Biomolecules in the treatment of lichen planus refractory to corticosteroid therapy: Clinical and histopathological assessment.

BACKGROUND: Local deficit of several biomolecules have been described in oral lichen planus (OLP). Such a deficit impairs cellular functions and cell-matrix communication. PURPOSE: Assess the efficacy of the local application of autologous biomolecules in the treatment of erosive OLP. MATERIALS AND METHODS: In this study, the use of plasma rich in growth factors (PRGF) as a source of blood-derived and autologous growth factors and proteins were tested in erosive oral lichen planus refractory to corticosteroids. Histopathological features of the disease were also analysed at the time of diagnosis. Clinical data were the number of recurrences and achievement of pain reduction and complete healing of the lesions. A total of 10 patients with erosive OLP refractory to treatment by corticosteroids were included in the study. All patients were females with a mean age of 48±12years. RESULTS: A complete remission of the disease was achieved after one infiltration of PRGF in 8 patients. Only 2 patients required a total of 2 infiltrations to heal. Hydropic degeneration of the epithelium basal layer, band-like subepithelial lymphocytic infiltration and fibrin deposits in the epithelium were observed in all patients. Interestingly plasma cells were present in 2 patients. All patients presenting plasma cells healed after only one PRGF infiltration. However, 2 patients out of 6 (no plasma cells) required 2 infiltrations. CONCLUSIONS: The local administration of autologous local factors could overcome the deficit of biomolecular clues and thus improve cell functions and restore cell-matrix communication.

Assessment of Uric Acid Level in the Saliva of Patients with Oral Lichen Planus.

OBJECTIVE: The aim of this study was to evaluate the level of uric acid (UA) in saliva, which is considered to be an antioxidant defense biomarker against oxidative stress in patients with oral lichen planus (OLP). SUBJECTS AND METHODS: In this case-control study, 25 OLP patients were included. The reticular form of OLP was verified by a clinical examination with Wickham striae, and other types (erosive, atrophic, ulcerative) were confirmed by histopathological assessment. Thirty healthy individuals matched for age and gender were selected as the control group. In both groups, the Navazesh technique was used to collect the unstimulated saliva. Then, the amount of UA was measured using a Cobas Mira autoanalyzer with a wavelength of 546 nm. The Student t test was used to analyze the data assuming a significance level at <0.05. RESULTS: Of the 25 patients, the most common type of OLP was erosive (n = 11, 44%), and the most common site of OLP was seen as bilateral in the buccal mucosa (n = 12, 48%). The mean level of salivary UA was significantly lower in the patients with OLP (2.10 ± 0.19 mg/dL) in comparison with the control group (4.80 ± 0.29 mg/dL; p < 0.001). CONCLUSION: In this study, OLP was associated with a decrease in UA levels in the saliva. Salivary UA as a biomarker could be used for monitoring and treating OLP.

Evaluation of salivary cortisol and psychological factors in patients with oral lichen planus.

BACKGROUND AND OBJECTIVES: Lichen planus is a relatively common chronic inflammatory disease of oral mucosa and skin. Cortisol, also called as "stress hormone", has been used as an indicator in various stress evaluation studies. Salivary cortisol measurement is an indicator of free cortisol or biologically active cortisol in human serum and provides noninvasive and easy technique. Recent studies have been conflicting, and hence, in the present study, evaluation of salivary cortisol levels and psychosocial factors in oral lichen planus (OLP) patients was done. MATERIALS AND METHODS: A total of 30 patients with clinically and histopathologically proven cases of OLP, along with the age and sex-matched healthy controls were included in the study. Samples of stimulated saliva were collected, centrifuged and analyzed for the level of cortisol with cortisol enzyme linked immunosorbent assay. Psychosocial factors of study and control groups were measured by depression anxiety and stress scale. Student's t-test was used to compare the psychological factors and salivary cortisol levels between patients with the OLP and the control group. RESULTS: Irrespective of sex, significantly higher depression (83.4 +/- 15.4%), anxiety (80.5 +/- 11.3%), and stress (94.2 +/- 6.2%) scores were observed in OLP patients compared to controls. Increased cortisol levels were observed among 17 (56.6%) OLP patients in the study group. A positive correlation was found between psychological factors and salivary cortisol levels in the OLP patients. The values of Pearson's correlation coefficient "r", between depression, anxiety, and stress with salivary cortisol was: +0.42,S; +0.27,NS; and +0.65,HS, respectively among the study group.

