Expert: Glen Aukerman, M.D. - 1/20/2009

Question
HELLO DR.    I HAVE BEEN GIVEN A DIAGNOSIS OF ORAL LICHEN PLANUS FOR THE LEFT LATERAL TONGUE AREA AFTER 3 BIOPSIES.  THIS AREA HAS REMAINED ULCERATED DESPITE ORAL STEROIDS.  I HAVE CHANGED CROWNS, TAKE PROBIOTICS, APPLE CIDER VINEGAR, AND CURCUMIN.  I EXERCISE DAILY AND DRINK ALOT OF WATER.  WOULD METAL OR BODY CLEANSES BE OF HELP?  ANY SUGGESTIONS WOULD BE GREATLY APPRRECIATED.  I NEED SOME HEALING RELIEF, BUT DO NOT WANT TO BE VICTIM OF THE MANY INTERNET CURES.  THANKS  

Answer
This is variable amongst individuals with no simple answer
I can attach some medical article abstracts but it is not clear that anything always works. For stomatitis, we have found B-100 time released taken 3 times a day to help some but need to clear with your doctors

1 - 30 of 30One page.
1: J Oral Pathol Med. 2008 Aug;37(7):417-22. Epub 2008 Apr 11.Related Articles, Links   
The effect of betel quid and cigarette on multistate progression of oral pre-malignancy.

Yen AM, Chen SC, Chang SH, Chen TH.

Institute of Preventive Medicine, and Division of Biostatistics, Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan.

BACKGROUND: Although the effect of betel quid chewing and smoking on oral cancer has been well documented, both influences, dose and duration during life time, on multistate progression of oral pre-malignancy are hardly addressed. METHODS: By recruiting a group of male chewers from different occupation groups, we modeled the effects of both duration and quantity of betel quid chewing and smoking on annual incidence rate of developing leukoplakia and average dwelling times (ADTs) staying in leukoplakia and erythroleukoplakia. RESULTS: The annual incidence rate (per year) of leukoplakia was estimated as 0.35% (95% CI: 0.22-0.48%). The ADTs were 24 years for leukoplakia and 7 years for erythroleukoplakia. Annual incidence rate of leukoplakia with high consumption and long duration of betel quid and smoking was higher. Both quantity and duration of smoking and betel quid chewing play minor roles in the influence of ADT. The risks of developing oral cancer after 20 years of follow-up were 42.2% for leukoplakia and 95.0% for erythroleukoplakia. CONCLUSION: The effects of betel quid chewing and smoking on multistate progressions between oral pre-malignancies were elucidated. These results can be applied to predict long-term risk of malignant transformation varying with different duration and quantity of betel quid and cigarette.

Publication Types:
Comparative Study
Multicenter Study

PMID: 18410311 [PubMed - indexed for MEDLINE]

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2: Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007 Dec;151(2):333-9.Related Articles, Links  
Oral lichenoid lesions and allergy to dental materials.

Ditrichova D, Kapralova S, Tichy M, Ticha V, Dobesova J, Justova E, Eber M, Pirek P.

Department of Dermatology and Venereology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic. dagmar.ditrichova@fnol.cz

BACKGROUND: Dental materials, oral hygiene products and food additives may cause contact allergic reactions in the mouth with varied clinical presentation. Oral lichenoid lesions (lichen planus-like lesions) can be induced by hypersensitivity to dental restorative metals, acrylates, flavorings and other substances. AIM: The aim of this study was to demonstrate contact allergy to dental materials in patients with oral lichenoid lesions using patch tests. PATIENTS AND METHODS: Routine patch tests with two sets of allergens - "European Standard" and "Dental Screening" (Chemotechnique Diagnostics, Sweden) supplemented with pulverized amalgam, iridium, indium, menthol, sorbic acid and platinum were done on a set of 25 patients with lichenoid lesions located on the buccal mucosa, tongue and lips. Application and interpretation of the tests were conducted according to ICDRG (International Contact Dermatitis Research Group). RESULTS: 15 (60 %) patients showed sensitization to 1 or more allergens, with a total of 31 positive reactions. The greatest frequency of positive reactions was to dental metals, with a total of 27 positive reactions. The order of tested metals according to frequency of positive reactions was mercury (6/25/24 %), amalgam (6/25/24 %), nickel (4/25/16 %), palladium (4/25/16 %), cobalt (3/25/12 %), gold (2/25/8 %), chrome (1/25/4 %), indium (1/25/4 %). The clinical relevance of the results with regard to the material's presence in the mouth was demonstrated in 11 (44 %) patients. In 9 patients, replacement of the positively tested materials led to healing or to significant regression of mucosal changes. CONCLUSIONS: The results of the patch tests showed the possible contribution of contact sensitization in the pathogenesis of lichenoid manifestations in the oral cavity. Due to the premalignant character of these lesions, replacement of positively tested materials and follow up of these patients is advised.

