Oral lichen planus - retrospective study of 563 Croatian patients

Objectives: To investigate the epidemiological and clinical characteristics of oral lichen planus (OLP) in a group of Croatian patients seen between 2006 and 2012. Study D esign: A group of 563 patients with a diagnosis of OLP was retrospectively reviewed in our clinic. Data regarding age, gender, medical history, drugs, smoking, alcohol, chief complaint, clinical type, localization, his - tology, treatment and malignant transformation were registered. Results: Of the 563 patients, 414 were females and 149 were males. The average age at the diagnosis was 58 (range 11-94). The most common site was buccal mucosa (82.4%). Most of our patients did not smoke (72.5%) or consume alcohol (69.6%). Patients reported oral soreness (43.3%), mucosal roughness (7%), xerostomia (3%), gingival bleeding (2%) and altered taste (0.5%) as the chief complaint, while almost half of them were asympto - matic (44.2%). The most common types of OLP were reticular (64.8%) and erosive (22.9%). Plaque-like (5.7%) atrophic/erythemtous (4.3%) and bullous (2.3%) type were also observed. Malignant transformation rate of 0.7% was recorded. Conclusions: OLP mostly affects non-smoking middle-aged women. Buccal mucosa is the most commonly af - fected site. In almost half of the cases patients are asymptomatic. In spite of the small risk for malignant transfor - mation all patients should be regularly monitored

Procjena alergija na hranu i aditive u bolesnika s angioedemom, sindromom pekućih usta, heilitisom, gingivostomatitisom, oralnim lihenoidnim reakcijama i peroralnim dermatitisom

Oral cavity and perioral area are constantly exposed to a variety of antigens, including food and additives, which have a potential role in the development of different oral mucosal and perioral cutaneous diseases since they can cause hypersensitivity reactions. Oral and perioral diseases mainly include angioedema, burning mouth syndrome, cheilitis, gingivostomatitis, oral lichenoid reactions, and perioral dermatitis. Previous studies were focused on delayed-type oral allergies by performing patch testing but did not include tests for immediate-type allergic reactions. Therefore, the objective of this study was to determine common nutritive and additive allergens in the prevalent oral and perioral diseases by using skin prick tests. Our study evaluated 230 participants, i.e. 180 patients with oral/perioral diseases (angioedema, burning mouth syndrome, cheilitis, gingivostomatitis, oral lichenoid reactions, and perioral dermatitis), and 50 healthy control subjects. The results of skin prick tests showed that immediate-type allergic reactions to food and additives were mostly seen in patients with burning mouth syndrome (40%) and cheilitis (33.3%), whereas allergies were least frequently observed in perioral dermatitis (10%) and gingivostomatitis (20%). Fruits, mushrooms, and vegetables were the most frequent causes of nutritive allergies in oral and perioral diseases. The most commonly identified additive allergens were glutaraldehyde, citric acid, and sodium glutamate. Study results suggest the possible association with nutritive and additive allergies be considered in cases of persistent oral mucosal or perioral skin disease accompanied by respective medical history.Usna šupljina i perioralna regija izložene su različitim antigenima, osobito hrani i aditivima, koji imaju potencijalnu ulogu u razvoju različitih bolesti oralne sluznice i perioralne kože s obzirom na to da mogu potaknuti reakcije preosjetljivosti. Oralne i perioralne bolesti najčešće se manifestiraju kao angioedem, sindrom pekućih usta, heilitis, gingivostomatitis,oralne lihenoidne reakcije ili perioralni dermatitis. Dosadašnje studije usmjerile su se na istraživanje kasne alergijske preosjetljivosti kod bolesti oralne sluznice koristeći samo epikutane (patch) testove. Stoga je cilj našeg istraživanja bio odrediti najčešće nutritivne i aditivne alergene u oralnim i perioralnim bolestima primjenom kožnog ubodnog (prick) testa. U istraživanje je bilo uključeno ukupno 230 ispitanika, tj. 180 bolesnika s oralnim/perioralnim bolestima (angioedem, sindrom pekućih usta, heilitis, gingivostomatitis, oralne lihenoidne reakcije i perioralni dermatitis) i 50 zdravih ispitanika. Rezultati kožnih ubodnih testova pokazali su da su alergijske reakcije rane preosjetljivosti na hranu i aditive najčešće uočene u bolesnika sa sindromom pekućih usta (40%) i heilitisom (33,3%), dok su najrjeđe opažene u bolesnika s gingivostomatitisom (20%) i perioralnim dermatitisom (10%). Najučestaliji uzrok nutritivnih alergijskih reakcija u oralnim i perioralnim bolestima bilo je različito voće, gljive i povrće, a najčešće identificirani aditivni alergeni bili su glutaraldehid, limunska kiselina i natrijev glutamat. Rezultati našeg istraživanja upućuju na to da kod ustrajnih bolesti oralne sluznice ili perioralne kože te značajnih povezanih anamnestičkih podataka treba razmotriti moguću povezanost s nutritivnim i aditivnim alergijama

