Академический Документы
Профессиональный Документы
Культура Документы
Abstract
Oral lichen planus (OLP) is a chronic inflammatory
disease of unknown etiology. In this paper we review
the clinical and histological features of OLP, process
of OLP diagnosis, causes of OLP, management of
OLP patients and medical treatment of OLP lesions.
Approximately 0.2 per cent OLP patients develop
intra-oral carcinoma each year compared with
approximately 0.005 per cent Australian adults.
Possible mechanisms of increased oral cancer risk in
OLP patients are presented. The aims of current
OLP therapy are to eliminate mucosal erythema and
ulceration, alleviate symptoms and reduce the risk of
oral cancer. Patient education may improve the
outcomes of OLP therapy and further reduce the risk
of oral cancer in OLP patients. Although OLP may
be diagnosed clinically, appropriate specialist
referral is required for: (i) histological diagnosis; (ii)
assessment of causative/exacerbating factors,
associated diseases and oral cancer risk; (iii) patient
education and management; (iv) medical treatment;
and (v) long-term review and re-biopsy as required.
Key words: Oral lichen planus, causes, management.
(Accepted for publication 30 January 2002.)
INTRODUCTION
Oral lichen planus (OLP) is a chronic inflammatory
oral mucosal disease of unknown etiology. The aim of
this communication is to provide an update of the
clinical and histological features of OLP, process of
OLP diagnosis, causes of OLP, management of OLP
patients and medical treatment of OLP lesions. The
malignant potential of OLP is discussed and practical
steps to reduce the risk of oral cancer in OLP patients
are presented. The need for OLP patient education is
highlighted. Although OLP may in many cases be
diagnosed clinically, specialist referral is required for
thorough patient investigation, management and
review.
Fig 2. Linear erosive lesion on the ventral surface of the tongue. The
surrounding mucosa is atrophic and erythematous with very faint
reticular striae.
Australian Dental Journal 2002;47:4.
Fig 4. Gingival OLP may present with the typical fine reticular striae
or, as in this case, with generalized erythema and fragility. The striae
can usually be seen as a very fine pattern on the tips of the interdental
papillae. This pattern is frequently and incorrectly referred to as
desquamative gingivitis and may be misdiagnosed as mucous
membrane pemphigoid.
291
Fig 5. Oral lichen planus involving the lateral hard palate with typical
reticular striae and secondary melanosis.
Fig 7. Extensive erosive OLP in a patient on long-term antiinflammatory medications. In this case the NSAIDS exacerbated a
previously existing OLP by introducing the erosive component that
had not previously been problematic. Withdrawal of the agent gave
rapid resolution to the erosion although the original OLP remained.
24. Zhou XJ, Savage NW, Sugerman PB, Walsh LJ, Aldred MJ,
Seymour GJ. TCR Vb gene expression in lesional T lymphocyte
cell lines in oral lichen planus. Oral Dis 1996;2:295-298.
25. Sugerman PB, Rollason PA, Savage NW, Seymour GJ. Suppressor
cell function in oral lichen planus. J Dent Res 1992;71:19161919.
26. Sugerman PB, Savage NW, Walsh LJ, Seymour GJ. Disease
mechanisms in oral lichen planus. A possible role for
autoimmunity. Australas J Dermatol 1993;34:63-69.
27. Sugerman PB, Savage NW, Xu LJ, Walsh LJ, Seymour GJ. Heat
shock protein expression in oral lichen planus. J Oral Pathol Med
1995;24:1-8.
28. Gallucci S, Matzinger P. Danger signals: SOS to the immune
system. Curr Opin Immunol 2001;13:114-119.
29. Sugerman PB, Savage NW, Seymour GJ, et al. Is there a role for
tumour necrosis factor alpha (TNF-) in oral lichen planus? J
Oral Pathol Med 1996;25:219-224.
31. Edwards KM, Davis JE, Browne KA, SuttonVR, Trapani JA.
Anti-viral strategies of cytotoxic T lymphocytes are manifested
through a variety of granule-bound pathways of apoptosis
induction. Immunol Cell Biol 1999;77:76-89.
32. Sugerman PB, Shillitoe EJ. The high risk human papillomaviruses
and oral cancer: evidence for and against a causal relationship.
Oral Dis 1997;3:130-147.
33. Jontell M, Watts S, Wallstrom M, Levin L, Sloberg K. Human
papilloma virus in erosive oral lichen planus. J Oral Pathol Med
1990;19:273-277.
34. Koch P, Bahmer FA. Oral lesions and symptoms related to metals
used in dental restorations: a clinical, allergological, and
histologic study. J Am Acad Dermatol 1999;41:422-430.
35. OGrady JF, Reade PC. Candida albicans as a promoter of oral
mucosal neoplasia. Carcinogenesis. 1992;13:783-786.
36. Thomas SJ, MacLennan R. Slaked lime and betel nut cancer in
Papua New Guinea. Lancet 1992;340:577-578.
18. Shimizu M, Higaki M, Kawashima M. The role of granzyme Bexpressing CD8-positive T cells in apoptosis of keratinocytes in
lichen planus. Arch Dermatol Res 1997;289:527-532.
39. Burkhart NW, Burkes EJ, Burker EJ. Meeting the educational
needs of patients with oral lichen planus. Gen Dent 1997;45:126132.
297