Publication Types:
Research Support, Non-U.S. Gov't

PMID: 18345274 [PubMed - indexed for MEDLINE]

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3: Tidsskr Nor Laegeforen. 2006 May 11;126(10):1342-4.Related Articles, Links  
[Contact allergy in the mouth]

[Article in Norwegian]

Morken T, Gjerdet NR.

Bergen hudlegeklinikk, Valkendorfs gate 9, 5012 Bergen. tmorke@online.no

Contact allergy is not frequently seen in the oral mucosa. Oral lichenoid reactions in conjunction with dental restorations, particularly amalgam fillings, are among the most common affections. Subjective symptoms such as burning mouth syndrome, could have an allergic component, but the etiology is unclear and complex. Food additives and oral hygiene products can cause oral lesions of allergic nature. Patch testing is the routine diagnostic tool used by dermatologists, though the interpretation of the clinical relevance is crucial.

Publication Types:
English Abstract
Review

PMID: 16691272 [PubMed - indexed for MEDLINE]

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4: BMC Cancer. 2006 Jan 11;6:7.Related Articles, Links   
The carcinogenic potential of tacrolimus ointment beyond immune suppression: a hypothesis creating case report.

Becker JC, Houben R, Vetter CS, Bröcker EB.

Department of Dermatology, Julius-Maximilians-University, Würzburg, Germany. becker_jc@klinik.uni-wuerzburg.de

BACKGROUND: Since tacrolimus ointment was approved by the U.S. Food and Drug Administration (FDA) as a promising treatment for atopic dermatitis, it has been approved in more than 30 additional countries, including numerous European Union member nations. Moreover, in the current clinical routine the use of this drug is no longer restricted to the approved indication, but has been extended to a wide variety of inflammatory skin diseases including some with the potential of malignant transformation. So far, the side-effects reported from the topical use of tacrolimus have been relatively minor (e.g. burning, pruritus, erythema). Recently, however, the FDA reviewed the safety of topical tacrolimus, which resulted in a warning that the use of calcineurin inhibitors may be associated with an increased risk of cancer. CASE PRESENTATION: Oral lichen planus (OLP) was diagnosed in a 56-year-old women in February 1999. After several ineffective local and systemic therapeutic measures an off-label treatment of this recalcitrant condition using Tacrolimus 0.1% ointment was initiated in May 2002. After a few weeks of treatment most of the lesions ameliorated, with the exception of the plaques on the sides of the tongue. Nevertheless, the patient became free of symptoms which, however, reoccurred once tacrolimus was weaned, as a consequence treatment was maintained. In April 2005, the plaques on the left side of the tongue appeared increasingly compact and a biopsy specimen confirmed the suspected diagnosis of an oral squamous cell carcinoma. CONCLUSION: The suspected causal relationship between topical use of tacrolimus and the development of a squamous cell carcinoma prompted us to test the notion that the carcinogenicity of tacrolimus may go beyond mere immune suppression. To this end, tacrolimus has been shown to have an impact on cancer signalling pathways such as the MAPK and the p53 pathway. In the given case, we were able to demonstrate that these pathways had also been altered subsequent to tacrolimus therapy.

Publication Types:
Case Reports

PMID: 16405733 [PubMed - indexed for MEDLINE]
PMCID: PMC1386691


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5: Stomatologiia (Mosk). 2005;84(5):28-31.Related Articles, Links
[Modern approach to pathogenetic therapy of the oral mucosa lichen]

[Article in Russian]

Ivanova EV, Shcherbakova EG, Rabinovich OF, Barsukov AA, Ezhova EG, Vasilenko IA.

Study of humoral immunity, morphofunctional status of cell factors of immunologic reactivity (T-lymphocytes, neutrophils) and intestinal microecology allowed design of comprehensive pathogenetic therapy of oral lichen.

Publication Types:
Comparative Study
English Abstract

PMID: 16247390 [PubMed - indexed for MEDLINE]

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6: Contact Dermatitis. 2005 Mar;52(3):160-1.Related Articles, Links   
Contact allergy to cinnamal in a patient with oral lichen planus.

Hoskyn J, Guin JD.

