Avaliação da angiogênese em lesões de líquen plano oral e pênfigo vulgar

Oral lichen planus and pemphigus vulgaris are chronic diseases mucous membrane immune of unknown aetiology that can be observed affecting to the oral mucous. A relevant as regards neoplasies the role angiogenesis in the inflammatory chronic disease pathogenesis as it provides a substancial interest can be considered as being an activity diseases marker; besides being through specialised research of this angiogenic process to improve of understanding pathogenic mechanism. This research proposes to assess angiogenic active through of antibody immunohistochemistry expression antiCD34 antibody in 26 OLP of reticular cases, 14 OLP erosives cases, 18 of PV cases and 15 specimens of normal oral mucosa. The result was submitted non-parametric tests of 5% significance level. It is not statistically significant correlacion was seen regarding between average vessels. However, only be effectively observed the median of OLP cases was larger than pemphigus vulgaris in fact proved average larger than oral normal mucosa (p=0,280). Regarding the microvascular count of CD34 concerning clinic form oral lichen planus (reticular and erosion) increased emphasis is more cross-border average for the form erosion clinic. Despite of the statistic tests could not be more effective (p=0,720). Even though, the results of the research is not sufficient to enable to consider of angiogenic process in the pathogenesis and lesions progression of oral lichen planus and pemphigus vulgaris, we suggest this process is present in both forms lesion, however, more studies must be made in the near future in order to prepare a well-founded proposal

Oral lichen planus versus oral lichenoid reaction: Difficulties in the diagnosis

Lichen planus (LP) is a mucocutaneous disease with well-established clinical and microscopic features. The oral mucosa and skin may present clinical and microscopic alterations similar to those observed in LP, called lichenoid reactions (LRs), which are triggered by systemic or topical etiological agents. The difficulties faced to establish the differential diagnosis between the two pathologies were investigated in the literature. It was observed that the etiology of LP is still under discussion, with a tendency to self-immunity, while the etiology of LRs is related to the contact with specific agents, such as metallic restorative materials, resins, and drugs, allowing the establishment of a cause-effect relationship. In this case, the disease is caused by the antigen fixation in the epithelial cells, which are destructed by the immune system. Based on these data, protocols are suggested for this differentiation. The important role played by the integration between the clinician and the oral pathologist in the diagnostic process is highlighted. The treatment of LP comprises mainly the utilization of corticosteroids and the LR is treated by removal of the causal factor. Differentiation between the two diseases allows an effective and correct therapeutic approach.

Low-level laser therapy on the treatment of oral and cutaneous pemphigus vulgaris: case report

Pemphigus vulgaris is a chronic autoimmune mucocutaneous disease that initially is manifested by painful intraoral erosions and ulcers which spread to other mucosa and the skin, generally more than 5 months after oral lesion manifestation. The treatment consists of prednisone alone or in combination with an immunosuppressive agent, and the clinical response is perceived within 2 to 4 weeks. Low-level laser therapy has been effective in accelerating the healing of injured tissue, thus inducing cell proliferation and increasing ATP, nucleic acid, and collagen synthesis. We reported two cases of pemphigus vulgaris that received systemic treatment associated with low-level laser therapy for oral and cutaneous lesions. We observed prompt analgesic effect in oral lesions and accelerated healing of oral and cutaneous wounds. Therefore, the present report suggests LLLT as a noninvasive technique that should be considered as an adjuvant therapy in oral and skin disorders in patients with PV.

Oral lichen planus: A retrospective study of 110 Brazilian patients

Background. Oral lichen planus (OLP) is a chronic autoimmune disease characterized by multiple clinical presentations and a relatively high prevalence in the population. This retrospective patient record study investigated the profile of OLP in a group of Brazilian patients seen between 1989 and 2009. Findings. The clinical records were analyzed and data such as gender, age, race, clinical presentation of OLP, site affected, presence of symptoms and extraoral manifestations of the disease, smoking habit, and consumption of alcoholic beverages were obtained. Among the 1822 records of patients with oral mucosal lesions, OLP was identified in 6.03%. Of these, 76.36% were females, with a mean age of 54 years, and 85% were whites. The reticular form was the most frequent (81.81%). Extraoral lesions were observed in 32.72% of the patients and painful symptoms were reported by 50.90%. The cheek mucosa was the site most affected (92.72%) and multiple oral lesions were observed in 77.27% of the patients. Among patients with OLP, 18.18% reported a smoking habit and 29.09% the consumption of alcoholic beverages. Conclusions. This retrospective study showed a relatively high prevalence of OLP in the population studied, with a predominance of the disease among middle-aged white women and bilateral involvement of the cheek mucosa. Reticular lesions were the most frequent, followed by the erosive form which is mainly associated with painful symptoms. No relationship with tobacco or alcohol consumption was observed. © 2010 Almeida et al; licensee BioMed Central Ltd.

