Image cytometric evaluation of nuclear texture features and DNA content of the reticular form of oral lichen planus

OBJECTIVE: To analyze image cytometric chromatin changes reflected in nuclear texture features and DNA ploidy of oral lichen planus in relation to the normal buccal mucosa and buccal mucosa expressing malignancy-associated changes in cancer patients. STUDY DESIGN: Twenty-eight patients with the reticular form of oral lichen planus, with a follow-up period of 25 years, 50 healthy controls and 50 lung cancer patients were included in the study. Scrapings of buccal mucosa were suspended in transport medium. Monolayer filter preparations were Feulgen-thionin stained. Image cytometric analysis was performed by Cyto-Savant. RESULTS: All oral lichen planus specimens in our study were diploid. In univariate analysis, differences between the normal buccal mucosa and oral lichen planus were found in several nuclear texture features, which gave an 80% correct classification rate in multivariate analysis. In the second part of the study, the classifier that recognizes malignancy-associated changes on the buccal mucosa of patients with lung cancer correctly recognized > 80% of oral lichen planus samples as normal buccal mucosa. CONCLUSION: Our results indicate that chromatin changes in oral lichen planus exist compared to normal cells; however, the chromatin structure of the reticular form of oral lichen planus does not express malignancy-associated changes and is more similar to normal squamous cells.     

Evaluation of angiogenesis in normal and lichen planus skin by CD34 protein immunohistochemistry: preliminary findings

Angiogenesis is a critical component of both neoplastic and chronic inflammatory disorders, but whether angiogenesis also occurs in inflammatory skin diseases (such as lichen planus) has yet to be established. This study tests the hypothesis that the development of cutaneous lichen planus is associated with alterations of dermal vascularization (microvessel density, MVD). Thirty cases of cutaneous lichen planus and 40 cases of normal skin were studied. Dermal microvessels were immunostained for CD34 and counted in 10 areas with the highest numbers of microvessels; the mean value represented the final MVD. Compared with normal skin, dermal microvessel density was increased in cutaneous lichen planus [mean, 2.50 (SEM, 0.09) versus 1.39 (SEM, 0.12)]. The microvessel number was higher in the dermal inflammatory infiltrate (intralichenoid infiltrate) and at dermoepidermal junction (below Max-Josef space) compared with adventitial dermis [mean, 2.50 (SEM, 0.09) versus 1.6 (SEM, 0.10)]. The higher MVD values in cutaneous lichen planus suggest a possible link between angiogenesis, and development of these cutaneous lesions. These results provide a morphological evidence of potent angiogenic activity in cutaneous lichen planus, indicating that the local microvasculature may undergo an intense process of inflammation-dependent angiogenesis.     

Lichen planus and liver diseases: a multicentre case-control study. Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).

OBJECTIVE--To assess the association of lichen planus with liver complaints and with known aetiological factors of liver diseases. DESIGN--Multicentre case-control study. Interviews were conducted by trained medical investigators on the basis of a structured questionnaire. At the interview patients and controls were asked for consent to blood samples being taken to determine transaminase activities and the presence of hepatitis B virus surface antigen. SETTING--Outpatient departments of 27 Italian general and teaching hospitals that were collaborating in the Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED). SUBJECTS--Incident cases and controls were eligible. A total of 577 patients with lichen planus and 1031 controls with dermatological diseases other than lichen planus were interviewed. Less than 1% of the people contacted refused to participate. Patients and controls were matched for sex and age in five year intervals. RESULTS--The risk of lichen planus was higher in patients with a history of liver diseases requiring hospital admission or specialist consultation (relative risk = 1.6; 95% confidence interval = 1.2 to 2.2), those who had had liver biopsy (5.5; 1.9 to 15.6), and those with a history of viral hepatitis (1.9; 1.1 to 3.1). High activities of liver enzymes and positive results of tests for hepatitis B virus surface antigen were also associated with lichen planus. The association with alcohol consumption was not clearly confirmed by a dose-risk relation. CONCLUSION--This study adds quantitative epidemiological evidence to the clinical observation that liver disease is a risk factor for lichen planus although not a specific marker of it.     