Department of Dermatology, University of Arkansas for Medical Sciences, 4301 West Markham Road, Slot 576, Arkansas 72205, USA.

Publication Types:
Case Reports

PMID: 15811033 [PubMed - indexed for MEDLINE]

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7: J Contemp Dent Pract. 2005 Feb 15;6(1):168-72.Related Articles, Links  
AAOMP case challenge: a "speckled" lesion.

Chi AC, Ravenel MC.

Publication Types:
Case Reports

PMID: 15719088 [PubMed - indexed for MEDLINE]

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8: Contact Dermatitis. 2004 Nov-Dec;51(5-6):314-5.Related Articles, Links   
Contact allergy to spearmint oil in a patient with oral lichen planus.

Clayton R, Orton D.

Department of Dermatology, Amersham Hospital, Whielden Street, Amersham, Buckinghamshire HP7 OJD, UK. r.clayton@doctors.org.uk

Publication Types:
Case Reports

PMID: 15606662 [PubMed - indexed for MEDLINE]

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9: Minerva Stomatol. 2003 Jul-Aug;52(7-8):381-91.Related Articles, Links
[Role of total IgE in unspecified burning oral symptoms. Serum and salivary comparative levels in a case-control study]

[Article in Italian]

Campisi G, Di Liberto C.

Sezione di Medicina Orale, Dipartimento di Scienze Stomatologiche G. Messina, Università degli studi di Palermo, Palermo, Italy.

BACKGROUND: Oral burning symptom is often taken into account in Oral Medicine for its high prevalence and respective management problems. The clinical evidence that exclusion from the diet of some foods, considered potentially allergenic, would relieve this symptom represented the rationale of the present study. So, the main aim was to investigate the role of the IgE-mediated pathogenesis in patients with unspecified oral burning symptoms and positivity to the challenge with some foods. METHODS: Comparative levels of total serum and salivary IgE were investigated in 97 patients referred to the Sector of Oral Medicine (University of Palermo), of whom 50/97 as a Test group, symptomatic for burning complaint and affected by burning mouth syndrome (BMS), oral lichen planus (OLP) and recurrent aphtous stomatitis (RAS) and 47/97 as Control group, non-symptomatic, matched for gender, age-decade group and affected with different oral mucosal lesions. RESULTS: In the Test group, the following results were found: total average values for serum IgE of 71.5 (SD+/-100.3; range 4-424) and for salivary IgE of 8.7 (SD+/-30.4; with range 0-218). In the Control group total average values for serum IgE were 85.8 (SD+/-210.7; range 5-1390) and for salivary IgE 20.6 (SD+/-66.6; range 2-408). Statistical evaluation of serum and salivary total IgE levels did not find any significant difference in the Test group vs controls (p>0.2) with respect to gender, age-decade or different type of oral disease with burning symptoms. Of note, in the Test group a positive correlation was found between serum IgE levels and salivary total IgE. CONCLUSIONS: On the basis of our results, no evidence of IgE-mediated allergic process can be suggested in such a generic oral burning symptom, even after a positive challenge for selective diet.

Publication Types:
Comparative Study
English Abstract

PMID: 14608259 [PubMed - indexed for MEDLINE]

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10: Drugs Today (Barc). 2002 Jan;38(1):7-15.Related Articles, Links  
Topical tacrolimus Protopic.

Lazarous MC, Kerdel FA.

Department of Dermatology and Cutaneous Medicine, University of Miami School of Medicine, Miami, FL 33136, USA.

Topical tacrolimus is the first topical immunomodulator of its kind, and its mechanism of action, pharmacokinetics, metabolism and efficacy will be discussed. Multiple studies have supported the safety and efficacy of topical tacrolimus in the treatment of atopic dermatitis in both adults and children. Studies have also suggested that topical tacrolimus may be effective in the treatment of acute contact dermatitis. Although oral administration of tacrolimus proved to be efficacious in psoriasis, results with topical tacrolimus have been disappointing in some studies. Additional reports of success in the use of topical tacrolimus in the treatment of pyoderma gangrenosum show promise, although there is a paucity of randomized, placebo-controlled trials examining its use. It has also been suggested that topical tacrolimus is useful in the treatment of alopecia areata, erosive lichen planus, isolated ichthyosis linearis circumflexa, steroid-induced rosacea, and in the prevention of allograft rejection, however more clinical trials need to be performed.

