Acquired White Oral Lesions with Specific Patterns: Oral Lichen Planus and Lupus Erythematosus

Background: Diagnosis of oral white lesions might be challenging. These lesions represent a wide spectrum of diseases with different etiology and prognosis. Oral white lesions can be categorized into two major groups, congenital and acquired, according to their development, and in four subgroups: lesions which can be scraped off or not and lesions with special pattern or not. Objectives: The aim of this manuscript is to review, from diagnosis to treatment, the current knowledge on oral white lesions with specific pattern. Methods: A review on oral white lesions with specific pattern was conducted on PubMed and Scopus from inception to January 2021. Results: Among acquired lesions with specific pattern two clinical entities are mostly represented: Oral lichenoid reactions and Lupus erythematosus. The etiology of both diseases is still not known but their pathogenesis is mainly immunological. At present the mucoscopic features of those disease have been described only in few case reports or case series. Immunomodulatory therapies are often the agents of choice for their treatment. Conclusions: The collaboration of dermatologists and dentists as a team is important for early diagnoses and effective treatments. Mucoscopy is a promising technique which may reveal important features for the differentiation of OLP and LE oral white lesions.

Dyskeratosis Congenita: Squamous Cell Carcinoma of the Buccal Mucosa on a Background of Lichen Planus – A Case Report During COVID-19 Pandemic

Dyskeratosis Congenita is a severe disorder that involves several systems in the human body and is well-known for its transmission hereditarily through generations. The triad of a) reticular atrophy of the skin with pigmentation b) dystrophy of the nails c) leukoplakia of the oral mucosa characterises this uncommon disorder, which most commonly affects men. One of the key reasons for premature death in this disease is malignant transformation within areas of mucosal hyperkeratosis. In Dyskeratosis Congenita, the simultaneous existence of squamous cell carcinoma (SCC) with lichen planus and or lichenoid reactions in the mucosa of the oral cavity is a rare, stated condition. This report discusses a case of a Libyan male patient affected by Dyskeratosis Congenita that ended with buccal mucosal squamous cell carcinoma developed on a lichen planus background after thirty years of suffering at the age of 64.

Cutaneous Manifestations in Biological-Treated Inflammatory Bowel Disease Patients: A Narrative Review

The biologic era has greatly improved the treatment of Crohn’s disease and ulcerative colitis. Biologics can however induce a wide variety of skin eruptions, especially those targeting the TNF-α and Th17 pathway. These include infusion reactions, eczema, psoriasis, lupus, alopecia areata, vitiligo, lichenoid reactions, granulomatous disorders, vasculitis, skin cancer, and cutaneous infections. It is important to recognize these conditions as treatment-induced adverse reactions and adapt the treatment strategy accordingly. Some conditions can be treated topically while others require cessation or switch of the biological therapy. TNF-α antagonists have the highest rate adverse skin eruptions followed by ustekinumab and anti-integrin receptor blockers. In this review, we provide an overview of the most common skin eruptions which can be encountered in clinical practice when treating IBD (Inflammatory bowel disease) patients and propose a therapeutic approach for each condition.

The Clinical and Histopathological Features of Cutaneous Immune-Related Adverse Events and Their Outcomes

Immune checkpoint inhibitors (ICIs) cause a variety of inflammatory eruptions. The understanding of ICI-induced inflammatory eruptions with detailed histopathological findings is not adequate, particularly in Asian populations. In this study, we retrospectively reviewed 51 patients who were histopathologically diagnosed with cutaneous immune-related adverse events (irAEs) following ICI therapy between 2014 and 2020 at the Department of Dermatology of Kyushu University Hospital. Of the 51 patients (30 men, 21 women), maculopapular rash (38/51, 74.5%), erythema multiforme (2/51, 3.9%), lichenoid reaction (3/51, 5.9%), psoriasiform reaction (3/51, 5.9%), bullous pemphigoid (3/51, 5.9%), scleroderma-like reaction (1/51, 2.0%), and Stevens–Johnson syndrome (1/51, 2.0%) were observed. The clinical and histopathological findings of these eruptions were equivalent to typical cases of common drug eruptions. The onset of maculopapular rash was relatively early (more than half of events occurred within 1 month), whereas lichenoid reactions and autoimmune diseases occurred relatively late (4–8 months). With appropriate treatment and/or interruption of ICIs, most rashes improved (50/51, 98.0%). The ICI-induced inflammatory eruptions shared similar clinical and histopathological features with classical inflammatory eruptions, but a variety of inflammatory eruptions may occur with different degrees of severity. Dermatologists play an important role in providing specialized care for cutaneous irAEs.

