Lichen Planus of the Lip-Case Series and Review of the Literature.

Background and Objectives: Lichen planus of the lip (LPL) is a chronic inflammatory condition that resembles actinic cheilitis, discoid lupus erythematosus, graft-versus-host disease, and lichenoid reaction to dental materials or drugs. The purpose of this study was to conduct a literature review on lichen planus lip involvement and to report a retrospective observational study that characterises and explores the clinical, histopathological, and evolution of the lesions in a group of patients with unique involvement of LPL. Materials and Methods: Clinical data of patients diagnosed with LPL was retrieved from the medical charts of the patients referred to the Oral Pathology Department of the "Carol Davila" University of Medicine and Pharmacy. A concurrent electronic literature research was carried out using PubMed and Web of Science from 2003 to 2023. Results: Eleven patients diagnosed with unique LPL were analysed (male/female ratio was 1.75, mean age 63.64 years ± 12.52). All patients presented lesions of the lower lip; the clinical forms were atrophic (six cases) and erosive (five cases), and the histopathological exam confirmed the diagnosis. After topical treatment with corticosteroids, most of the patients had complete remission. The literature review revealed 24 studies (sixteen case reports and eight case series) which comprised 84 patients. Isolated lip involvement was reported in 17 studies, and five articles with concomitant oral lichen planus, while two articles did not mention this criterion. Conclusions: Our study brings new data on isolated lichen planus of the lip that primarily affects the lower lip with predominance in male patients. It was reported worldwide in patients between 22 and 75 years old. Topical corticosteroids were the main treatment prescribed and they usually brought remission of the lesions. Lichen planus of the lip is a challenging diagnosis for oral health practitioner providers as well as for dermatologists.

Unraveling Immunological Dynamics: HPV Infection in Women-Insights from Pregnancy.

During pregnancy, hormonal and immune adaptations are vital for supporting the genetically distinct fetus during elevated infection risks. The global prevalence of HPV necessitates its consideration during pregnancy. Despite a seemingly mild immune response, historical gestational viral infections underscore its significance. Acknowledging the established HPV infection risks during pregnancy, our review explores the unfolding immunological changes in pregnant women with HPV. Our analysis aims to uncover strategies for safely modulating the immune system, mitigating adverse pregnancy consequences, and enhancing maternal and child health. This comprehensive narrative review delves into the existing knowledge and studies on this topic.

Mast Cell Activation Syndrome Update-A Dermatological Perspective.

Mast cells (MCs) are infamous for their role in potentially fatal anaphylaxis reactions. In the last two decades, a more complex picture has emerged, as it has become obvious that MCs are much more than just IgE effectors of anaphylaxis. MCs are defenders against a host of infectious and toxic aggressions (their interactions with other components of the immune system are not yet fully understood) and after the insult has ended, MCs continue to play a role in inflammation regulation and tissue repair. Unfortunately, MC involvement in pathology is also significant. Apart from their role in allergies, MCs can proliferate clonally to produce systemic mastocytosis. They have also been implicated in excessive fibrosis, keloid scaring, graft rejection and chronic inflammation, especially at the level of the skin and gut. In recent years, the term MC activation syndrome (MCAS) was proposed to account for symptoms caused by MC activation, and clear diagnostic criteria have been defined. However, not all authors agree with these criteria, as some find them too restrictive, potentially leaving much of the MC-related pathology unaccounted for. Here, we review the current knowledge on the physiological and pathological roles of MCs, with a dermatological emphasis, and discuss the MCAS classification.

Oral health-related quality of life in different clinical forms of oral lichen planus.

OBJECTIVES: The aim of the study was to determine the prevalence of clinical forms in a group of oral lichen planus (OLP) patients and to investigate whether the oral health-related quality of life (OHRQoL) of patients with common clinical OLP forms differs significantly from that of other clinical forms of OLP and healthy patients, respectively. METHODS: OHRQoL was assessed using the Romanian version of the short form of the Oral Health Impact Profile (OHIP-14). OLP patients rated the pain they were currently experiencing on a visual analog scale (VAS). Statistics was performed using parametric and non-parametric tests and multiple linear regression. RESULTS: Eighty OLP patients and 80 healthy controls were enrolled. The most prevalent OLP clinical form was keratotic form (n = 39, 48.75%, group 1), followed by atrophic (31.25%), erosive-ulcerative (17.5%), and bullous (2.5%) forms, which were included in group 2 (n = 41). The OHRQoL did not differ significantly between group 1 and the other two groups. A negative social impact was reported on psychological discomfort domain for both OLP groups, as compared with healthy controls. VAS scores were significantly associated with OHIP total scores in group 1 (rho = 0.41, n = 39, p = 0.009, Spearman's correlation coefficient). Within the same group, significantly higher OHIP total scores were recorded in patients lacking academic education (p = 0.0086, Mann-Whitney U test). CONCLUSIONS: Overall, the most common clinical OLP form did not impact significantly the OHRQoL of OLP patients. CLINICAL RELEVANCE: Psychological therapy and meeting the educational needs might improve the OHRQoL of patients with common clinical forms of OLP.