Učestale alergije i alergeni u etiologiji oralne i perioralne sluznice i kože

Allergic reactions sometimes participate in the development of perioral and oral diseases, indicating the need for appropriate allergen assessment. This review discusses current knowledge on the potential allergic reactions to different dental materials in patients with oral and perioral diseases. Aside from allergies to various dental materials, similar non-allergic, non-immune contact reactions (irritant or toxic) can occur. Among dental materials, the most frequent allergens are alloys, followed by rubber materials, polymers and acrylates. Allergic reactions to dental alloys that contain nickel, cobalt and amalgam are especially frequent since dentists use them for prosthetic and other restorations. There is a broad spectrum of clinical presentations of oral and perioral diseases possibly related to allergies, such as lichenoid reactions, cheilitis, perioral dermatitis, burning sensations, etc. Despite some limitations, patch test is crucial in the diagnosis and recognition of causative allergens because it reveals contact allergies, and is still superior in differentiating allergic and irritant contact reactions. It is important to examine patient medical histories (e.g., occurrence of symptoms after dental therapy or food consumption), and in consultation with their dentist, carry out allergy tests to specific dental allergens which are used or planned to be used in subsequent treatment.Alergijske reakcije ponekad sudjeluju u razvoju perioralnih i oralnih bolesti, što ukazuje na potrebu određivanja potencijalnih alergena. Ovaj pregledni članak govori o trenutnim saznanjima o potencijalnim alergijskim reakcijama na različite dentalne materijale u bolesnika s oralnim i perioralnim bolestima. Uz alergije na razne dentalne materijale mogu se pojaviti slične nealergijske, neimunske kontaktne reakcije (nadražujuće ili toksične). Među zubnim materijalima zubne legure najčešći su alergeni, a slijede ih gumeni materijali, polimeri i akrilati. Alergijske reakcije na zubne legure koje sadrže nikal, kobalt i amalgam osobito su česte, jer ih stomatolozi koriste za protetičke i druge restauracije. Postoji širok spektar oralnih i perioralnih bolesti koje su vjerojatno povezane s alergijama, poput lihenoidnih reakcija, heilitisa, perioralnog dermatitisa, osjećaja pečenja itd. Unatoč određenim ograničenjima epikutani test je presudan u dijagnozi i prepoznavanju uzročnih alergena, jer otkriva kontaktne alergije i još je superiorniji u razlikovanju alergijskih i iritativnih kontaktnih reakcija. Važno je uzeti detaljnu anamenzu bolesnika (npr. pojavu simptoma nakon stomatološke terapije ili konzumiranja hrane) i uz savjetovanje sa stomatologom provesti alergološko testiranje na specifične stomatološke alergene koji se koriste ili se planiraju koristiti u sljedećem liječenju