Quantitative cytomorphologic analyses of Papanicolaou-stained smears from oral lichen planus

OBJECTIVE: To apply quantitative techniques to cytologic smears in order to improve the diagnostic sensitivity of cytology in the detection of malignant change in the oral cavity. STUDY DESIGN: Eighty-two patients with lesions of oral lichen planus were investigated. A total of 247 Papanicolaou-stained buccal smears underwent nuclear and cytoplasmic area measurements using a TV image analyzer. RESULTS: The cytomorphologic results of this study suggest that lesions of oral lichen planus contain smaller cells and nuclei than those observed in clinically normal oral mucosal smears. There was a statistically significant reduction in nuclear area (P < .001) and cytoplasmic area (P < .05) for the oral lichen planus smears. CONCLUSION: The TV image analysis system could provide a valuable method of quantifying cell changes in oral smears collected from oral mucosa as a method of monitoring lesions of oral lichen planus.     

清热解毒祛风中药治疗口腔扁平苔癣的临床疗效及对患者外周血T淋巴细胞亚群的影响观察

目的：探讨养血解毒祛风中药治疗40例口腔扁平苔藓的临床疗效以及其对OLP患者外周血T淋巴细胞亚群的影响。方法：将80例扁平苔癣患者随机分为中药组40例和西药对照组40例。治疗组采用中药养血解毒祛风法辨证施治,对照组患者以西药治疗,用左旋咪唑50mg／次,3次／d,口服3天停4天一个月。结果：治疗组与对照组统计学上有显著性差异,中药治疗对患者T细胞亚群有很好的调节作用。结论：中药清热解毒祛风治疗口腔扁平苔癣有显著疗效。     

Candida biotypes in patients with oral leukoplakia and lichen planus

Prevalence of yeasts in 35 leukoplakia and 34 oral lichen planus patients was compared with that observed in persons without oral diseases. Serotype and morphotype were determined on Candida albicans isolates. Yeasts were isolated from the oral cavity specimens of 43.7% of the patients. C. albicans (serotype A) was the predominant species (76% in leukoplakia, 88.2% in lichen planus and 60.8% in healthy persons). Sixteen morphotypes were encountered on malt extract agar, being 732, 733, 734, 753 and 754 the most frequently found. Morphotypes SP1N and SP1Y were the most common on Sabouraud-trypheniltetrazolium agar (68.4% of the isolates from leukoplakia and 73.3% from lichen planus, but only 46.6% of the isolates from healthy oral mucosa showed SP1N morphotype). Presence of oral lesions was associated with a marked reduction in the yeast species and C. albicans biotypes, suggesting that C. albicans and particularly some of its biotypes, show a high potential of adaptation to the changes associated with the development of oral leukoplakia and lichen planus.     

肥厚性扁平苔藓皮损中浸润淋巴细胞的研究

目的探讨淋巴细胞浸润在肥厚性扁平苔藓发病机制中的意义。方法采用免疫组织化学SP法对10例肥厚性扁平苔藓患者皮损、20例非肥厚性扁平苔藓患者皮损及10例正常人皮肤中CD3、CD4、CD8、CD20进行检测。结果所有患者皮损均以CD3^＋’T、CD4^＋T、CD8^＋T细胞浸润为主,散在CD20^＋B细胞浸润。肥厚性皮损中浸润T淋巴细胞数少于非肥厚性皮损（P〈0．01）,CD20^＋B细胞占浸润淋巴细胞百分率高于非肥厚性皮损（P〈0．05）。正常人皮肤仅在真皮偶见CD3^＋T细胞。结论肥厚性扁平苔藓皮损T淋巴细胞的减少,B淋巴细胞的增多表达可能与疾病的持续存在及局部过度增殖性改变密切相关。     

Cytometric analysis of oral scrapings of patients with oral lichen planus

A. Acha‐Sagredo, Y. Jiménez, J. V. Bagán, M. A. Echebarria‐Goicouria and J. M. Aguirre‐Utric analysis of oral scrapings of patients with oral lichen planus Objective: Aneuploidy has been associated with malignant and premalignant oral lesions. In the past few years, its application in oral precancerous lesions and its prognostic meaning have been controversial issues. The aim of our study was to characterize alterations in DNA content by automated DNA image cytometry in oral scrapings of patients with oral lichen planus. Methods: Cytological samples from 40 patients clinicopathologically diagnosed with oral lichen planus were analysed by DNA image cytometry. Results: All the cases were classified as diploid, showing a predominant population of cells with normal DNA content (DNA index, 0.85–1.15). Atrophic/erosive lesions showed a higher percentage of tetraploid cells when compared with reticular/papular lesions but this was not statistically significant (P = 0.09). Conclusions: Aneuploidy does not seem a common event in oral lichen planus lesions. However, we consider that the use of DNA image cytometry of oral scrapings may be an easy and helpful methodology in the follow‐up of patients with these lesions.     

