Current controversies in oral lichen planus: report of an international consensus meeting. Part 2. Clinical management and malignant transformation.

Despite recent advances in understanding the immunopathogenesis of oral lichen planus (LP), the initial triggers of lesion formation and the essential pathogenic pathways are unknown. It is therefore not surprising that the clinical management of oral LP poses considerable difficulties to the dermatologist and the oral physician. A consensus meeting was held in France in March 2003 to discuss the most controversial aspects of oral LP. Part 1 of the meeting report focused on (1) the relationship between oral LP and viral infection, with special emphasis on hepatitis C virus (HCV), and (2) oral LP pathogenesis, in particular the immune mechanisms resulting in lymphocyte infiltration and keratinocyte apoptosis. Part 2 focuses on patient management and therapeutic approaches and includes discussion on malignant transformation of oral LP.     

Familial oral lichen planus: presentation of six families.

OBJECTIVE: To present a series of 13 different cases of oral lichen planus (OLP) in 6 different families. STUDY DESIGN: From 249 lichen planus cases, we found 13 that could be considered to be family related. A study of these 13 cases of OLP was carried out across the various generations, and the means of presentation, placement, and injuries were studied, as well as signs and symptoms. RESULTS: The predominant affectation was in the women; only 2 patients were male. The mothers showed predominance toward erythematous OLP with greater symptoms, and in their children, symptom-free white OLP was predominant. CONCLUSIONS: It seems there may be some genetic predisposition toward OLP.     

Clinical and immunopathologic findings in oral lichen planus pemphigoides.

Lichen planus pemphigoides (LPP) is a rare, acquired, immunobullous disorder of skin that occasionally involves oral mucous membranes. Clinical, histologic, and immunopathologic findings of the oral manifestations of LPP are described. Clinical features are lichenoid striae, erosions, and ulcerations involving gingiva and buccal mucosae. Histopathologic features are similar to those of ora lichen planus. Direct immunofluorescence demonstrates linear deposits of immunoglobulin G and complement component C3 along the basement membrane with fibrillar deposits of fibrin at the epithelial/lamina propria junction. Fluorescence overlay antigen mapping and laser scanning confocal microscopy of the biopsy specimen exhibits colocalization of in situ antibodies with beta4 integrin, a marker of the keratinocyte basal plasma membrane and upper lamina lucida, consistent with the location of the bullous pemphigoid antigens. This case report describes a case of LPP that presented exclusively as an oral condition. Lichen planus pemphigoides should be considered in the clinical differential diagnosis of vesiculoerosive oral mucosal diseases.     

Study of microcirculation in oral lichen planus by video-capillaroscopy.

OBJECTIVE: The aim of this study was to evaluate "in vivo" the oral microcirculatory characteristics in patients with oral lichen planus (OLP) and to discover any differences in microcirculation in comparison with healthy patients. STUDY DESIGN: Twenty patients with established diagnosis of OLP and 20 healthy patients were examined in our laboratory by means of contact optical probe videocapillaroscopy. The examined areas for each patient were the right and the left buccal mucosae. Capillary density and total capillary diameter, as well as afferent and efferent loop diameter were studied; the discovery of characteristic (tortuous, branched) loops was also investigated. RESULTS: The results were observed by 2 different researchers using the capillaroscope's software. Capillary density and the diameter of the afferent and efferent ansa were found to be significantly increased in OLP patients compared with controls. There was also a significant difference between the study of capillary tortuousity and the discovery of characteristic branched loops, indicating angiogenesis. CONCLUSIONS: Our methodology allowed an in vivo observation of the angiogenesis. Angiogenesis was interpreted as an increase in capillary density, total vascular caliber, and afferent and efferent loop caliber; the discovery of tortuous, branched loops, indicating the angiogenic phenomenon in vivo, was particularly significant. The capillaroscopy in correspondence with the lesion can be a very important method in the evaluation of the microcirculation of the patients suffering from OLP.     

胰腺癌外科治疗现状:争议与共识

现阶段胰腺癌的外科治疗,虽有共识但更有争议,也存在一些正在探索中的问题。手术技术的进步、新的有效药物的出现、更为严谨的临床研究的开展、治疗模式的优化以及观念的更新,是促成胰腺癌外科治疗取得突破性进展的重要因素。     

Prevalence of oral lichen planus in Brazilian patients with HCV infection.