Publication Types:
Review

PMID: 12532181 [PubMed - indexed for MEDLINE]

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11: J Trace Elem Med Biol. 2001;15(2-3):79-83.Related Articles, Links  
Trace metals in oral mucosa in relation to the lichen ruberplanus pathology. A preliminary study carried out by neutron activation analysis.

Bonda PLF, Porrini R, Rizzio E, Pietra R, Fortaner S, Sabbioni E.

University of Eastern Piedmont A. Avogadro, Novara, Italy.

Lichen ruberplanus, contact allergy and hypersensitivity can be linked to oral exposure to metals released from metal alloys commonly used in dentistry. In this context neutron activation analysis was developed for the microdetermination of 36 elements in oral mucosa biopsies of two patients affected by lichen ruber planus and of five subjects as control group. In order to minimise metal contamination during sample collection, biopsies were taken by laser bistoury technique and then submitted to radiochemical neutron activation analysis (RNAA). Among the metals analysed, chromium showed obvious high concentration in gingival biopsies of the two pathological subjects compared to the corresponding tissues of control group. Cobalt and nickel were also determined in higher concentrations, but only in one of the oral mucosa of the two patients. The present findings way support the hypothesis concerning a potential link of lichen ruber planus condition with the exposure to Cr, Co and Ni as released into oral cavity from prosthodontic alloys.

PMID: 11787991 [PubMed - indexed for MEDLINE]

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12: Med Oral. 2001 Nov-Dec;6(5):358-63.Related Articles, Links
Presence of lichen planus during a course of interferon alpha-2a therapy for a viral chronic C hepatitis.

Guijarro Guijarro B, López Sánchez AF, Hernández Vallejo G.

Departamento de Odontologia, Facultad de Ciencias de la Salud, Universidad Europea de Madrid, Spain.

We present the case of a 66-year-old woman with a diagnosis of chronic active viral C hepatitis, for whom a course of interferon alpha-2A was prescribed at a dose of 4.5 MU per day for a 2 month period, followed by the same dose on alternate days for 4 months. After completion of a month of therapy, the patient presented with painful oral lesions that made normal oral food intake impossible. These lesions persisted, in spite of withdrawal of interferon therapy. Intraoral examination revealed erosive intraoral lesions in both yugal mucosae, the upper vestibular gum, the floor of the mouth, the ventral region of the tongue, and the lower lip. A diagnosis of erosive lichen planus induced by interferon therapy was established. The prescribed treatment was 0.1% triamcinolone acetonide in orabase applied 3 times a day for 4 weeks. Following the therapeutical course, the erosive lesions disappeared, and the symptoms stopped, although the reticular lesions remained visible.

Publication Types:
Case Reports

PMID: 11694869 [PubMed - indexed for MEDLINE]

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13: Rev Stomatol Chir Maxillofac. 2001 Apr;102(2):77-108.Related Articles, Links
[Precancerous lesions of the buccal mucosa]

[Article in French]

Ben Slama L.

Service de Stomatologie et de Chirurgie Maxillo-Faciale, Hôpital de la Salpêtrière, 45, Bd de l'Hôpital, 75013 Paris.

OBJECTIVES: We analyzed data in the literature in comparison with experience at the Department of Cancer and Oral pathology of the Stomatology and Maxillo-Facial Surgery division of la Salpêtrière Hospital on precancerous lesions of the oral mucosa, in order to establish definitions and describe epidemiological, clinical, histological findings as well as natural history and treatment outcome. MATERIAL AND METHODS: Three literature sources were analyzed: Medline and Current Contents searches, books and references listed in articles. The following key words were used and classed into three groups; 1) oral mucosa, epidemiology, precancerous lesions, malignant transformation, dysplasia, leucoplakia, oral lichen planus, erythroplasia, verrucous, cheilitis, candidosis, immunodepression, 2) oral mucosa, tumor markers, carcinogens, keratin, keratinocytes, gene, nuclear proteins, p53 protein, Ki-67 antigen, 3) oral mucosa, therapy, prevention, nutrients. The period chosen ran from 1980 to 1998. This automatic literature search was completed by systematic manual search of summaries in specialized journals published in 1997-1998. The lists of references in the identified articles were consulted and furnished the principal publications concerning precancerous lesions of the buccal mucosa. In all 383 references were selected and analyzed by level of scientific proof. Among these 135 are cited in the text. If data in the literature were insufficient, the physicians at the Department of Cancer and Oral pathology of the Stomatology and Maxillo-Facial Surgery division of La Salpêtrière Hospital were consulted to provide their experience-based recommendations. RESULTS AND DISCUSSION: Clear and practical definitions drawn from current knowledge were adopted. Precancerous lesions were distinguished from precancerous states. Precancerous lesions included chronic lesions of the oral cavity on which cancer of the oral cavity is known to develop. These were: leucoplakia, oral lichen planus, erythroplasia, papillomatous lesions, actinic cheilitis, submucosal fibrosis, keratotic candidosis, and tertiary syphilis. The precancerous states included cancers occasionally observed in the oral cavity: immunodepression and Plummer Vinson syndrome were analyzed. Epidemiological, clinical, histological, and evolutive data as well as therapeutic strategies were described. A decisional algorithm was elaborated for leucoplakia. The text was enriched with images available in the Department. CONCLUSION: Precancerous lesions of the oral mucosa offer a particularly interesting area of research for understanding the process of cancer formation and its prevention. The level of scientific proof available in the large majority of the published reports is low. Few recent publications provide relevant data. In practice, the experience in the management of cancer and precancerous lesions of the oral mucosa accumulated over the last 40 years at the Department of Cancer and Oral pathology of the Stomatology and Maxillo-Facial Surgery division of la Salpêtrière Hospital provides an invaluable source of information.