Promjene na sluznici usne šupljine kod bolesnika s lihen planusom

Forty patients with lichen planus admitted to University Department of Dermatology and Venereology, Sestre milosrdnice University Hospital in Zagreb during the 2004-2006 period were assigned to this retrospective study. In these 40 patients (27 female and 13 male), lichen planus was diagnosed on the basis of clinical presentation, laboratory findings and histopathologic analysis. The results obtained indicated an increased prevalence of lichen planus in middle-aged patients (40% of patients were aged 40-60), with a significant female predominance (67.5% vs. 32.5%). The majority of patients with lichen planus presented with both cutaneous and oral lesions (62.5%), one third of cases had only cutaneous lesions (35%), and only one patient had isolated oral lesions (2.5%). The initial symptoms in patients with lichen planus usually manifested on the skin (82.5%), in oral cavity (5%), or both simultaneously. Oral lesions usually developed on buccal mucosa (88.5%) in the form of Wickham.s striae. All patients were administered topical therapy (corticosteroids, keratolytics), while 55% of patients were given both systemic and topical therapy (corticosteroids, retinoids). Phototherapy was used in 27.5% of patients. The management of patients with oral lichen planus lesions requires multidisciplinary approach including dermatologists and oral pathologists, general practitioners, as well as ENT specialists, internal medicine specialists, and others.Ovo retrospektivno istraživanje obuhvatilo je bolesnike hospitalizirane zbog lihen planusa u Klinici za dermatovenerologiju KB "Sestre milosrdnice" u Zagrebu u razdoblju od siječnja 2004. do kraja 2006. godine. Obuhvaćeno je 40 bolesnika (27 žena i 13 muškaraca) koji su bolovali od lihen planusa, a dijagnoza je postavljena na temelju kliničko-laboratorijskih pretraga te patohistološkog nalaza. Prema našim rezultatima lihen se najčešće javljao u dobi od 40. do 60. godine (45%), češće kod žena (67,5%) nego kod muškaraca (32,5%). Većina bolesnika je istodobno imala promjene na koži i sluznici (62,5%), kod oko trećine bolesnika promjene su bile isključivo na koži (35%), dok je samo jedan bolesnik imao promjene isključivo na sluznici usne šupljine (2,5%). Bolest je najčešće započinjala na koži (82,5%), zatim na sluznici usne šupljine (5%), dok je istodobni početak pojave promjena na sluznici usne šupljine i koži zabilježen u 12,5% bolesnika. Promjene usne šupljine najčešće su bile lokalizirane na bukalnoj sluznici (88,5%), uglavnom u obliku Wickhamovih strija (65,4%). Kod svih bolesnika se primijenila lokalna terapija (kortikosteroidi, keratolitici), dok je 55% bolesnika uz lokalnu primilo i sistemsku terapiju (kortikosteroidi, retinoidi). Kod 27,5% bolesnika je provedena fototerapija. S obzirom na to da se promjene kod lihen planusa često javljaju na sluznici usne šupljine potreban je multidisciplinski pristup koji uključuje suradnju specijalista dermatovenerologa, oralnog patologa, liječnika obiteljske medicine, ORL, internista i drugih

Clinical Characteristics of Topical Propolis Induced Oral Lesions

Uvod: Propolis, smolasta tvar koju proizvode pčele, uporablja se u narodnoj medicini više od dvije tisuće godina. No, njegovi mnogobrojni sastojci mogu djelovati kao potencijalni antigen. Topikalna primjena može uzrokovati nuspojave u usnoj šupljini. Materijali i metode: Retrospektivnom studijom bili su obuhvaćeni pacijenti s oralnim lezijama zbog topikalne uporabe propolisa. Pritom su korišteni podaci iz medicinske dokumentacije pacijenata: izgled i lokalizacija lezija, kada su se pojavili simptomi, terapija i vrijeme cijeljenja te osnovni demografski podaci (dob, spol). Rezultati: Sudjelovalo je dvadeset dvoje pacijenata s lezijama uzrokovanima korištenjem propolisa. Najčešća klinička slika bila je erozivni stomatitis. Simptomi su se obično pojavljivali dva i pol dana nakon uporabe propolisa, iako su se neke lezije pojavile odmah. Većina pacijenata (21/22) uspješno je liječena topikalnim kortikosteroidima. Šestero je bilo podvrgnuto alergološkom testiranju – troje je bile pozitivno, a troje negativno. Zaključak: Topikalni preparati propolisa mogu prouzročiti teške oralne nuspojave. Dosadašnje spoznaje ne podupiru njegovu široku primjenu u terapiji bolesti usta.Objectives: Propolis, a resinous substance produced by bees, has been used in popular medicine for more than 2000 years. Material and methods: Numerous compounds of propolis can act as potent sensitizers. Topical application of propolis can induce oral lesions. Patients with oral lesions due to topical propolis are presented. Basic demographic (age, gender) and clinical data (appearance and localization of the lesions, symptoms onset, treatment and healing time) were recorded. Results: Twenty two patients with propolis-induced lesions were evaluated. The most common occurring presentation was erosive stomatitis. Symptoms tended to appear 2.5 days after propolis use although some lesions occurred immediately after utilization. Majority of patients (21/22) were successfully treated with topical corticosteroids. Six patients underwent patch testing, 3 patients were positive and 3 were negative. Conclusion: Topical propolis can have serious oral side effects. Current knowledge does not support its widespread use in the treatment of oral diseases