OBJECTIVE: The objective of this investigation was to assess the prevalence of oral lichen planus (OLP) in Brazilian patients infected with hepatitis C virus (HCV) from the state of Rio de Janeiro. STUDY DESIGN: The study group consisted of 134 patients with HCV infection. The control group consisted of 95 individuals. All patients were physically examined for evidence of OLP. The diagnosis of OLP was established on the basis of usual clinical features and histological findings. RESULTS: The prevalence of OLP was 1.5% in patients with HCV infection and 1.1% in the control group. There was no statistically significant difference between the 2 groups (P = .63). CONCLUSION: Our findings indicate that there is no association between OLP and HCV infection in Brazilian patients from the state of Rio de Janeiro.     

Tacrolimus powder in Orabase 0.1% for the treatment of oral lichen planus and oral lichenoid lesions: an open clinical trial.

OBJECTIVES: The aim of our study was to evaluate the clinical efficacy and safety profile of a novel compound, Tacrolimus powder in Orabase 0.1% in patients with LP and LL. STUDY DESIGN: Seven patients with LP and 3 with LL were asked to participate. All patients received a 1 week treatment of Fluconazole, prior to entering the study, and on follow up visit were provided with a 15 g container of the study medication. Patients were asked to treat the most symptomatic site, three times a day for two weeks. RESULTS: Disease control (signs) was achieved in most patients by the end of two weeks (from 1.58 to 0.55); all patients experienced a high degree of discomfort (pain) at baseline, which dropped quickly by the end of the second week of treatment (from 1.95 to 0.45); none developed yeast during the course of treatment. Recurrent headaches were reported by one patient with erosive LP, and transient burning by a patient with reticular LP. CONCLUSIONS: Tacrolimus powder in Orabase 0.1% appears to have a relatively safe profile, and represents a likely alternative to topical steroids in the treatment of LP and LL, especially in those at risk for oral candidiasis.     

Esophageal lichen planus: case report and review of the literature

Involvement of the esophagus by lichen planus is a rarely reported condition. The histologic features of esophageal lichen planus, which may differ from those of cutaneous disease, have only rarely been illustrated. We describe a 58-year-old woman with skin and oral lichen planus who presented with dysphagia and an esophageal stricture that were ultimately diagnosed as esophageal lichen planus. Multiple esophageal biopsies demonstrated a lichenoid, T cell-rich lymphocytic infiltrate, along with degeneration of the basal epithelium and Civatte bodies. Correct diagnosis of esophageal lichen planus is critical because of its prognostic and therapeutic distinction from other more common causes of esophagitis and stricture formation.     

A comparative treatment study of topical tacrolimus and clobetasol in oral lichen planus.

BACKGROUND: Existing clinical trials have shown that topical corticosteroids are often effective in the management of oral lichen planus (OLP). However, tacrolimus has recently been shown to be an effective treatment of OLP. OBJECTIVE: To compare the effectiveness of clobetasol and tacrolimus in the topical management of OLP. STUDY DESIGN: In this randomized comparative double-blind study, 30 consecutive patients with oral lesions consistent clinically and histologically with OLP were recruited.The patients were divided into 2 groups to receive clobetasol 0.05% or tacrolimus 0.1% ointment and were treated for 6 weeks. RESULTS: The profiles of mean lesion sizes and mean pain measures did not differ between the tacrolimus and clobetasol treatment groups. CONCLUSION: We found tacrolimus to be as useful as clobetasol in treatment of OLP. We believe that up-to-date evidence indicates the effectiveness of tacrolimus in treating OLP.     

Behavior of oral squamous cell carcinoma in subjects with prior lichen planus.

OBJECTIVE: To characterize the clinical behavior of oral squamous cell carcinomas (OSCCA) arising in patients with pre-existing oral lichen planus (OLP). STUDY DESIGN AND SETTING: Retrospective case-control study. Disease-free interval, time to first recurrence, subsequent therapy, and overall survival were calculated and compared between cases and controls matched for age, gender, primary site, and tumor stage. RESULTS: In 10 identified subjects with OLP/OSCCA, mean time from OLP diagnosis to OSCCA was 5.5 years. Three subjects suffered a local recurrence and two developed a second primary OSCCA. Mean actuarial survival for OLP patients was 119 months vs 42 months for the control patients, though this difference was not significant (P = 0.201, log-rank). CONCLUSIONS: OLP/SCCA subjects may exhibit better actuarial survival than SCCA patients despite a somewhat higher rate of local recurrence and second primary SCCA. Further study is required to characterize the behavior of OSCCA arising in pre-existing OLP.     

