Ozel, AE Onal,
D Ofluoglu,
Y Guven,
H Tanyeri
J Oral Pathol Med, October 7, 2010; .            

       
Department of Oral Medicine and Surgery,
Faculty of Dentistry,
Istanbul University,
Istanbul, Turkey

Department of Biochemistry,
Faculty of Dentistry,
Istanbul University,
Istanbul, Turkey

Department of Oral Medicine and WHO Collaborating Centre for Oral Cancer,
King's College London Dental Institute,
London, UK

Department of Biostatistics and Medical Informatics,
Istanbul Faculty of Medicine,
Istanbul University,
Istanbul, Turkey

Department of Public Health,
Istanbul Faculty of Medicine,
Istanbul University,
Istanbul, Turkey

Sunday, November 7, 2010

Esophageal Lichen Planus Abstract 2

Esophageal lichen planus is an under-recognized condition, with fewer than 50 cases reported to date.

Unlike cutaneous lichen planus, esophageal lichen planus occurs almost exclusively in middle-aged or older women who also have oral involvement.

It commonly involves the proximal esophagus and manifests as progressive dysphagia and odynophagia.

Endoscopic findings can include lacy white papules, pinpoint erosions, desquamation, pseudomembranes, and stenosis.

Histologic features of esophageal lichen planus have only rarely been illustrated. They differ from those of cutaneous disease in several respects, including the presence of parakeratosis, epithelial atrophy, and lack of hypergranulosis.

Correct diagnosis of esophageal lichen planus is difficult but bears important therapeutic implications. It is typically a chronic and relapsing condition that can require systemic or local immunosuppressive therapy and repeated endoscopic dilatations for esophageal strictures.

Esophageal lichen planus may have malignant potential, as evidenced by 3 patients who developed squamous carcinoma of the esophagus after longstanding disease.


Note: This abstract is from these sources:


Arch Pathol Lab Med. 2008 Jun;132(6):1026-9.
Esophageal lichen planus.

Chandan VS,
Murray JA,
Abraham SC.

Division of Anatomic Pathology,
Mayo Clinic,
Rochester, MN 55905, USA.

Abstract

PMID: 18517264 [PubMed - indexed for MEDLINE]

Friday, November 5, 2010

Oral Lichen Planus Research Study

I frequently search for information on oral lichen planus in hope that there will be some new discovery to help resolve lesions efficiently, to stop scarring, to reduce pain, to have a cure.

So far, no major changes have occurred. I guess there is not enough interest or perhaps not enough funding to make new inroads.

I guess Lichen Planus is a "turtle" disease. In the story of The Tortoise and the Hare, the motto was slow and steady wins the race. Okay, I guess patience is the answer here for patients. (pun intended).

Today I came across evidence of a new study published in the Journal of Oral Pathology and Medicine. I can't get a copy of the paper, but it appears the abstract is self explanatory.

I was once in a study similar to this in that the treatment was what most people would consider "alternative". This study used Aloe Vera. Before you roll your eyes, continue reading, please.

32 OLP patients were given Oral Aloe Vera to apply directly in their mouth. Another 32 OLP patients were given a placebo, which means they did not get the Aloe Vera. This was done to compare the results, to determine if Aloe Vera would be useful for Oral Lichen Planus.

It didn't work for everyone. But, the percentages were considered good in that it worked for some, and in comparison to those who used the placebo they did better.

What bothers me is that like many research studies I've read about I think that they didn't continue it for a long enough period of time. I doubt very much that the 32 who were taking the Aloe Vera were not all in the exact same condition. Some may have been lighter cases.  Some may have been severe cases. This is not mentioned in the Abstract. So, my thought is if those with more severe cases were given more time, perhaps they would have had more improvement.

These are the authors of the study

N. Salazar-Sánchez
P. López-Jornet
F. Camacho-Alonso
M. Sánchez-Siles

This is their institution
Mariano Sánchez-Siles
Clínica Odontológica Universitaria
Medicina Bucal
Hospital Morales Meseguer
Murcia, Spain

This is the Abstract


Always seek the advice and supervision of a qualified licensed medical professional!

The information provided on this site has been created as an online journal only. The author is writing from her personal viewpoint and cannot guarantee the completeness or accuracy of the information displayed.

Comments to any of the entries are appreciated.