Assessment of 14 functional gene polymorphisms in Japanese patients with oral lichen planus: a pilot case-control study.

Oral lichen planus (OLP) is a refractory mucosal disease. Its pathogenesis is thought to involve immunologic and genetic alterations. To gain a better understanding of the genetic risk factors, the authors evaluated associations between 14 functional gene polymorphisms and OLP. 32 Japanese patients with OLP and 99 unrelated healthy Japanese controls were genotyped for 14 single nucleotide polymorphisms (SNPs) of genes that regulate host immune responses. Genotyping was performed with a modified version of the serial invasive signal amplification reaction. A trend towards over-representation of tumor necrosis factor receptor 2 (TNFR2) +587 G allele was found in the patients compared with the controls (allele frequency: P=0.049). The other 13 SNPs were unassociated with OLP. These results suggest that TNFR2 +587 gene polymorphism may be associated with susceptibility to OLP.

Assessment of local angiogenesis and vascular endothelial growth factor in the patients with atrophic-erosive and reticular oral lichen planus.

OBJECTIVES: The objective of this study was to assess local angiogenesis and expression of VEGF in atrophic-erosive and reticular oral lichen planus (OLP). STUDY DESIGN: Microvessel density (MVD) and VEGF level in 30 OLP subjects and 7 matched controls were detected by immunohistochemistry and ELISA. RESULTS: MVD and VEGF levels in whole OLP group were significantly elevated (P = .033, P < .0001, respectively), and there was a positive correlation between MVD and VEGF (correlation coefficient = 0.84, P < .0001). MVD in atrophic-erosive OLP was significantly higher than that in controls (P = .001) and reticular OLP (P = .042), and the expression of VEGF in both subgroups was significantly higher (P < .0001, P = .008, respectively) compared to control group. CONCLUSION: These results indicated that angiogenesis and VEGF expression were closely correlated to the different clinical forms of OLP lesions, which may give new insights into the mechanisms and treatment strategy of OLP.

Epithelial p53 gene expression and mutational analysis, combined with growth fraction assessment, in oral lichen planus.

The immunohistochemical detection of epithelial p53 protein expression in oral lichen planus (OLP) biopsies was supplemented with molecular analysis for mutations of the p53 gene using the polymerase chain reaction - single stranded conformational polymorphism (PCR-SSCP) technique. p53 protein expression, in the basal epithelial cell layer, as detected by the DO7 and 1801 antibodies, was significantly more frequent in OLP compared with other oral keratoses and normal mucosa, as was the growth fraction. The 10 OLP biopsies that had the most frequent p53 staining (plus a case of OLP found in continuity with a SCC) were screened by the PCR-SSCP technique, but no mutations were detected in the p53 gene (exons 5 9). The p53 overexpression in the OLP samples may be a physiological response to the hyper-proliferative state, as revealed by the growth fraction determination. This may usefully serve to protect against mutagenesis, and so be a factor in the low incidence of carcinoma associated with OLP.

[The quantitative assessment of DNA in potentially cancerous cases of oral lichen]. / La valutazione quantitativa del DNA nei casi di lichen del cavo orale potenzialmente cancerosi.

The increased prevalence of all variants of oral lichen, both as a result of increasing frequency and improved knowledge of the pathologist, coupled with its greater trend to malignant transformation has focused the attention of researchers on the development of new technology that could help in the early detection of the precancerous lesion. DNA cytometric detection can be useful to detect the precancerous lesion when clinical and histological findings of the transformation are still absent. The early diagnosis of such lesions entitles to use a more aggressive treatment, both medical and surgical.