Shouldice standard 2020: review of the current literature and results of an international consensus meeting

Hernia - For many years the Shouldice technique was the gold standard for inguinal hernia repair. Nowadays mesh repair has been proven to entail better results in randomized trials. Since the first...     

Validation of instruments to measure the symptoms and signs of oral lichen planus.

OBJECTIVE: The aim of this study was to validate the visual analog scale (VAS), numeric rating scale (NRS), and change in symptoms scale (CSS) in measuring symptoms of oral lichen planus, and the modified oral mucositis index (MOMI) in measuring the signs of oral lichen planus. STUDY DESIGN: Criterion validity, construct validity, and internal consistency reliability were evaluated using data from a randomized, double blind, placebo-controlled clinical trial of curcuminoids in oral lichen planus. RESULTS: Moderate to high correlations were found between VAS, NRS, and CSS. Correlations of symptom scores with clinical signs ranged from minimal to high. Correlation of NRS with clinical signs was stronger than that of VAS with clinical signs. Significant changes from baseline at each follow-up in NRS, VAS, and MOMI scores were seen. The Cronbach alpha for erythema and ulceration scores from the MOMI were 0.66. CONCLUSIONS: This study gives some evidence of the validity of NRS, VAS, CSS, and MOMI for use in oral lichen planus. The NRS has better construct validity than VAS, based on higher correlations with clinical signs. Erythema plus ulceration is a better measure than ulceration alone.     

判定药物治疗ED的疗效标准:国际专家组看法一致的研讨报告

评价和讨论一个国际专家组发表了ED治疗结果的定义和分类。专家组推荐采用“治疗效果”模型,该模型结合了安全性和效能的传统结果,以及患者和性伴侣的满意度(治疗满意度)。这四个方面可概念化为在两个层面(反应,满意度)上是相互作用的。建议的模型是预期患者对治疗方法优先选择     

判定药物治疗ED的疗效标准:国际专家组看法一致的研讨报告

治疗满意度治疗满意度可定义为：某一特定治疗所产生效能与患者及其性伴侣所期待的结果相符或超过的程度。这种程度的变异属于内在主观性,只能用随访或提问式自我报告来评估(如勃起功能障碍治疗满意度指标)。专家组一致同意如下两种说法：     

判定药物治疗ED的疗效标准:国际专家组看法一致的研讨报告

概念框架为评估ED的治疗效果,专家提出了一种全新的概念框架,它包括以下两个方面:·治疗反应:它是从药理学的角度(即药物反应的角度)进行了解,包括治疗功效和耐受性(药物的副作用)两方面。这些疗效一般由患者自报作为阴茎勃起在硬度上客观的、生理性变化的替代目标“。疗效指数     

New clinical approach for use of Er:YAG laser in the surgical treatment of oral lichen planus: a report of two cases

The aim of this clinical report is to demonstrate the efficiency of Er:YAG laser in reducing symptoms and lymphoplasmocytic infiltrate in case of oral lichen planus (OLP). In addition to medical therapy and conventional surgery, laser has been proposed for the treatment of this disease, but currently, use of Er:YAG laser (2940 nm) has not been reported. Two clinical cases of female patients who came to our clinic with lesions in the internal portion of the cheek and in the hard palate mucosa close to the upper right molars, surgically treated by Er:YAG laser, are described. The parameters used were as follows: energy, 80-120 mJ; frequency, 6-15 Hz; non-contact hand piece; spot size diameter, 0.9 mm; pulse duration, 100 μsec (VSP) to 300 μsec (SP) ; fluences, 12.6-18.9 J/cm(2); and air/water spray (ratio: 6/5). In the two patients, the peeling of the lesions was completed with much less discomfort (<25% in visual analogue scale). A very small recurrence was observed in one case (cheeks) after 15 months, and the same protocol was applied successfully. The use of this wavelength offers several advantages including, a good and fast healing process, a very low level of discomfort during and after intervention, and a rapid disappearance of symptoms. Even if this methodology seems to be an interesting new surgical approach in the management of non-erosive OLP, this clinical report has to be considered as a preliminary one because of the limited number of cases. As a consequence, further studies and long-term follow-up will be necessary.