Humoral immunological parameters in Italian patients with oral lichen planus

Serum humoral immunological parameters were determined in 25 patients with atrophic-erosive forms of oral lichen planus (OLP) (Group 1), in 28 patients with reticular-plaque-like lesions of OLP (Group 2) and in 21 healthy patients without oral lesions (Group 3). Comparing patients affected by atrophic-erosive forms of OLP (Group 1) with normal Controls (Group 3), increased levels of serum IgG approaching the statistical significance were found (Kruskal-Wallis test p = 0.0572). It was also found a significantly higher value of kappa (Kruskal-Wallis test p = 0.0017; Mann-Whitney test with Bonferroni’s correction p < 0.001) and lambda (Kruskal-Wallis test p = 0.0346; Mann-Whitney test with Bonferroni’s correction p = 0.013) light chains in patients with atrophic-erosive OLP (Group 1) as compared with normal controls (Group 3). However these higher levels were probably caused by strong prevalence of chronic liver diseases (40%), in patients with atrophic-erosive variety of OLP. No one of these patients was affected by autoimmune liver disease. No differences were noted between atrophic-erosive OLP (Group 1) and hyperkeratosic OLP (Group 2). This study does not confirm the suggestion that patients with OLP may have a generalized immunologic disorder and it also add some evidences that the role of humoral immunity in the pathogenesis of OLP is probably secondary to the cell-mediated reaction against basal keratinocytes.Les principaux aspects de l’immunologie humorale ont été évalués dans deux groupes de malades porteur d’un lichen plan de la muqueuse buccale, 25 à formes atrophiques-érosives (Groupe 1), 28 à formes en réseaux ou en plaques blanches (Groupe 2), et chez 21 sujets sains. Au terme de cette étude les différences les plus remarquables sont les suivantes: le taux des IgG sériques est nettement plus élevé chez les sujets du Groupe 1 ce qui est presque significatif par rapport au Groupe 3 (p = 0.0577). L’analyse statistique a surtout révélé des différences significatives entre le Groupe 1 et le Groupe 3 (contrôle) en ce qui concerne les taux sériques des chaînes Kappa (Kruskal-Wallis test p = 0.0017; Mann-Whitney test corrigé par Bonferroni p < 0.001 ) et des chaînes Lambda (Kruskal-Wallis test p = 0.0346; Mann-Whitney test corrigé par Bonferroni p = 0.013). Aucune autre différence significative entre les trois groupes n’a été observee. Nous pensons que ces résultats sont probablement dus à la présence d’une hépatopathie chronique non auto-immune qui a été diagnostiquée dans 40% des cas du Groupe 1. Cette étude ne confirme donc pas la thèse selon laquelle les sujets atteints de lichen plan buccal pourraient avoir une défaillance de l’immunité humorale. Elle nous permet de penser que le rôle de cette dernière dans la pathogénèse de la maladie est probablement secondaire à la réaction cellulaire dirigée contre les kératinocytes

Phenotypic analysis of peripheral blood cell immunity in Italian patients with different varieties of oral lichen planus

Quantitative analysis of peripheral blood lymphocytes was carried out in 25 patients with atrophic-erosive type of oral lichen planus (OLP) (Group 1), in 28 patients with reticular-plaque like lesions of OLP (Group 2) and in 21 healthy patients (Group 3) by using flow cytometry. CD4 + subsets decreased significantly in patients with reticular-plaque like varieties when compared with healthy patients (Group 3) (One way analysis of variance p = 0.039; t-test with Bonferroni correction p< 0.05). Moreover, in patients with hyperkeratosic forms of OLP (Group 2) CD8 + cell populations were significantly higher than in controls (Group 3) (Kruskal-Wallis test p = 0.035; Mann-Whitney test with Bonferroni’s correction p< 0.0001) and consequently CD4/CD8 ratio was significantly lower in patients with reticular-plaque like lesions than in controls (Kruskal-Wallis test p = 0.01; Mann-Whitney test with Bonferroni’s correction p = 0.013). No statistical differences between patients of Group 1 (atrophic-erosive OLP) and the other two Groups (hyperkeratosic OLP and healthy controls) were detected. 40% of the patients of Group 1 were affected by chronic hepatopathies, most of which were related to hepatitis C virus (HCV), but the data were not substantially modified after adjustment for the patients with chronic liver disease HCV positive. There is no clear evidence that these results indicate the existence of a different pathogenetic mechanism between erosive-atrophic and hyperkeratosic types of OLP. On the other hand, these results and the previously reported immunohistochemical findings suggest that quantitative alterations of peripheral blood lymphocytes in hyperkeratosic varieties of OLP could represent a shift of CD4 + cells from the vascular to the oral mucosa compartment.Les lymphocytes du sang périphérique ont été évalués par cytométrie de flux dans deux groupes de malades porteurs d’un lichen plan de la muqueuse buccale: 25 à forme atrophique-érosive (Groupe 1), 28 à forme en réseaux ou en plaques blanches (Groupe 2), et chez 21 sujets sains (Groupe 3). Au terme de cette étude les différences les plus remarquables ont été les suivantes: diminution de la fraction CD4 + et une augmentation de la fraction CD8 + dans le Groupe 2 (réseaux et plaques blanches) comparés au Groupe 3 (contrôle), la différence est statistiquement significative (One ways analysis of variance p = 0.039, t test corrigé par Bonferroni p<0.05 pour CD4 + et Kruskal-Wallis test p = 0.035, Mann-Whitney test corrigé par Bonferroni p< 0.001 pour CD8 + ) par conséquent le rapport CD4/CD8 du Groupe 2 a été significativement plus bas par rapport au Groupe 3 (Kruskal-Wallis test p = 0.014; Mann-Whitney test corrigé par Bonferroni p = 0.013). Aucune autre différence significative entre les trois groupes n’a été observée, en particulier avec le Groupe 1 (formes atrophiques-érosives) dont il faut signaler que le 40% des sujets sont porteurs d’une hépatopathie chronique souvent due au virus de l’hépatite C. En conclusion la différence des résultats entre les groupes 1 et 2 ne permet pas d’affirmer l’existence d’une pathogénie différente entre les formes atrophiques-érosives et les formes en réseaux ou en plaques, elle est en accord avec les précédentes études en histo-immunochimie. Il est possible que la diminution des lymphocytes CD4 + soit secondaire au déplacement de cette population cellulaire du compartement vasculaire de la muqueuse affectée par le lichen plan.