Evaluation of the expression of p53, MDM2, and SUMO-1 in oral lichen planus

Objective: The objective of this study was to compare the expression of proteins p53, MDM2, and SUMO-1 in oral lichen planus (OLP) lesions, epithelial dysplasia, and squamous cell carcinoma. Materials and Methods: The sample consisted of the following five groups of cheek mucosa lesions: normal mucosa (NM), inflammatory fibrous hyperplasia (IFH), lichen planus, epithelial dysplasia, and squamous cell carcinoma. The tissue samples were stained with hematoxylin-eosin and submitted to immunohistochemistry using anti-p53, anti-MDM2, and anti-SUMO-1 antibodies. Results: The results of this study demonstrated similar expression of p53 and MDM2 between OLP, oral epithelial dysplasia and, to a lesser extent, between OLP and oral squamous cell carcinoma (OSCC). However, for SUMO-1 a similar expression was observed in OLP, NM, and IFH. Conclusions: The results demonstrated overexpression of important proteins (p53 and MDM2) related to regulatory mechanisms of apoptosis in OLP, suggesting that there is a favorable environment for malignant transformation. The expression of SUMO-1 in OLP was similar to NM and IFH, suggesting that alterations of this protein occur at later stages of carcinogenesis, because important overexpression occurred in oral epithelial dysplasia and OSCC. © 2013 John Wiley & Sons A/S.

Comparative analysis of cell proliferation ratio in oral lichen planus, epithelial dysplasia and oral squamous cell carcinoma

Background: Although oral lichen planus has been classified by the World Health Organization (WHO) as a potentially malignant disorder, such classification is still the target of much controversy. Aim: To evaluate the cell proliferation rate in oral lichen planus, comparing it to the rate observed in epithelial dysplasia and oral squamous cell carcinoma, aiming at indications which might indicate the potential for malignant transformation. Material and Methods: Twenty-four cases of each lesion were submitted to the streptoavidin-biotin and AgNOR technique to evaluate the immunohistochemical expression of PCNA and the mean NORs/ nucleus, respectively. Results: Positivity for PCNA was observed in 58.33% of oral lichen planus cases, 83.33% of epithelial dysplasia cases and 91.67% of oral squamous cell carcinoma cases. Chi-squared test showed that the number of positive cases for PCNA was significantly lower in oral lichen planus than in oral squamous cell carcinoma (p<0.05). No significant statistical difference between oral lichen planus and epithelial dysplasia (p>0.05) and between the epithelial dysplasia and oral squamous cell carcinoma (p>0.05) was observed. The mean NORs/ nucleus in oral lichen planus, epithelial dysplasia and oral squamous cell carcinoma were 1.74 +/- 0.32, 2.42 +/- 0.62 e 2.41 +/- 0.61, respectively. Variance analysis (ANOVA) revealed significant statistical difference between oral lichen planus and the other studied lesions (p<0.05). Conclusion: Oral lichen planus cell proliferation rate was less than in oral epithelial dysplasia and oral squamous cell carcinoma which might explain the lower malignant transformation rate.

Comparative analysis of the expression of proliferating cell nuclear antigen, p53, bax, and bcl-2 in oral lichen planus and oral squamous cell carcinoma

Several epidermiologic studies have shown the malignant transformation potential of oral lichen planus; however, this potential is subject of much controversy. To evaluate the expression of proteins related to the cell proliferation and apoptosis processes in oral lichen planus, we compared oral lichen planus with oral squamous cell carcinoma. Twenty-four cases of each lesion were submitted according to streptavidin-biotin technique to evaluate the immunohistochemical expression of proliferating cell nuclear antigen, p53, bax, and bcl-2 proteins. X 2 test showed no statistically significant differences between the expression of p53, bax, and bcl-2 in oral lichen planus and oral squamous cell carcinoma (P > .05). However, the expression of proliferating cell nuclear antigen was significantly lower in oral lichen planus than in oral squamous cell carcinoma (P < .05). No statistically significant differences between the expression of p53, bax, and bcl-2 in oral lichen planus and oral squamous cell carcinoma were observed, which may be an evidence of the potential of malignant transformation of oral lichen planus. (C) 2009 Elsevier B.V. All rights reserved.

Oral lichen planus versus epithelial dysplasia: difficulties in diagnosis

O diagnóstico histopatológico do líquen plano bucal não é fácil, pois alguns casos de displasia epitelial podem apresentar características bastante semelhantes às do líquen plano. OBJETIVO: Comparar as alterações celulares sugestivas de malignidade presentes no líquen plano bucal com as da displasia epitelial. MATERIAL E MÉTODOS: Cortes histológicos de líquen plano bucal e displasia, corados com hematoxilina-eosina, foram analisados por meio da microscopia de luz. RESULTADOS: A análise de variância (alfa=5%) revelou haver diferença estatisticamente significante entre o número médio de alterações celulares no líquen plano bucal (5,83±1,61) e na displasia epitelial (4,46±1,26). O teste de qui-quadrado não mostrou diferença estatisticamente significante entre o líquen plano bucal e a displasia epitelial em relação às seguintes alterações celulares: aumento da relação núcleo/citoplasma, hipercromatismo nuclear, distribuição irregular da cromatina e núcleos aumentados (p>0,05). CONCLUSÃO: Algumas alterações celulares sugestivas de malignidade presentes no líquen plano bucal também podem ser encontradas na displasia epitelial, dificultando o seu diagnóstico e, consequentemente enfatizando a importância do acompanhamento a longo prazo dos pacientes com a doença.