Publication Types:
English Abstract
Review

PMID: 11446145 [PubMed - indexed for MEDLINE]

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14: J Oral Pathol Med. 2001 May;30(5):264-7.Related Articles, Links   
Serum antioxidant micronutrient levels in oral lichen planus.

Nagao T, Warnakulasuriya S, Ikeda N, Fukano H, Yamamoto S, Yano M, Miyazaki H, Ito Y.

Second Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan.

The aim of this study was to elucidate any association between oral lichen planus (OLP) and serum antioxidant micronutrients by a population-based case-control study. A total of 9536 subjects were examined, and 62 (58 reticular, 4 atrophic and erosive) diagnosed with OLP at referral facilities were compared with four controls per case (n=248) selected among disease-free subjects matched for age and sex. Serum levels of micronutrients (retinol, alpha-tocopherol, zeaxanthin/lutein and cryptoxanthin, lycopene, alpha-carotene and beta-carotene) were estimated by the high performance liquid chromatography (HPLC) method. Among cases, mean serum retinol level (2.820+/-0.849 micromol/l) was significantly higher compared with that of controls (2.562+/-0.735 micromol/l) (P<0.05). No significant differences were noted in carotenoid levels examined in this study, except for a lower level of lycopene found in atrophic/erosive OLP cases. The results of this study suggest that low serum retinol or carotenoid levels are not risk factors for occurrence of lichen planus, and any specific benefits of antioxidant micronutrients cannot be claimed for this inflammatory disorder.

Publication Types:
Research Support, Non-U.S. Gov't

PMID: 11334461 [PubMed - indexed for MEDLINE]

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15: J Dermatol. 2000 Nov;27(11):755.Related Articles, Links
Nicotine gum for oral lichen planus.

Kuwahara RT, Skinner RB, Rosenberg EW.

Publication Types:
Case Reports
Letter

PMID: 11138547 [PubMed - indexed for MEDLINE]

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16: J Am Acad Dermatol. 2000 Feb;42(2 Pt 1):177-82.Related Articles, Links   
Relevant contact sensitivities in patients with the diagnosis of oral lichen planus.

Yiannias JA, el-Azhary RA, Hand JH, Pakzad SY, Rogers RS 3rd.

Department of Dermatology, Mayo Clinic Scottsdale, Arizona 85259, USA.

BACKGROUND: The concept of contact allergy aggravating or inducing oral lichenoid mucositis diagnosed as oral lichen planus (OLP) is well recognized but somewhat controversial. OBJECTIVE: We sought to identify clinically relevant contact allergens that may be important in the management of patients with OLP. METHODS: We retrospectively reviewed patients with OLP who had patch tests performed at Mayo Clinic Rochester and Mayo Clinic Scottsdale from 1994 to 1997 and 1988 to 1997, respectively. RESULTS: Patch tests were performed on 46 patients with a clinical and histopathologic diagnosis of OLP. Of these, 25 (54%) had positive patch test results. Eighteen (72%) of the patients with positive results had clinically relevant reactions. Of the patients with positive metal reactions, 5 had improvement after removal of the metal prosthesis or restoration. Six others noted that their most troublesome areas were adjacent to metal dental restorations. Six patients with reactions to flavorings and one patient with an acrylate dental retainer sensitivity had improvement after avoiding these allergens. CONCLUSION: Our findings support the concept that contact allergy to metals, flavorings, and plastics can be important in the pathogenesis and management of patients with oral lichenoid mucositis diagnosed as OLP.

