Cutaneous, genital and oral lichen planus: A descriptive study of 274 patients

Background: Lichen planus (LP) is a chronic autoimmune disease that affects the oral mucosa as well as the skin, genital mucosa and other sites. Objective: To evaluate the correlation between oral, genital and cutaneous lichen planus, in a sample of LP patients. Material and Methods: This descriptive study reviewed 274 clinical histories of patients, who all presented histological confirmation of lichen planus verified by a pathologist, attending research centers in Barcelona. Results: A total of 40 LP patients (14.59%) presented genital lesions. Of 131 patients with cutaneous LP (47.8%), the most commonly affected zones were the body’s flexor surfaces, representing 60.1% of cases. 24% of patients (n=55) related the start of the lesions with previous stress events. Of the 131 subjects with cutaneous lesions, 19% (n=25) also presented oral lichen planus (OLP). Of the total sample, 53.6% (n=147) of patients presented oral lesions. The systemic diseases most commonly associated with this patient sample were psychological problems such as stress, anxiety and depression (48%), hypertension (27%), gastric problems (12%), and diabetes (9.7%). A family history of lichen planus was found in only 2 cases (0,72%) out of the total of 274. Conclusions: Any patient with OLP should undergo a thorough history and examination to investigate potential extraoral manifestations. The fact that 37 patients with OLP in this series were identified with simultaneous involvement at more than one site highlights the need for exhaustive evaluation and multidisciplinary approaches to this disease

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Oral lichen planus and its relationship with systemic diseases. A review of evidence.

BACKGROUND: Oral lichen planus (OLP) is one of the most common dermatological diseases which are present in the oral cavity. It is a chronic autoimmune, mucocutaneous disease that affects the oral mucosa as well as the skin, genital mucosa and other sites. OBJECTIVE: Review the relevant information to OLP and its relationship with systemic diseases. MATERIAL AND METHODS: Searches were carried out in the Medline/PubMed, Lilacs, Bireme, BVS, and SciELO databases by using key-words. After an initial search that provided us with 243 papers, this number was reduced to 78 from the last seven years. One of the first criteria adopted was a selective reading of the abstracts of articles for the elimination of publications that presented less information regarding the subject proposed for this work. All the selected articles were read in their entirety by all of the authors, who came to a consensus about their level of evidence. The Scottish Intercollegiate Guidelines Network (SIGN) criteria were used as the criteria of methodological validation. RESULTS: Only 9 articles showed an evidence level of 1+, 2+, 3 or 4, as well as a recommendation level of A, B, C or D. Three of them were non-systematic reviews, one was a cohort study and only one was a controlled clinical trial. Three of the studies were case series, with respective sample sizes of 45, 171 and 633 patients. CONCLUSIONS: Several factors have been associated with OLP. Patients with OLP are carriers of a disease with systemic implications and may need the care of a multidisciplinary team. The correct diagnosis of any pathology is critical to making effective treatment and minimizes iatrogenic harm. For OLP is no different, taking into account its association with numerous systemic diseases that require special attention from health professionals. Periodic follow-up of all patients with OLP is recommended. Key words:Oral lichen planus, etiopathogenesis, systemic diseases.

Boca seca, mal aliento y síndrome de boca ardiente. Actualización / Dry mouth, breath malodour and burning mouth syndrome. Update

La xerostomía o boca seca como síntoma y la hiposialia como signo, afecta a la calidad de vida de muchos pacientes y no siempre es diagnostica y tratada de manera adecuada. Sabemos que el síndrome de boca seca es muy frecuente en la población adulta. En recientes estudios, se afirma que el 30% de la población mayor de 65 años la sufre, y en nuestro país esta cifra supone más de 1,5 millones de personas afectadas con un crecimiento casi exponencial en las próximas décadas. Puede estar producido, entre otras causas, por enfermedades sistémicas y tratamientos oncológicos, destacando de manera especial el consumo de medicamentos. La disminución de saliva se encuentra íntimamente relacionada con dos cuadros frecuentes en patología oral, la halitosis y el síndrome de boca ardiente. En el presente monográfico que refleja los resultados de un seminario realizado en la universidad de Barcelona con la colaboración de la empresa Biocosmetics, se actualizan, en primer lugar, los aspectos más relevantes de la boca seca y de la boca ardiente. Después se incide de manera detallada en la etiopatogenia y diagnóstico de la boca seca, la patología oral asociada a la xerostomía y finalmente se actualiza su tratamiento. A continuación se revisa el tratamiento del síndrome de boca ardiente. En una tercera etapa se repasa la etiopatogenia de la halitosis haciendo especial hincapié en la importancia de los compuestos sulfurados y de la cubierta lingual y se actualizan los aspectos terapéuticos. Finalmente se presenta por la doctora Margarita Martín un trabajo que nos repasa de manera específica la xerostomía postradioterapia y nos presenta los resultados de un ensayo clínico en pacientes irradiados que tiene como base el tratamiento con un producto a base aceite de oliva, betaína y xilitol (AU)