Oral Lesions in Patients with Pemphigus Vulgaris and Bullous Pemphigoid

Ova studija obuhvatila je 33 bolesnika hospitaliziranih u Klinici za kožne i spolne bolesti Kliničke bolnice "Sestre milosrdnice". Svrha ove studije bila je usporedba podataka o dobi i spolu, navikama, lokalizaciji kožnih promjena, pojavi simptoma i terapiji u bolesnika s vulgarnim pemfigusom i onih koji boluju od buloznog pemfigoida. Dijagnosticirano je 15 bolesnika s vulgarnim pemfigusom i 18 bolesnika s buloznim pemfigoidom temeljeno na kliničkoj slici, patohistološkoj analizi, direktnoj i indirektnoj imunofluorescenciji, Tzanckovom testu i dezmogleinima. Dobiveni rezultati upućuju na porast učestalosti vulgarnog pemfigusa u bolesnika srednje dobi (46,6% bolesnika između 50 i 70 godina), dok bulozni pemfigoid zahvaća bolesnike starije životne dobi (83,3% bolesnika bilo je starije od 70 godina). Vulgarni pemfigus zahvaća značajnije više žene (66,6%) nego muškarce (33,4%), dok je jednak broj žena i muškaraca bio zahvaćen buloznim pemfigoidom. Bolesnici s objema bolestima su imali promjene kože i/ili sluznice usne šupljine. Većina bolesnika s vulgarnim pemfigusom je imala promjene kože s promjenama na sluznici usne šupljine (86,6%), pri čemu su u 40% slučajeva promjene na sluznici usne šupljine prethodile kožnim promjenama. U samo 16,6% bolesnika s buloznim pemfigoidom su nađene erozije na sluznici usne šupljine. Većina bolesnika je dobivala sistemsku i lokalnu kortikosteroidnu terapiju uz dodatnu sistemsku imunosuprimirajuću terapiju. Pravodobno prepoznavanje vulgarnog pemfigusa i buloznog pemfigoida te odgovarajuća terapija važni su za ishod ovih autoimunih buloznih bolesti.Thirty three patients admitted to the University Department of Dermatology and Venereology, Sestre milosrdnice University Hospital, were included in the study. The purpose of the study was to compare data on age and gender, habits, lesion localization, onset of symptoms and therapy between patients with pemphigus vulgaris and those suffering from bullous pemphigoid. Based on clinical presentation, histopathologic analysis, direct and indirect immunofluorescence, Tzanck smear and desmogleins, 15 cases of pemphigus vulgaris and 18 cases of bullous pemphigoid were diagnosed. The results obtained indicated an increased prevalence of pemphigus vulgaris in middle-aged patients (46.6% of patients were aged between 50 and 70), while bullous pemphigoid predominantly affected elderly individuals (83.3% of patients were older than 70). Pemphigus vulgaris showed a female predominance (female 66.6% vs. male 33.4%), while no sex difference was recorded for bullous pemphigoid. Patients with both diseases presented with cutaneous and/or oral lesions. The majority of patients with pemphigus vulgaris had skin lesions with oral manifestations (86.6%), whereas in 40% of cases oral lesions were preceded by the cutaneous ones. Mucosal erosions were found in only 16.6% of patients with bullous pemphigoid. The majority of patients were administered systemic and topical corticosteroid therapy with adjuvant systemic immunosuppressant therapy. Timely recognition of pemphigus vulgaris and bullous pemphigoid and appropriate treatment are important for the prognosis of these autoimmune bullous disorders