PMID: 10642670 [PubMed - indexed for MEDLINE]

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17: Nippon Rinsho. 1996 Jan;54(1):99-105.Related Articles, Links
[Essential trace element and skin diseases]

[Article in Japanese]

Yamada H, Ogawa H.

Department of Dermatology, International Goodwill Hospital.

We have described herein various skin diseases which are caused by essential trace element deposition, deficiency, allergy, etc. Pigmentation of hemochromatosis and hemosiderosis are recognized by hemosiderin deposition in the dermis. Acrodermatitis enteropathica is caused by a deficiency of Zn and is classified as either a hereditary type or as an acquired type. The former is autosomal recessive and the latter is caused by a low intake of Zn. Wilson's disease and Menkes' kinky hair syndrome, which are caused by abnormal Cu metabolism, elicit hyperpigmentation and morphological changes of the hair, respectively. It appears that kinky hair formation results from low activity of sulfhydryl oxidase which is a Cu enzyme. Bowen disease, which is carcinoma in situ, is caused by As toxicosis. Some cases, such as palmo-plantar-pustulosis, lichen planus and oral lichen planus are caused by allergies to metals used in dental surgery, especially Ni, Co, Cr and Sn.

Publication Types:
English Abstract
Review

PMID: 8587213 [PubMed - indexed for MEDLINE]

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18: Stomatologiia (Mosk). 1995;74(1):22-5.Related Articles, Links
[The use of eiconol in the combined treatment of lichen ruber planus of the oral mucosa]

[Article in Russian]

Barer GM, Polovets ML.

Clinical and laboratory examinations of patients with lichen ruber planus revealed diseases of the hepatobiliary system in 85%, pancreatic diseases in 29%, chronic gastritis with manifest secretory insufficiency in 32.5%, and fatty hepatosis in 17.5% of patients. Biochemical analysis of the peripheral blood in patients with the exudative hyperemic and erosive ulcerative forms of the disease revealed hypercholesterolemia and hypertriglyceridemia. Administration of eikonol in a dose of 6 g/day led to reduction of triglyceride level by 18% and of total cholesterol by 6%, the hypocholesterolemic and hypotriglyceridemic effect of the drug being more expressed in the patients with initially higher levels of these parameters. Eikonol therapy promoted an improvement in the clinical course of lichen planus. A positive time course of changes was observed in 69% of patients with the exudative hyperemic form of the disease (less expressed unpleasant subjective sensations, decrease of hyperemia of the buccal mucosa and of the size of foci of lesions, less pronounced papular pattern). In the group with the erosive ulcerative form of the disease only 18% of patients developed positive changes under the effect of therapy (epithelialization of erosions, attenuation of the inflammatory reaction, less expressed papular pattern). Combination of eikonol with applications of keratoplasties to the foci of lesions in patients with the erosive ulcerative condition brought about a better therapeutic effect, with the periods of epithelialization reducing by 7 to 10 days.

Publication Types:
Comparative Study
English Abstract

PMID: 7770872 [PubMed - indexed for MEDLINE]

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19: Ann Otol Rhinol Laryngol. 1994 Jun;103(6):495-7.Related Articles, Links
Lichen planus and lichenoid lesions of the oral cavity.

Batsakis JG, Cleary KR, Cho KJ.

Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston 77030.

Lichen planus is a mucocutaneous disease of unknown cause that has its principal clinical manifestations in the skin and mucosa of the oral cavity. The natural history of the cutaneous form is one of spontaneous resolution over time, while oral lichen planus pursues a much more chronic course with a low order of resolution. Oral lichen planus must be distinguished from lichenoid lesions, including lichenoid dysplasia. Malignant change in oral lichen planus is rare and is prompted by carcinogenic cofactors. There is no increased risk of development of carcinoma in cutaneous lichen planus.

PMID: 8203818 [PubMed - indexed for MEDLINE]

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20: Scand J Dent Res. 1991 Aug;99(4):320-8.Related Articles, Links
Hypersensitivity reactions to dental materials in patients with lichenoid oral mucosal lesions and in patients with burning mouth syndrome.

Skoglund A, Egelrud T.

Department of Oral Surgery, University of Umeå, Sweden.