Xerostomia or dry mouth as a symptom and hyposalivation as a sign affects the quality of life of many patients and it is not always diagnosed and treated adequately. We know that the dry mouth syndrome is very frequent in the adult population. in recent studies it has been shown that 30% of the population over 65 years suffers from it, and in our country this figure represents more than 1.5 million affected people, with an almost exponential growth in the coming decades. It can be produced, among other causes, due to systemic diseases and cancer treatments, emphasizing especially on the consumption of medicines. The decrease in saliva is found closely related to two common forms in oral pathology, halitosis and the burning mouth syndrome. In the present monographic which reflects the results of a seminar held at the university of Barcelona in collaboration with the company Biocosmetics, the most relevant aspects of dry mouth and burning mouth were updated first of all. Afterwards, a detailed account of the etiopathogenesis and diagnosis of dry mouth, oral pathology associated with xerostomia and finally its treatment, were updated. In continuation, the treatment of the burning mouth syndrome was reviewed. In a third stage, the etiopathogenesis of halitosis with particular emphasis on the importance of sulphur compounds and of the lingual cover were reviewed and the therapeutic aspects were updated. Finally Dr. Margarita Martín presented her work specifically reviewing xerostomia post-radiotherapy and presented the results of a clinical trial in irradiated patients which is based on treatment with a product containing olive oil, betaine and xylitol (AU)

Lepromatous leprosy: a review and case report.

Leprosy is a contagious and chronic systemic granulomatous disease caused by Mycobacterium leprae (Hansen s bacillus). It is transmitted from person to person and has a long incubation period (between two and six years). The disease presents polar clinical forms (the multibacillary lepromatous leprosy and the paucibacillary tuberculoid leprosy), as well as other intermediate forms with hybrid characteristics. Oral manifestations usually appear in lepromatous leprosy and occur in 20-60% of cases. They may take the form of multiple nodules (lepromas) that progress to necrosis and ulceration. The ulcers are slow to heal, and produce atrophic scarring or even tissue destruction. The lesions are usually located on the hard and soft palate, in the uvula, on the underside of the tongue, and on the lips and gums. There may also be destruction of the anterior maxilla and loss of teeth. The diagnosis, based on clinical suspicion, is confirmed through bacteriological and histopathological analyses, as well as by means of the lepromin test (intradermal reaction that is usually negative in lepromatous leprosy form and positive in the tuberculoid form). The differential diagnosis includes systemic lupus erythematosus, sarcoidosis, cutaneous leishmaniasis and other skin diseases, tertiary syphilis, lymphomas, systemic mycosis, traumatic lesions and malignant neoplasias, among other disorders. Treatment is difficult as it must be continued for long periods, requires several drugs with adverse effects and proves very expensive, particularly for less developed countries. The most commonly used drugs are dapsone, rifampicin and clofazimine. Quinolones, such as ofloxacin and pefloxacin, as well as some macrolides, such as clarithromycin and minocyclin, are also effective. The present case report describes a patient with lepromatous leprosy acquired within a contagious family setting during childhood and adolescence.

Buccodental health and oral mucositis. Clinical study in patients with hematological diseases.

OBJECTIVES: The objective of the present study is to assess whether a good buccodental status (evaluated by means of dentogingival indices), is associated with a lower incidence and severity of oral mucositis in patients with hematological diseases who receive treatment with chemotherapy or bone marrow transplant. STUDY DESIGN: The study was carried out on 97 patients admitted to the Hematology Service of the Hospital Duran y Reynals in Barcelona during 2002-2003. These patients received treatment with chemotherapy or conditioning prior to bone marrow transplant. A descriptive study was made, analyzing oral hygiene, one dental index, and two gingivales indices, and evaluating their relationship with the appearance of mucositis. RESULTS: The patients with high plaque (PI) and gingival (GI) indices during chemotherapy presented a higher percentage of mucositis (77.4% and 65.7% respectively) against those who had little or no visible plaque. In the case of the PI, the differences were statistically significant (p=0.015). Likewise, patients who brushed their teeth 3 times/day presented mucositis in only 26.7% of cases, against those who did not brush, or brushed only once a day (65.9% and 68.4%), these differences also being statistically significant (p=0.013). The CAO showed similar results in patients with or without mucositis (7.59 and 7.03 respectively). CONCLUSIONS: In our study, a good gingival status as well as good oral hygiene during chemoradiotherapy is associated with a lower incidence and severity of mucositis.

Association of burning mouth syndrome with xerostomia and medicines.

OBJECTIVE: A case control study to identify risk factors for burning mouth syndrome (BMS). MATERIAL AND METHODS: Quantitative analysis was carried out on the total salivary flow at rest and stimulated; subjective xerostomia, ingestion of medicines and the psychological states of anxiety and depression in 40 patients with BMS and 40 controls. RESULTS: The ANOVA analysis showed significant differences in the means of the number of medicines/day, number of xerostomising agents/day, subjective xerostomia, anxiety and depression, between the groups studied. No significant differences were seen in the at rest or stimulated saliva flow rates. The odds ratio analysis determined the association of BMS with xerostomia and the consumption of hypotensives and diuretics. CONCLUSIONS: From the results of this study, it can be shown that the consumption of hypotensives and diuretics was a risk factor for the development of BMS. The function of the salivary glands in patients with BMS is not affected.