Can We Separate Oral Lichen Planus from Allergic Contact Dermatitis and Should We Patch Test? A Systematic Review of Chronic Oral Lichenoid Lesions

Background: Oral lichenoid lesions (OLLs) resemble oral lichen planus (OLP) but develop secondary to various underlying causes. The role of contact allergy in precipitating and/or perpetuating OLL is well documented but remains controversial. Objective: To help elucidate the association of contact allergy and OLL, we reviewed patch-test readings in patients diagnosed with OLP-like lesions. Methods: We retrospectively reviewed patients diagnosed with OLP-like lesions who had patch tests performed between January 1, 2006, and December 31, 2007. Results: Patch tests were performed on 24 patients with a histopathologic and/or clinical diagnosis of OLP. Of these, 16 (67%) had positive patch-test readings. At least eight (50%) of these patients had clinically relevant reactions. Ten of the 16 patients (63%) had reactions to metals. In most of these patients, troublesome areas tended to localize adjacent to metallic dental restorations. Of the nine patients (56%) who had reactions to fragrances, flavorings, gallates, and/or diallyl disulfide, the majority improved after avoiding these allergens. Conclusion: Our findings support the notion that contact allergy may underlie the pathogenesis of OLL and that allergen avoidance may result in amelioration of disease.

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Descoberta de carcinoma de células escamosas em lesão previamente diagnosticada como líquen plano oral: malignização ou erro de diagnóstico inicial?

ARCHIVES OF HEALTH INVESTIGATION ◽

10.21270/archi.v8i4.3296 ◽

2019 ◽

Vol 8 (4) ◽

Author(s):

Adriana Caroline Leite ◽

Nathalia Torres Assay ◽

Fabio Augusto Ito ◽

Heliton Gustavo de Lima ◽

Ademar Takahama Junior

Keyword(s):