Epicutaneous patch testing of a battery of 35 dental test substances was carried out in 24 patients with visible lichenoid oral mucosal lesions and in 24 patients with burning mouth syndrome (BMS) without any visible lesions. Reactions to mercury ammonium chloride were found in 33% (8/24) of the patients with visible lesions compared to 0% (0/24) of the patients with BMS. The difference was statistically significant. In 7 of the 8 patients who reacted to mercury, total or partial regression of the lesions was observed after removal of dental amalgam. Reactions to nickel sulfate were found in 21% (5/24) of the patients with BMS compared to 3% (1/24) of the patients with lichenoid lesions. This difference was also statistically significant. Nickel is a rare component in dental restorations, but the oral mucosa is daily exposed to nickel through food and water intake. Removal of nickel from the environment of the patient can therefore be hard to accomplish.

Publication Types:
Research Support, Non-U.S. Gov't

PMID: 1771379 [PubMed - indexed for MEDLINE]

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21: Stomatologiia (Mosk). 1991 Jan-Feb;70(1):29-31.Related Articles, Links
[Lipid peroxidation and the trace element content of the blood in patients with lichen ruber planus of the oral mucosa]

[Article in Russian]

Skliar VE, Kondrat'eva NI, Shafran LM.

Examinations of 143 patients with lichen planus of the buccal mucosa and of 45 normal subjects included studies of lipid peroxidation (LPO) activity and of anti-radical defence system, as well as measurements of a number of blood trace elements. Plasma and red cell LPO intensity in the patients was several times higher than in the controls. Plasma glutathione peroxidase activity was found essentially reduced in the patients, whereas in red cells this activity surpassed 5 times the normal values. Glutathione reductase plasma activity was elevated and its red cell activity decreased. These findings indicate significant LPO disorders in the patients with lichen planus; their blood trace element levels were also found changed.

Publication Types:
Comparative Study
English Abstract

PMID: 2057946 [PubMed - indexed for MEDLINE]

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22: Cutis. 1991 Jan;47(1):39-43.Related Articles, Links
Diagnosis and management of commonly occurring oral vesiculoerosive disorders.

Siegel MA, Balciunas BA, Kelly M, Serio FG.

Department of Oral Medicine and Diagnostic Sciences, Dental School, University of Maryland, Baltimore 21201.

Vesiculoerosive disorders are often difficult to diagnose and manage. The oral cavity is often overlooked as a source of diagnostic signs of dermatologic disease. In some disorders, oral manifestations precede cutaneous signs by as much as one year. The authors describe the oral presentation and management of lichen planus, allergic stomatitis, pemphigus vulgaris, and cicatricial pemphigoid, to enable the physician to recognize, diagnose, and treat commonly encountered oral manifestations of dermatologic disease.

PMID: 1993401 [PubMed - indexed for MEDLINE]

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23: Nippon Hifuka Gakkai Zasshi. 1989 Nov;99(12):1243-54.Related Articles, Links
[Electric current around dental metals as a factor producing allergenic metal ions in the oral cavity]

[Article in Japanese]

Nogi N.

Allergy to dental metal alloys has been reported to occasionally cause dermatitis, stomatitis, lichen planus and pustulosis palmaris et plantaris. According to Faraday's law of electrolysis, when electric current flows into an anode, cationic metal ions dissolve in parallel with the amount of the electric current. Therefore, when patients hypersensitive to metals have suffered from the above mentioned persistent dermatoses, measurement of voltages and electric currents around the dental alloys of the patient's oral cavities was deemed necessary, in order to investigate whether or not such dental metals have been supplied causative metal ions to the patients. For the investigation of electrochemical dissolution of metal ions; firstly, voltages and electric currents between the mucous membrane and standard dental alloy tips placed in the oral cavities of each 15 healthy volunteers and patients were measured. Secondly, the same study was performed with the mucous membrane and actually installed dental metals with 158 patients who showed positive reactions to dental metal series patch test allergens composed of 19 reagents. The results were as follows: 1) Voltages between the mucous membranes and standard metal plates placed in the oral cavities varied depending on the composition of the dental metal. 2) The above-mentioned voltages changed when various food were present in the oral cavity. 3) With the dental metals actually present in the metal-hypersensitive patient's oral cavities, the voltages between the adjacent mucous membrane and dental metals varied greatly, depending on the individual patient rather than on the types of metal. Certain alloys acted as cathodes with some patients, but as anodes with others. 4) Amalgam and silver alloys showed higher voltages and more electric current with the smaller ranges of variation than other kinds of alloys. Both of these alloys tended to act as anodes, therefore, the electrochemical dissolution of metal ions was expected to be higher than with other metals. 5) The voltages and electric currents were often higher between mucous membrane and metals than between metals. These findings indicate that the patient's own mucous membrane acts as cathode for the electrochemical dissolution rather than the dental metals. 6) Measuring the voltage and electric current in the patient's oral cavities is technically easy, and is considered to be valuable since the tendancy of electrochemical dissolution of metal ions from the dental metals is clearly demonstrated.