Immunohistochemical expression of PCNA, p53, bax and bcl-2 in oral lichen planus and epithelial dysplasia.

The potential for malignant transformation of oral lichen planus is still controversial. The expression of proteins related to cell proliferation and apoptosis in oral lichen planus and epithelial dysplasia was analyzed to evaluate the true potential for malignant transformation of this disease. Twenty-four cases of each lesion were subjected to the streptoavidin-biotin technique for identifying the immunohistochemical expression of PCNA, p53, bax, and bcl-2 proteins. Of the 24 cases of oral lichen planus, 14 (58.33%) were positive for PCNA, 10 (41.67%) for p53, 4 (16.67%) for bcl-2 and 12 (50%) for bax, whereas of the 24 cases of epithelial dysplasia, 20 (83.33%) were positive for PCNA, 10 (41.67%) for p53, 6 (25%) for bcl-2, and 20 (83.33%) for bax. Chi-squared test showed no statistically significant differences between the expression of p53 and bcl-2 in oral lichen planus and epithelial dysplasia, regardless of the grade (P > 0.05). However, the expression of PCNA and bax was significantly increased in epithelial dysplasia (P < 0.05). The results of this study showed that alterations in expression of these proteins are observed in oral lichen planus and epithelial dysplasia, suggesting the potential for malignant transformation in both lesions.

Plaque control improves the painful symptoms of oral lichen planus gingival lesions. A short-term study

BackgroundLichen planus is a mucocutaneous disease with manifestation in the oral mucosa, the gingiva being one of the most affected regions. In some cases, the lesion may be painful and lead to fragility of the tissues, so that precise diagnosis and adequate treatment are indispensible factors for improving the clinical condition. The aim of this study was to evaluate the effectiveness of plaque control in the improvement of clinical features and painful symptoms of oral lichen planus with gingival involvement.MethodsTwenty patients diagnosed with gingival lichen planus confirmed by histopathological examination were selected. The patients were evaluated by a trained examiner, with regard to the clinical features of the lesions [Index of Escudier etal. (Br J Dermatol, 157, 2007, 765)]; painful symptoms (Visual Analog Scale); and periodontally, as regards the visible plaque and gingival bleeding indices. Periodontal treatment consisted of supragingival scaling and oral hygiene instruction, with professional plaque removal afterward for a period of 4weeks. The entire sample was evaluated at the baseline and at the conclusion of treatment, and the results were analyzed by the Wilcoxon nonparametric test.ResultsThe data demonstrated that the majority of patients were women (90%), with a mean age of 55.9years. Periodontal treatment resulted in statistically significant reduction (P<0.05) in the periodontal indices, with consequent improvement in the clinical features and painful symptoms of the lesions.ConclusionsIt was demonstrated that plaque control was effective in improving the clinical features and painful symptoms of oral lichen planus with gingival involvement.

A clinical report of an oral lichen planus associated to epidermoid carcinoma in contact with metallic restorations

The aim of this study was to relate the clinical case of a patient with oral lichen planus (OLP) and a history of epidermoid carcinoma associated with metallic restorations. The etiology of OLP is a mucocutaneous disease, which is poorly understood. Studies point to the potential of malignant transformation of OLP and its association with metallic restorations. The metallic restorations were replaced by crowns with a ceramic covering associated and osseointegrated implants in the edentulous areas. About 1 year later, it was observed a bilateral regression of the tongue lesions. The replacement of metallic restorations can contribute to improvement of OLP.

Emotional assessment of patients with oral lichen planus

Background Oral lichen planus is a chronic immune-mediated disease with an estimated prevalence of 0.5-2.5% in the general population. Patients with oral lichen planus are often emotionally unstable and anxious and may develop concomitant systemic disorders. The objective of this study was to evaluate emotional characteristics of patients with oral lichen planus.Methods Two groups were studied: the first group consisted of 48 patients with a diagnosis of oral lichen planus, and the second group consisted of controls without the disease matched for age and gender at a proportion of 1 : 1. The emotional state of the patients was evaluated using the State-Trait Anxiety Inventory, SF-36 generic quality of life questionnaire, and the Self Reporting Questionnaire-20.Results and conclusions The present investigation demonstrated the presence of anxiety and depression in patients with oral lichen planus and a negative impact of the disorder on the patient's quality of life as indicated by impairment of the physical aspect, vitality, mental health, and social aspect domains. This could indicate that associated psychological treatment may be important in the follow-up of these patients.