Systematic Review ◽

Retrospective Study ◽

Malignant Transformation ◽

Lichen Planus ◽

Clinical Management ◽

Oral Lichen Planus ◽

Oxidative Dna Damage ◽

Malignant Potential ◽

Oral Lichenoid Lesions ◽

Oral Lichen

O Líquen Plano Oral (LPO) é uma doença crônica imunologicamente mediada com potencial de malignização incerto. O objetivo desse artigo é relatar um caso de Carcinoma de Células Escamosas (CCE) diagnosticado em paciente com diagnóstico prévio de LPO. Paciente do sexo feminino, 69 anos, foi atendida durante uma campanha de diagnóstico precoce de câncer de boca realizada na cidade de Londrina/PR, sendo detectada uma lesão eritroplásica em língua e encaminhada para uma melhor avaliação. Na anamnese a paciente relatou que há 2 anos atrás foi diagnosticada com LPO através de biópsia em língua, não sendo proposto nenhum tratamento. Ao exame físico, observamos uma mancha eritematosa em borda lateral de língua do lado esquerdo, não apresentando nenhuma outra lesão na cavidade oral. Com a hipótese diagnóstica de eritroplasia, foi requisitada a lâmina da biópsia anterior para análise, que revelou características microscópicas incompatíveis com o diagnóstico de LPO. Optamos então por realizar uma nova biópsia e a análise histopatológica revelou ilhas de células epiteliais malignas invadindo o tecido conjuntivo, estabelecendo o diagnóstico de CCE. A paciente foi encaminhada para tratamento, sendo realizada glossectomia parcial. Em acompanhamento de 6 meses a paciente encontra-se bem e sem sinais de recidiva. A transformação maligna do LPO ainda é discutida na literatura e muitos casos relatados podem se tratar de erro no diagnóstico inicial, como no caso apresentado. O erro de diagnóstico pode levar a morbidades importantes e comprometer o prognóstico do caso.Descritores: Diagnóstico; Líquen Plano; Carcinoma de Células Escamosas.ReferênciasGiuliani M, Troiano G, Cordaro M, Corsalini M, Gioco G, Lo Muzio L et al. Rate of malignant transformation of Oral Lichen Planus: a systematic review. Oral Dis. 2019; 25(3):693-709.Bardellini E, Amadori F, Flocchini P, Bonadeo S, Majorana A. Clinicopathological features and malignant transformation of oral lichen planus: a 12-years retrospective study. Acta Odontologica Scandinavica 2013;71(3/4):834-40.Eisen D. The clinical features, malignant potential, and systemic associations of oral lichen planus: a study of 723 patients. J Am Acad Dermatol. 2002;46(2):207-14.Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies. Clin Dermatol. 2010;28(1):100-8.Roopashree MR, Gondhalekar RV, Shashikanth MC, George J, Thippeswamy SH, Shukla A. Pathogenesis of oral lichen planus – a review. J Oral Pathol Med. 2010;39(10):729-34.van der Meij EH, van der Waal I. Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications. J Oral Pathol Med. 2003;32(9):507-12.Kramer IR, Lucas RB, Pindborg JJ, Sobin LH. Definition of leukoplakia and related lesions: an aid to studies on oral precancer. Oral Surg Oral Med Oral Pathol. 1978;46(4):518-39.Aghbari SMH, Abushouk AI, Attia A, Elmaraezy A, Menshawy A, Ahmed MS et al. Malignant transformation of oral lichen planus and oral lichenoid lesions: a meta-analysis of 20095 patient data. Oral Oncology. 2017;68:92-102.Eisenberg E. Oral lichen planus:a benign lesion. J Oral Maxillofac Surg. 2000;58(11):1278-85. Alrashdan MS, Cirillo N, McCullough M. Oral lichen planus: a literature review and update. Arch Dermatol Res. 2016;308(8):539-51.Lodi G, Scully C, Carrozzo M, Griffiths M, Sugerman PB, Thongprasom K. Current controversies in oral lichen planus: report of an international consensus meeting. Part 2. Clinical management and malignant transformation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(2):164-78.Sousa FACG, Paradella TC, Brandão AAH, Rosa LEB. Líquen plano bucal versus displasia epitelial: dificuldades diagnósticas. Braz J Otorhinolaryngol. 2009;75(5):716-20.Rode M, Kogoj-Rode M. Malignant potential of the reticular form of oral lichen planus over a 25-year observation period in 55 patients from Slovenia. J Oral Sci. 2002;44(2):109-11.Van der Meij EH, Mast H, Van der Waal I. The possible premalignant character of oral lichen planus and oral lichenoid lesions: a prospective five-year followup study of 192 patients. Oral Oncol. 2007;43(8):742-48.Oliveira Alves MG, Almeida JD, Balducci I, Guimarães Cabral LA. Oral lichen planus: a retrospective study of 110 Brazilian patients. BMC Res Notes. 2010;3:157.Radochová V, Drˇízhal I, Slezák R. A retrospective study of 171 patients with oral lichen planus in the East Bohemia-Czech Republic–single center experience. J Clin Exp Dent. 2014;6(5):e556-61.Fitzpatrick S, Hirsch S, Gordon S. The malignant transformation of oral lichen planus and oral lichenoid lesions: a systematic review. J Am Dent Assoc. 2014;145(1):45-56.Bermejo-Fenoll A, Sánchez-Siles M, López-Jornet P, Camacho-Alonso F, Salazar-Sánchez N. A retrospective clinicopathological study of 550 patients with oral lichen planus in south-eastern Spain. J Oral Pathol Med. 2010;39(6):491-96.Chaiyarit P, Ma N, Hiraku Y, Pinlaor S, Yongvanit P, Jintakanon D et al. Nitrative and oxidative DNA damage in oral lichen planus in relation to human oral carcinogenesis. Cancer Sci. 2005;96:553-59.Georgakopoulou EA, Achtari MD, Achtaris M, Foukas PG, Kotsinas A. Oral lichen planus as a preneoplastic inflammatory model. J Biomed Biotechnol. 2012;2012:759626.Accurso BT, Warner BM, Knobloch TJ, Weghorst CM, Shumway BS, Allen CM et al. Allelic imbalance in oral lichen planus and assessment of its classification as a premalignant condition. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(3):359-66.

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Inter-Observer and Intra-Observer Variations in the Assessment of Epithelial Dysplasia in Oral Lichenoid Diseases

Dermatopathology ◽

10.3390/dermatopathology8020013 ◽

2021 ◽

Vol 8 (2) ◽

pp. 84-88

Author(s):

Marwa Zohdy ◽

Simone Cazzaniga ◽

Helga Nievergelt ◽

Roland Blum ◽

Valérie G. A. Suter ◽

...

Keyword(s):

Lichen Planus ◽

Oral Lichen Planus ◽

Epithelial Dysplasia ◽

Observer Variability ◽

Oral Lichenoid Lesions ◽

Inter Observer Variability ◽

Oral Lichen

Oral lichen planus (OLP) and oral lichenoid lesions (OLL) can both present with histological dysplasia. Despite the presence of WHO-defined criteria for the evaluation of epithelial dysplasia, its assessment is frequently subjective (inter-observer variability). The lack of reproducibility in the evaluation of dysplasia is even more complex in the presence of a lichenoid inflammation. We evaluated dysplasia in 112 oral biopsies with lichenoid inflammation in order to study the inter-observer and the intra-observer variability.

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