Integrative Approaches for the Diagnosis and Management of Erosive Oral Lichen Planus.

Erosive oral lichen planus (EOLP) represents a significant challenge in dental and medical management due to its chronic inflammatory nature, painful symptoms, and impact on quality of life. This study aims to evaluate the current diagnostic approach with novel non-invasive techniques, such as dermoscopy, and also the landscape of treatment options for EOLP, focusing on its efficacy, safety, and the challenges that it present in clinical practice. Through a comprehensive literature review, we explored the use of topical corticosteroids, systemic immunosuppressants, biologics, and Janus kinase (JAK) inhibitors in treating EOLP, alongside examining patient compliance, psychological impacts, and the risk of adverse effects and recurrence. Our findings reveal that while topical corticosteroids are the cornerstone of EOLP treatment, offering symptomatic relief, their long-term use is limited by side effects and tolerance development. Systemic therapies and biologics provide alternatives for refractory cases but necessitate careful adverse effect monitoring. JAK inhibitors show promise as an innovative treatment avenue but require more evidence on long-term safety and efficacy. This study highlights the necessity of personalized treatment approaches due to the variable disease course and response to treatment, underscoring the importance of a multidisciplinary strategy in managing EOLP. The complexity of EOLP treatment, compounded by its psychological and quality of life impacts, demands ongoing research into targeted therapies, the establishment of standardized treatment protocols, and the development of effective outcome measures to improve patient care and treatment outcomes.

Colchicine in the treatment of refractory aphthous ulcerations: Review of the literature and two case reports.

Colchicine has been known and used for over a millennium for its anti-inflammatory properties, being the treatment of choice for gout and familial Mediterranean fever. A tricyclic alkaloid extracted from the herbaceous plant, Colchicum autumnale, colchicine blocks multiple inflammatory pathways, and has antimitotic and antifibrotic action. Although there are insufficient data on the beneficial mechanism of action, colchicine is a widely used treatment in dermatology, one of the morbid conditions with more evidence of efficacy being recurrent aphthous stomatitis (RAS), a disorder with incompletely known etiopathogenesis and, consequently, with poorly defined treatment. Colchicine is considered as the first therapeutic line in complex or severe aphthoses, significantly relieving pain, decreasing the number of lesions, increasing the free interval between eruptive episodes, without inducing noticeable side effects. We examined the treatment efficacy of colchicine in two cases of chronic, severe RAS, evolving in different morbid contexts, who did not respond to other therapeutic measures. The two cases presented with recurrent aphthous stomatitis with herpetiform aphthae; one patient with Turner syndrome and one patient with major Sutton ulcers.

High serum level of interleukin-6 is linked with dyslipidemia in oral lichen planus.

Oral lichen planus (OLP) is a complex chronic inflammatory disorder in which autocytotoxic CD8+ T cells, locally present in the affected tissue, induce basal keratinocyte apoptosis, through the release of several cytokines, such as interleukin-6 (IL-6). IL-6 is a proinflammatory cytokine that is related to alterations in lipid metabolism in psoriasis patients. Impaired lipid metabolism together with high serum levels of triglycerides have been found in association with OLP. However, the correlation between serum levels of IL-6 and dyslipidemia has not yet been studied in this disorder. The present study aimed to demonstrate the association between OLP, systemic inflammation through increased release of inflammation mediators such as IL-6 and alteration of lipid metabolism, in order to support the concept of OLP as a marker of systemic inflammation and a potential risk factor of cardiovascular morbidities. For this purpose, we designed a case-control study using a cohort of 18 patients with different clinical forms of OLP compared with 18 control group patients with other oral conditions, to identify a potential correlation between serum levels of IL-6 and serum lipid levels. High plasma serum levels of IL-6 were found to be correlated with cholesterol, high density lipoprotein cholesterol and triglyceride serum levels in the patients with OLP. There was a significant association between erosive and atrophic clinical forms of OLP and the pathological serum values of IL-6 and triglycerides, respectively, making these two parameters good predictive factors of the clinical form of OLP. Further studies of other biomarkers of systemic inflammation using larger cohorts of OLP patients are necessary in order to consider LP as a marker of systemic inflammation and to support the screening of these patients for lipid metabolism changes and treatment with specific antagonists in order to prevent cardiovascular events.

Correlation between lymphatic vessel density and microvessel density in cutaneous malignant melanoma.

BACKGROUND: Malignant melanoma is an aggressive neoplasm, known for its propensity to early metastatic spread, via lymphatic as well as blood vessels. Tumor progression to an aggressive phenotype is associated with angiogenesis. Tumor lymphangiogenesis may represent a marker for assessing the risk of metastasis in the regional lymph nodes. MATERIALS AND METHODS: We studied the lymphatic vessel density in peritumoral and intratumoral areas compared to overall microvessel density in 12 cases of malignant melanoma of the face. All cases were primary invasive melanomas, with a Clark level of invasion III and IV. Lymphatic vessels were marked with D2-40 murine monoclonal antibody and their density evaluated through hot-spot method by examination on optic microscopy (200×). Overall microvessel density was assessed using the same method, vascular endothelial cells being visualized using CD31 monoclonal antibody. Statistical analysis was made using SPSS 17.0 software package (Pearson correlation test and Student's t-test). RESULTS: The disposition and aspect of the lymphatic vessels were different in peritumoral and intratumoral areas. Thus, in peritumoral areas lymphatics were generally regular, large, dilated vessels whereas intratumoral lymphatic vessels were smaller, with an irregular lumen. Lymphatic vessel density was generally higher in peritumoral areas. Intratumoral lymphatic vessel density was lower, but significantly correlated to overall microvessel density in these areas. Overall microvessels density was increased in thick cutaneous melanoma. Vessels in the peritumoral areas were larger and more numerous compared to those found in normal tissue. In cases with a dense peritumoral inflammatory infiltrate, we found the highest vascular density. Intratumoral angiogenesis was moderate in most cases, with irregular, smaller or collapsed vessels. CONCLUSIONS: Evaluation of the lymphatic vessel density may prove to be useful for the prognostic assessment in malignant melanoma, as it may predict the patients with a risk of developing lymph node metastasis.