Treatment Effects upon Prolactin and Soluble Receptor of Interleukin-2 in Psoriatic Patients.

BACKGROUND: Psoriasis vulgaris is a chronic inflammatory hyper-proliferative disease of the skin, scalp, nails, and joints. It has been hypothesized that prolactin (PRL) may modulate the skin immune system and be involved in the pathogenesis of psoriasis. Psoriasis exerts significant, negative impact on patients' quality of life. Relatively high rates of depression are reported in patients with psoriasis. OBJECTIVES: The aim of this work was to study the possible role of PRL in the pathogenesis of psoriasis and its correlation with the disease activity, clinically, molecular and emotional status of patients. SUBJECTS AND METHODS: A total of 41 samples were analyzed - 21 new patients with psoriasis vulgaris before treatment and 20 after therapy - were included in this study. In all patients, we determined skin disease activity according to the PASI index, the psychological impact measured with HAMA and HAMD scales and the quality of their life measured by DLQI. The concentration of prolactin in the serum was measured by enzyme-linked immunosorbent assay (ELISA), and the concentration of soluble receptor of IL-2 was measured with automated immune chemiluminescent system - IMMULITE procedure. RESULTS: The PRL and sIL2R serum levels were significantly decreased after three months of therapy, at least 50% with a p value <0.00001. Clinical, hormonal, molecular correlations between before and after therapy were measured with a statistically significant result. Correlations between HAMA-PRL and DLQI-PRL before therapy were not statistically significant, only the relationship between HAMD and PRL was demonstrated. After treatment, we obtained a significant clinical, psychological and paraclinical (especially serum levels of prolactin and sIL2R) decreased and relevant response on all the patients treated and analyzed. CONCLUSION: Prolactin seems to have a role in the pathogenesis of psoriasis and may represent a cause and/or a consequence of psoriasis pathology. The most likely scenario is that PRL enhances interferon-induced chemokine production in keratinocytes, thereby facilitating cutaneous T-cell infiltration. This raises the intriguing light that PRL may offer a novel future therapeutic target in psoriasis and other skin diseases that worsen in response to psychological distress.

Interplay Between Prolactin and Pathogenesis of Psoriasis Vulgaris.

INTRODUCTION: The polypeptide hormone prolactin (PRL) represents the pituitary modulator of lactation and reproduction. Currently, we discuss the wide range of PRL actions "beyond the mammary horizon". Multiple studies had showed the role of PRL as a cytokine, with comparable structural motifs, similar receptor structures and signal transduction pathways. Almost two decades ago it was fi rst hypothesized that PRL acts as a neuroendocrine modulator of both skin epithelial growth and the skin immune system. Moreover, it was described the PRL circuit between the skin and the central nervous system. Psoriasis vulgaris, an immunologically mediated skin disease, is a common disorder, having as main pathogenetic mechanisms the chronic infl ammation and keratinocytes hyperproliferation. Psoriasis vulgaris is not a life threatening disease, but aff ects seriously the quality of life; there is still no causative treatment. METHODS: After we describe the essentials of general PRL biology, the almost ubiquitous distribution of its receptors and the vast list of extrapituitary PRL-expressing tissues, our aim is to summarize clinical observations that provide insights into how PRL may impact on the psoriatic skin and defi ne research for be% er characterize the complex role of PRL in human skin biology and pathology. RESULTS: Focusing on psoriasis, as a stress-related disease, we then discuss the possible role of PRL/ PRLR in its pathology and may identify one potential biological marker and therapeutic targets for the management of this autoimmune skin disorder. CONCLUSION: This theory/concept can now be integrated into current views on the multilevel neuroendocrine- immune communication along the brain-skin axis in health and disease. Due to the pathogenic complexity, there is no curative treatment for psoriasis and pharmacological modulation of PRL may represent a future target to restrict the lesions in psoriatic patients.

Oral lichen planus: a retrospective study of 633 patients from Bucharest, Romania.