Trace metals in oral mucosa in relation to the lichen ruberplanus pathology. A preliminary study carried out by neutron activation analysis.

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.     

低功率氩离子激光治疗口腔癌前病变的临床研究

目的对氩离子激光治疗口腔癌前病变的治疗机理、照射功率、方法及疗效差异进行探讨。方法 对５３例口腔白斑和扁平苔藓患者应用Ａｒ＾＋激光治疗,检查比较患者治疗前后的临床变化。结果 口腔白斑３１例全部治愈,治愈率１００％;口腔扁平苔藓２２例治愈１３例,显效７例,无效２例,治疗有效率９０．９％,总有效率达９６．２％。结论 氩离子激光治疗口腔白斑和扁平苔藓等清表的口腔慢性病损,不仅疗效显著,操作简便,并发症少     

Affections dermatologiques de la muqueuse genitale masculine et de la verge

A wide variety of infectious, inflammatory or dysplasic disorders may affect both male genital skin and mucous membranes. We review here the clinical patterns or the most common disorders. The diagnosis is based upon the existence of erythematous balanitis, erosions or ulcerations. Among infections, candidiosis, genital herpes, HPV papillomas are the most common. Most of inflammatory skin disorders may affect the male organ, especially psoriasis, lichen planus or erosive lichen planus, allergic dermatitis, auto-immune bullous dermatoses, drug-reactions. Chronic balanitis, or recurrent inflammatory balanitis, lichen sclerosus may lead to the emergence of intraepithelial neoplasias (PIN) or invasive carcinomas. The management of genital lesions needs in fact: the observation or oral mucous membrances and of the skin it-self with a special attention to very peculiar body sites for the presence of typical skin disease lesions; a surgical biopsy for microscopic observation; in some cases immunopathology with direct and indirect immunofluorescence for the diagnosis of auto-immune disorders.     

蕈样肉芽肿与扁平苔藓、慢性皮炎湿疹浸润细胞的免疫组化比较研究

目的探讨免疫表型对蕈样肉芽肿与扁平苔藓、慢性皮炎湿疹鉴别诊断的意义。方法本研究应用ABC免疫组化技术检测15例蕈样肉芽肿,17例慢性皮炎湿疹,17例扁平苔藓,6例正常皮肤的CD1a、CD8、ICAM-1和CD7的表达情况。结果1.蕈样肉芽肿表皮CD1a,CD8,ICAM-1的阳性细胞密度明显高于扁平苔藓、皮炎湿疹和正常皮肤。2.蕈样肉芽肿真皮中CD1a阳性细胞的线性密度高于扁平苔藓、慢性皮炎湿疹和正常皮肤,蕈样肉芽肿真皮内CD8阳性细胞百分比较慢性皮炎湿疹增多,蕈样肉芽肿真皮表达ICAM-1抗原的细胞百分比高于扁平苔癣和慢性皮炎湿疹。3.慢性皮炎湿疹、扁平苔藓真皮内CD7阳性细胞百分比高于蕈样肉芽肿和正常皮肤。结论CD1a、CD8、ICAM-1、CD7免疫表型的研究可能为蕈样肉芽肿和扁平苔藓、慢性皮炎湿疹等一些炎症性皮肤病的鉴别诊断提供一定的线索。     

DNA-cytometric detection of euploid polyploidization in oral lichen ruber planus

The DNA distribution was analyzed in 29 cases of oral lichen ruber planus that were negative for human papillomavirus and not suspected of being precancerous. Monolayer smears prepared from formalin-fixed, paraffin-embedded tissues were automatically Feulgen stained and used for rapid interactive DNA cytometry via a TV-based image analysis system combined with an automated microscope. Nuclei with DNA contents greater than 4c were found in 25 cases (86%). DNA contents greater than 8c were seen in five cases (17%), and small peaks at 8c were found in three cases. These increased DNA values in nonprecancerous lesions must be interpreted as euploid polyploidization and have to be taken into account if DNA measurements are performed for diagnostic purposes in lichen ruber planus lesions that are suspected of having malignant transformation.     

