Oral lichen planus: A look from diagnosis to treatment (original) (raw)

2013, Journal Oral Of Research

Oral lichen planus (OLP) is a mucocutaneous disease which can alter the skin, oral mucosa and other mucous membranes. It affects approximately one to two percent of the population, mainly women, and it occurs most frequently during the fifth and sixth decades of life. Usually, oral lesions appear before skin lesions and, sometimes, they expose themselves only in the oral mucosa. In the mouth, the most affected area is the buccal mucosa, although it can present itself on the tongue, gums and/or palate as well. 1-7 The course is chronic with frequent recurrences. Diagnosis is based on clinic and histology, but techniques such as direct immunofluorescence (DIF) can provide a valuable additional criterion. There is no fully effective treatment. 1, 8 Etiology and pathogenesis. Today, it is considered a disease of obscure etiology, although various triggers are proposed. Besides, there is a considerable controversy about OLP pathogenesis. 2, 9 Current evidence presents multifactorial pathogenesis of various immune mechanisms 2, 3, 10-13 : 1. Antigen-specific immune response: CD8+ cytotoxic cells are activated in OLP by major histocompatibility complex class I and II molecules when antigens are presented. 2. The proposed mechanisms involved in nonspecific immune response are mast cell degranulation and marked matrix metalloproteinases activation. 3. Another hypothesis is the autoimmune response. It is supported by various OLP characteristics such as chronicity, adult onset, association with other autoimmune diseases, female predilection, lack of TGF-ß1expression, overexpression of heat shock proteins, keratinocytes apoptosis and Langerhans cell maturation. Among others, these factors have been proposed as causative agents: genetic component, trauma, drugs, both viral and bacterial infectious agents, food allergy, autoimmunity, stress, immunodeficiency, dental materials