Preliminary evaluation of the utility of optical coherence tomography in detecting structural changes during photobiomodulation treatment in patients with atrophic-erosive oral lichen planus

INTRODUCTION: Oral lichen planus (OLP) is a common oral inflammatory condition. Against symptomatic atrophic-erosive OLP, topical steroids, or photobiomodulation (PBM) are deployed. Optical coherence tomography (OCT) provides a real-time, non-invasive, tissue investigation. Aim of this study was to evaluate modifications of OCT pattern in patients with painful atrophic-erosive OLP, before and after treatment with PBM, comparing those results with patients treated with topical steroid. METHODS: Two groups of 20 OLP patients were evaluated. Group A underwent two daily application of 0.05% clobetasol propionate for 8 weeks; group B was treated with eight weekly PBM sessions using a 980/645 nm diode laser. OCT scans were performed before and after treatment, and six months after end of the proposed protocol. Changes of width of stratified epithelium (EP) and lamina propria (LP) were quantified. RESULTS: After 8-weeks, both groups experienced a significant increase of EP width (p  0.05). After six months, significant increase of EP width remained only in group B (p = 0.01), with no significant decrease of LP mean width in both groups (p > 0.05). CONCLUSIONS: Increase of EP and decrease of LP might be explained as consequence of clobetasol and PBM ability to promote epithelial healing, and to reduce interface inflammation. When investigated with OCT, clobetasol appears to provide more significant short-term structural changes, whereas PBM might guarantee long-term alterations

In-vivo usefulness of optical coherence tomography in atrophic-erosive oral lichen planus: Comparison between histopathological and ultrastructural findings

Oral lichen planus (OLP) is a common premalignant chronic inflammatory disorder. Optical Coherence Tomography (OCT) provides a real-time, non-invasive, and in-situ optical signature using light of varying wavelengths to examine tissue. Aim of the present study was to assess the possible role of OCT as diagnostic tool for atrophic-erosive OLP by examining OCT scans of healthy buccal mucosa, and comparing their ultrastructural features with those of a buccal mucosa affected by atrophic-erosive OLP, using their histopathological counterparts as the gold standard. Through grayscale (enface scan) and an application in which the vascularization of the tissue is visible (dynamic scan), it was possible to distinguish the healthy from the lichenoid pattern from 20 controls (12 M; 8 F; mean age: 41.32 years) and 20 patients with histologically confirmed atrophic-erosive OLP (7 M; 13 F; mean age: 64.27 years). In detail, mean width of stratified squamous epithelium (EP) and lamina propria (LP) were evaluated. Among controls, EP and LP showed a mean width of 300 (±50) and of 600 (±50) μm respectively; among cases, disruption of membrane basement prevented from any measurement. Furthermore, a differential pattern of EP and LP emerged between the two groups: a light-grayish, hypo-reflective, homogeneous area of EP recurring in controls turned into a hyper-reflective, non-homogeneous area among cases. Dynamic scan showed a differential profile of LP vascularization, varying from a hypo-reflective red area with small blood vessels in the control group, to a hypo/hyper-reflective area, completely overrun by a denser, wider blood flow amid OLP cases. Although histopathological examination remains the gold standard for OLP diagnosis, OCT could be a potentially helpful tool for the clinician and the pathologist, since it allows analysis of the vascularization of the sample without adversely affecting histological processing