OBJECTIVE: In this retrospective study, patients' medical records were reviewed to investigate the profiles of 633 OLP cases in a group of Romania. MATERIAL AND METHODS: In this retrospective study, the following clinical data were obtained from the medical charts of patients: gender, age, clinical presentation of OLP, site affected, presence of symptoms, extraoral manifestations of lichen planus, presence of systemic diseases, and history of medications. RESULTS: Most (78.67%) OLP patients were female and the mean age at presentation was 52 years. The white type of the disease (reticular/papular/plaque lesions) was the main form encountered in this sample (48.97%). Among patients with available hepatitis C virus test results, 9.6% were serum-positive. OLP was associated with gallbladder disease (i.e. cholecystitis, cholelithiasis) in 19% of patients. Six patients (0.95%) developed squamous cell carcinoma at a site with confirmed OLP lesions. CONCLUSIONS: To the best of our knowledge, no similar study has been conducted in a Romanian population. The present investigation revealed the predominance of OLP among middle-aged white women and the prevalence of bilateral involvement of the buccal mucosa with reticular white lesions. Anti-HCV circulating antibodies were more common in patients with OLP than in the general population and, notably, OLP was associated with gallbladder disease (cholecystitis, cholelithiasis) in 19% of patients.

Recurrent intraoral HSV-1 infection: A retrospective study of 58 immunocompetent patients from Eastern Europe.

OBJECTIVES: To revise the clinical features of the recurrent intraoral herpetic infection (RIOH) with respect to precipitating factors, demographic, clinical features and outcome. STUDY DESIGN: Fifty-eight, unrelated Caucasian, immunocompetent patients with positive laboratory test for intraoral Herpes simplex virus infection were studied. RESULTS: The mean age in the women's group (n=42) was 41.23 years (± 21.73) and in the men's group was 32.25 years (±15.68). Possible trigger factors were identified in 9 cases (15.5%). General symptoms were noted in 20 cases (34.48%). Most of patients in this study presented multiple lesions. 14 patients had vermillion lesions associated with intraoral lesions. In most of the cases both fixed and mobile mucosa was concomitantly involved. Treatment was prescribed in order to control the symptoms and to shorten the evolution with minimal side effects. CONCLUSIONS: Intraoral secondary herpetic infection could be polymorphous and sometimes associated with general symptoms. The recognition of its atypical features may prevent unnecessary and costly investigations and treatments for unrelated though clinically similar-appearing disorders.

Characterization of oral keratinocyte stem cells and prospects of its differentiation to oral epithelial equivalents.

OBJECTIVE: Although oral keratinocyte stem cells play a key role in tissue homeostasis, wound healing, and neoplasia, they remain difficult to identify and characterize. The specific aim of the present study is to characterize an oral keratinocyte stem-cell population separated using a magnetic technique. MATERIAL AND METHODS: Oral human keratinocytes obtained from keratinized oral mucosa were magnetically separated using a proliferation-related marker, CD71 and α6ß4 integrin. The expression of different stem cell markers: CD44H, Nestin, Nanog, Oct 3÷4, CD117 was checked by immunofluorescence. The ability of α6ß4pos CD71neg fraction to form oral epithelial equivalents was also assayed. RESULTS: Three different oral keratinocyte subpopulations were obtained following magnetic separation: α6ß4pos CD71neg, α6ß4pos CD71pos and α6ß4neg. Our α6ß4pos CD71neg stem cell fraction was positive for Oct 3÷4, CD44H and cytokeratin 19 while Nanog, Nestin and CD117 expression was absent. At the same time, the other two cell fractions α6ß4pos CD71pos and α6ß4neg were negative for all stem cell markers. Also, α6ß4pos CD71neg fraction was able to regenerate a well stratified and organized oral epithelial equivalent. The distribution of cytokeratin 19 and involucrin in the oral epithelial equivalent reflected the in vivo situation in oral gingival epithelium. CONCLUSIONS: The human gingival α6ß4pos CD71neg fraction was strongly positive for a panel of stem cell markers and could form oral epithelial equivalent. It is also suggested that a magnetic system may be an important tool in acquiring oral keratinocyte stem cells for research.

Primary herpetic gingivostomatitis in children and adults.

OBJECTIVES: To investigate if the onset of primary herpetic gingivostomatitis (PHG) is shifting toward an adult age and compare the clinical characteristics of PHG between children and adults. METHOD AND MATERIALS: The charts of patients diagnosed with PHG in an oral medicine clinic in Bucharest, Romania, over a 10-year period were revisited. Diagnosis was based on history, clinical data, and laboratory confirmation (Tzanck cytology, polymerase chain reaction [PCR], or immunofluorescence). Seventy-three cases (38 females, 35 males) were included. The age range was between 22 months and 53 years, with a mean age of 18.6 years. All patients were healthy with no suspicion of HIV infection or immunodeficiency. RESULTS: Nearly 48% (47.94%) of the sample were in the young adult group. General symptoms (fever, malaise, and lymphadenopathy) were equally present in children and adults. The most involved areas were the gingiva, vermilion border, and tongue. No differences in the extent of lesions were observed between children and adults. Inflammatory gingivitis and pharyngotonsillitis were more frequent in children than in adults although their frequency was less than expected. CONCLUSIONS: PHG was more frequently observed in young adults than in children. No significant differences between children and adults in the severity of infection were observed. Most of the patients presented widespread lesions.