Roger Küffer

New perspectives on the dynamic behaviour of oral lichen planus

Lichen planus, a chronic inflammatory disease that affects the skin and mucous membranes, is one of the most frequent dermatological disorders of the oral cavity. The prevalence of oral lichen planus ranges from 0.2% to 4%. The triggering factors remain unknown. Oral lichen planus can be considered to be a chronic disease of long duration with a dynamic evolution and frequent changes in clinical appearance. Three successive active stages can be distinguished, without sharp limits between them: an initial stage; a protracted intermediate stage with alternate periods of variable activity and quiescence, which carries a progressively increasing risk of malignant transformation; and a late stage that often ends in a clinically little-known, inactive cicatricial post-lichen stage, which does not respond to steroid treatment but retains the same risk.

Eosinophilic ulceration of the oral mucosa: A case report

Chronic ulcerative lesions affecting the maxillary vestibular mucosa and the lower labial mucosa of a white female patient are described. Histopathologic examinations indicated a diagnosis of eosinophilic ulceration. Clinical aspects, pathogenesis, and histopathology of this uncommon lesion are discussed.

Erosion and Ulceration Occurring on Oral Lichen planus. Comments on the Article ‘Erosive Lichen planus: What Is This? by A. Rebora

We thank Dr. Rebora for his interest and comments [1] on our recently published paper on acute diffuse and total alopecia of the female scalp (ADTAFS) [2]. The term of alopecia areata (AA) incognita was introduced by him in 1987, together with a hypothesis to explain why the hair falls out in a particular area in AA. He suggested that normal people with low percentages of telogen hairs who happen to have a group of hairs that are simultaneously in the early anagen phase produce localized AA under the influence of noxious events; in contrast, those with high percentages of telogen hairs as in patients with androgenic alopecia preferentially develop a diffuse and delayed hair loss under a strong influence of noxious events. The latter type, AA incognita, was speculated by Rebora to possibly include telogen effluvium that affects especially females. Although the presence of a diffuse type of AA, which mimics telogen effluvium, has been repeatedly mentioned in the past, nobody has ever tried to characterize it further. Thus, we carried out our analyses of 9 cases in detail, proposing the unique entity of ADTAFS based on its inflammatory nature. First of all, all of our cases were too young in age to suffer from androgenic alopecia that, according to Rebora’s opinion, facilitates the development of ophiasis or diffuse alopecia. Next, our cases were clearly discriminated from telogen effluvium because of its histopathological lack of an inflammatory infiltrate around the hair follicles such as noted in AA. As we reported, there are inflammatory changes characterized by tissue eosinophilia in ADTAFS. Moreover, in our 9 cases, acute hair shedding occurred following patchy AA in 2 cases, and a family history of AA was found in 3 cases. Therefore, it is impossible for us to call these ADTAFS cases by the name of AA incognita that, as suggested by Dr. Rebora, possibly includes telogen effluvium.

Polishing-Paste-Induced Silica Granuloma of the Gingiva

Polishing-paste-induced silica granuloma of the gingiva, an uncommon condition, may mimic various local or systemic pathological entities. A 33-year-old woman and a 42-year-old man were referred for a localised refractory gingival inflammation. Clinical diagnoses included allergy, lichen planus and herpes. Biopsy showed well-demarcated non-caseating granulomas, associating epithelioid and Langhans giant cells. Special bacterial and mycological stains were negative. Systemic examination and laboratory tests ruled out sarcoidosis and Crohn’s disease. Polarised light revealed birefringent crystalline foreign material. A diagnosis of silica granuloma was made. Both patients had frequent dental hygiene treatment including polishing with abrasive paste, suggesting an iatrogenic implantation of the foreign bodies. Gingival damage can result from the use of some dental materials containing silica. Often asymptomatic, sometimes producing visible lesions, granulomatous gingivitis may mislead into wrong diagnosis and treatment. Old silica granulomas may become symptomatic if the patient contracts sarcoidosis.

Analysis of the expression of heat-shock protein 27 in patients with oral lichen planus.

OBJECTIVE Heat-shock protein 27 (hsp27) has been implicated in several biological events. In this experimental study, we aimed at analysing, for the first time, the expression of hsp27 in the diverse stages of oral lichen planus (OLP) lesions. MATERIALS AND METHODS Thirty-six biopsy specimens of patients with OLP and 10 of healthy patients were selected. OLP specimens were divided into three groups: G1 - moderate or mildly active OLP; G2 - active or moderately active atrophic OLP; G3 - mild or inactive atrophic OLP. Hsp27 expression was analysed by immunohistochemistry (staining intensity and percentage of stained cells), and results of staining were compared between the different groups. Gender, age and anatomical location were also studied. RESULTS In the basal layer, an increase of hsp27 expression in both G2 and G3 was observed when compared to G1 and control group. In contrast, a decrease of hsp27 expression in the superficial layer was observed in all groups when compared to control group. CONCLUSION The increased expression of Hsp27 in the basal layer observed during the OLP evolution and the less staining in the superficial layers in all cases of OLP suggest that hsp27 may have a role in the OLP pathogenesis.

Reply to the Letter to the Editor entitled: ‘Hsp 27 as a potential preneoplastic marker in patients with chronic kidney disease (CKD)

Dear Editor,We would like to send our thanks to the authors of theLetter to the Editor entitled ‘Hsp 27 as a potential preneo-plastic marker in patients with chronic kidney disease(CKD)’ for their interest in our article, and to Oral Dis-ease for allowing us to express our opinion. The maincommon factor between oral lichen planus (OLP) andCKD is a protracted chronic evolution, during which vari-ous changes occur and risk factors may appear. The mainprogressive changes occurring in CKD include the actionof uraemic toxins, inflammation, increase in apoptosis andan impairment of immunity (Musial and Zwolinska,2011), whereas in OLP, they consist, mainly, in epithelialatrophy, hyperkeratosis and fibrosis of the corium. In bothdiseases, there is an increased possibility for malignanttransformation in the late stages (Stewart et al, 2009; Gar-cia-Garcia et al, 2012).The authors suggest that among other co-morbidities,OLP could be present in a part of CKD patients, espe-cially after renal transplantation on immunosuppressivetherapy, a notion still unknown to stomatologists and oralpathologists, which should need a large cooperative studyfor verification. A lot of mainly drug-induced oral liche-noid manifestations have been described, and it is oftenvery difficult to distinguish between them and true OLP.The presence of lichen-planus-like diseases in CKDpatients has been described (Potter and Wilson, 1979).An uncommon complication of uraemia that may occuras a result of advanced renal failure is uraemic stomatitis(Antoniades et al, 2006). Such disorder, which is attrib-uted to a toxic effect of urea with formation of urea com-pounds, is in its main form characterized by a painfulwhite tongue and a more or less white oral mucosa, some-times clinically mimicking OLP, but the histologicalfeatures of lichen planus are always absent.A protective role of both the intracellular and extracel-lular forms of HSP27 has been suggested (Van Why andSiegel, 1998). It is not clear yet whether the extracellularexpression and intracellular expression of HSPs play thesame role in the sense of cytoprotection or deleteriouseffects in OLP. A defending role of Hsp70 has beendetected in saliva as it is involved in both innate andacquired immune activation (Fabian et al, 2012). Despitethe fact that OLP does not involve the salivary glands,considering the saliva as a transport fluid, an analysis ofthe possible correlation between the intracellular andextracellular expression in saliva of HSP27 in the differentstages of OLP would be interesting.