A Quest for miRNA Bio-Marker: A Track Back Approach from Gingivo Buccal Cancer to Two Different Types of Precancers

Deregulation of miRNA expression may contribute to tumorigenesis and other patho-physiology associated with cancer. Using TLDA, expression of 762 miRNAs was checked in 18 pairs of gingivo buccal cancer-adjacent control tissues. Expression of significantly deregulated miRNAs was further validated in cancer and examined in two types of precancer (leukoplakia and lichen planus) tissues by primer-specific TaqMan assays. Biological implications of these miRNAs were assessed bioinformatically. Expression of hsa-miR-1293, hsa-miR-31, hsa-miR-31* and hsa-miR-7 were significantly up-regulated and those of hsa-miR-206, hsa-miR-204 and hsa-miR-133a were significantly down-regulated in all cancer samples. Expression of only hsa-miR-31 was significantly up-regulated in leukoplakia but none in lichen planus samples. Analysis of expression heterogeneity divided 18 cancer samples into clusters of 13 and 5 samples and revealed that expression of 30 miRNAs (including the above-mentioned 7 miRNAs), was significantly deregulated in the cluster of 13 samples. From database mining and pathway analysis it was observed that these miRNAs can significantly target many of the genes present in different cancer related pathways such as “proteoglycans in cancer”, PI3K-AKT etc. which play important roles in expression of different molecular features of cancer. Expression of hsa-miR-31 was significantly up-regulated in both cancer and leukoplakia tissues and, thus, may be one of the molecular markers of leukoplakia which may progress to gingivo-buccal cancer.     

Isolated congenital anonychia cases with coincident chromosomal fragility

Isolated anonychia without any associated phenotypical disturbances is one of the rarest anomalies of congenital nail disorders. Some or all fingers of the hands or feet could be affected. Anonychia can be encountered in dermatologic disorders like pemphigus, lichen planus, epidermolysis bullosa; it can also be seen as a component of some syndromes like Nail-Patella and Cooks syndromes. We present a sister couple in whom all fingernails and toenails were lacking without any additional physical sign. A fragile chromosomal site was also encountered in peripheral chromosome analysis in the long arm of the chromosome 10 in both of the cases.     

THE TOPICAL AND SYSTEMIC USE OF CORTISONE IN DERMATOLOGY

Part I of this report deals with the topical use of cortisone in a variety of skin diseases. Fifteen patients with chronic discoid lupus erythematosus, four patients with necrobiosis lipoidica diabeticorum, four with psoriasis, one with lichen planus and one with granuloma annulare were treated with cortisone ointment. All the patients with chronic discoid lupus erythematosus had some degree of improvement. In two patients with chronic lupus erythematosus, complete clearing of the eruption occurred. In four patients with necrobiosis lipoidica diabeticorum remarkable involution resulted. Patients with psoriasis, lichen planus and granuloma annulare were not benefited.Part II deals with the systemic use of cortisone. Eight patients with severe serum sickness-like penicillin reaction responded dramatically to parenterally administered cortisone. In two cases of pemphigus vulgaris and one case of Sulzberger-Garbe disease, the disease was kept in remission with cortisone administered intramuscularly as well as orally. Partial improvement resulted in a case of localized myxedema associated with malignant exophthalmus. Two patients with exfoliative dermatitis due to therapy with heavy metals responded dramatically to cortisone. No beneficial effects were noted in patients with chronic urticaria and atopic dermatitis.The systemic use of ACTH and cortisone in dermatology at present should be confined to patients with known fatal or hopelessly incapacitating diseases and to patients with extreme hypersensitivity reactions which may be protracted or life-endangering, and which can be controlled or cured with a relatively small total dosage of the agents in a short time.     

Oral lichen planus: a microbiologist point of view

International Microbiology - Oral lichen planus (OLP) is a chronic disease of uncertain etiology, although it is generally considered as an immune-mediated disease that affects the mucous membranes...     

Cutaneous and Ocular Reactions to Practolol

A total of 21 patients suffering from drug-induced rashes from practolol have been seen over the past two years. The clinical manifestations varied, with the morphological appearances of the rash resembling those of eczema, lupus erythematosus, lichen planus, and a highly characteristic toxic erythematous psoriasiform eruption. Persistent ocular damage was a feature in three cases.