Publication Types:
English Abstract

PMID: 2622059 [PubMed - indexed for MEDLINE]

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24: Zhonghua Kou Qiang Ke Za Zhi. 1985 Sep;20(5):291-3.Related Articles, Links
[Preliminary study of the relation between trace element zinc and oral mucosal diseases]

[Article in Chinese]

Deng DH.

PMID: 3869508 [PubMed - indexed for MEDLINE]

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25: Acta Stomatol Croat. 1985;19(3):183-91.Related Articles, Links
[The possibilities of drug therapy in oral lichen ruber]

[Article in Croatian]

Cekić-Arambasin A, Durcević-matić A.

Publication Types:
English Abstract

PMID: 3868297 [PubMed - indexed for MEDLINE]

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26: Zhonghua Kou Qiang Ke Za Zhi. 1983 Mar;18(1):5-8.Related Articles, Links
[Analysis of trace elements in the hair of patients with lichen planus and leukoplakia]

[Article in Chinese]

Xu GQ.

PMID: 6575903 [PubMed - indexed for MEDLINE]

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27: Aust Dent J. 1977 Dec;22(6):446-50.Related Articles, Links
Vitamin status of patients with oral lichen planus.

Jolly M, Nobile S.

Correction of proven vitamin deficiencies in patients with oral lichen planus resulted in both clinical and subjective improvement in the majority treated but did not produce complete remission of the lesions. The common finding of low levels of vitamins B1 and B6 in both the lichen planus group and in healthy controls suggests that this is a reflection of dietary habits of the local community not generally appreciated.

PMID: 274104 [PubMed - indexed for MEDLINE]

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28: Int Dent J. 1976 Dec;26(4):405-10.Related Articles, Links
Corticosteroids in diseases of the oral mucosa.

Kay LW.

The introduction of corticosteroids into oral medicine heralded a therapeutic advance, and substantial benefits have occurred from their use. Three topical steroids are being used currently in oral diseases, i.e. hydrocortisone hemisuccinate, triamcinolone in Orabase 0-1 per cent and betamethasone valerate 0-1 mg. The efficacy of these agents can be increased markedly if they are administered during the prodromal phase of ulceration, i.e. when lymphocyte activity is at its maximum. Therapeutic doses of all of them can be exceeded three times without impairing adrenal function. Nevertheless some of these preparations, as exemplified by topical medication, induced an unfortunate acute pseudomembranous candidiasis without any alteration in the plasma cortisol level. The routine examination and treatment of ulcers in the mouth should be a careful exercise helped by a good light source and a tongue spatula. Oral lesions affecting the soft tissues may be often difficult to diagnose, because of the rapid occurrence of secondary changes, such as maceration from moisture, abrasion by food and teeth, perhaps, and the existence of erosions and ulcerations from ruptured vesicles or bullae. Thus, diagnosis will depend not only on the grouping and distribution of lesion, but also on its subsequent behaviour. In some cases too there will be associated changes in the facial skin or elsewhere in the body.

PMID: 1068978 [PubMed - indexed for MEDLINE]

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29: J Clin Pathol Suppl (R Coll Pathol). 1975;9:54-7.Related Articles, Links  
The clinical aspects of drugs and disease of the skin.

Sneddon IB.

Publication Types:
Review

PMID: 134046 [PubMed - indexed for MEDLINE]
PMCID: PMC1347181


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30: J Clin Pathol. 1973 May;26(5):371-4.Related Articles, Links   
Food antibodies in oral disease: a study of serum antibodies to food proteins in aphthous ulceration and other oral diseases.

Thomas HC, Ferguson A, McLennan JG, Mason DK.

We have investigated the incidence of antibodies to food antigens in patients with recurrent minor aphthous ulceration and in patients with other oral ulcerative diseases. The incidence of these antibodies was the same in both groups of patients and was significantly greater than the incidence in a control group of normal people. There was no evidence to support the hypothesis that aphthous ulceration is primarily due to hypersensitivity to food antigens. The factors which might contribute to the absorption of antigenic molecules from the mouth and to the increased immune response in patients with oral disease have been considered.

PMID: 4740333 [PubMed - indexed