Effects of chemotherapy on oral mucosa

Cancer leads to several oral and dental complications arise during the course of a malignant condition, oral or non-oral. These are largely due to the direct effect of cancer but may also result from the complication of treatment modality undertaken to cure the malignancy. This article elaborates on complications of the chemotherapeutic agents, which when employed to combat cancerous cells, may target the host cells. The oral complications of such a therapy results in several conditions like oral mucositis, infections, hemorrhage, salivary alterations, dysgeusia, lichenoid reactions amongst others. Thus, an in-depth understanding of these complications is a must in order to provide better care for an already frail and ailing patient.

Adverse Oral Reactions Associated with Low Doses of Methotrexate

Doctors of various medical specialties often encounter adverse drug reactions in their clinical practice. Methotrexate (MTX) can cause adverse reactions in the oral cavity, primarily erosions and ulcerations. The aim of the study was to analyse scientific literature on the prevalence, pathophysiological mechanisms, risk factors for oral lesions associated with low doses of MTX, their prevention and treatment. It was demonstrated that the most frequent oral adverse reactions associated with low doses of MTX are hard-to-heal painful necrotic and often irregularly shaped lesions of the oral mucosa (including aphthae and ulcers). The spectrum of histopathological changes ranges from nonspecific ulcerations to lichenoid reactions. Treatment of oral lesions induced by low doses of MTX consists in drug withdrawal or dose tapering. Folic acid and local symptomatic therapy can also be used, if necessary. Practitioners should be aware of the potential development of MTX-induced oral lesions, and specific aspects of the drug pharmacokinetics and pharmacodynamics in order to be able to ensure timely detection of adverse reactions and their effective treatment.

Clinical Study of Patients with Oral Lichenoid Processes Attending Khanzad Specialized Teaching Center and Erbil Dermatology Teaching Center

Background: Lichen planus is a common chronic inflammatory disease of the skin and mucous membranes. Oral Lichenoid Reactions (OLRs) comprise a group of lesions with different causative factors such as systemic medication, dental restorative materials, foods, or flavoring agents. Pathologists often group these conditions under the umbrella term of ‘lichenoid processes’. Objective: To provide prevalence and demographic distribution of Oral Lichen Planus (OLP) and OLR among a sample of patients. Patients and Methods: This cross-sectional study was conducted in the Khanzad Teaching Center and Erbil Dermatology Teaching Center. The diagnosis of patients with OLP and OLR were suspected clinically and histopathologically confirmed. Eighty patients of OLP and OLR have been enrolled from both centers. Detailed case histories and clinical presentations were recorded through a questionnaire. Results: Among those patients, 60 (75.0%) were diagnosed as OLP, and 20 (25.0%) patients diagnosed as OLR. Their mean age ± SD was 49.01 ± 11.22 years. Bilateral buccal mucosa (83.8%) was the most affected sites in both groups. The most common clinical types were reticular (90%), and erosive (33.8%). Only 7 patients (8.8%) had an associated skin lichen planus (SLP). Conclusion: The present study revealed that the buccal mucosa was the most affected site, followed by the tongue and palate. The reticular type was the most common affected type followed by the erosive type. Keywords: Oral lichenoid processes, oral lichen planus, oral lichenoid reactions, skin lichen planus