Comparative Analyses of Clinical Features, Histopathology, and CD123 Immunohistochemistry of Oral Lupus Erythematosus, Lichen Planus, and Other Lichenoid Lesions

Dermatology ◽  
2021 ◽  
pp. 1-12
Author(s):  
Kumutnart Chanprapaph ◽  
Cherrin Pomsoong ◽  
Jutamas Tankunakorn ◽  
Chime Eden ◽  
Poonkiat Suchonwanit ◽  
...  
Keyword(s):  
Lichen Planus ◽  
Lupus Erythematosus ◽  
Immunohistochemical Staining ◽  
Median Number ◽  
Diagnostic Value ◽  
Direct Immunofluorescence ◽  
Oral Lichenoid Lesions ◽  
Perivascular Infiltrate ◽  
Common Causes ◽  
Perivascular Area

<b><i>Background:</i></b> Oral lupus erythematosus (OLE) and oral lichen planus (OLP) are among the common causes of oral lichenoid lesions (OLLs). The differential diagnosis among causes of OLLs, particularly between OLE and OLP, is challenging as they have significant clinical and histopathological overlap. <b><i>Objectives:</i></b> To compare and summarize the clinical, histopathological, and direct immunofluorescence (DIF) findings between OLE, OLP, and other OLLs and to explore the diagnostic value of CD123 immunohistochemistry. <b><i>Methods:</i></b> A retrospective study on patients with OLE, OLP, and other OLLs was performed between January 2014 and December 2019. The baseline characteristics, the clinical, histopathological, and DIF features, as well as CD123 immunohistochemistry for plasmacytoid dendritic cells (PDCs) were statistically analyzed and compared between groups. <b><i>Results:</i></b> Of 70 patients, 12 had OLE, 39 had OLP, and 19 had other OLLs. Oral erosions/ulcers were the most common findings in all three groups. Red macules, telangiectases, and discoid plaques were more common in OLE patients, while OLP cases were typified by reticulated patches (<i>p</i> &#x3c; 0.05). Additionally, white patches were found more often in other OLLs than in both OLE and OLP (<i>p</i> = 0.002). Histologically, mucosal atrophy, basal vacuolization, and perivascular infiltrate were observed in OLE, whereas OLP specimens possessed mucosal hyperplasia, hypergranulosis, and compact orthokeratosis (<i>p</i> &#x3c; 0.05). Mucosal spongiosis was a histologic feature that favored other OLLs over OLE and OLP (<i>p</i> &#x3c; 0.001). Data on DIF were nonspecific for all three conditions. For immunohistochemical staining, the median number of total CD123+ PDCs was observed to be higher in OLE than OLP in the mucosal-submucosal junction (MSJ) (<i>p</i> = 0.021), the superficial perivascular area (<i>p</i> = 0.026), and the superficial and deep perivascular areas (<i>p</i> = 0.001). Likewise, PDCs in clusters ≥2+ were seen in significantly higher numbers on OLE than OLP along the MSJ (<i>p</i> = 0.002), the superficial perivascular area (<i>p</i> &#x3c; 0.001), as well as the superficial and deep perivascular areas (<i>p</i> = 0.011). CD123+ PDCs were found to be significantly more numerous in both OLE and OLP than other OLLs in all of the abovementioned areas (all <i>p</i> &#x3c; 0.05). <b><i>Conclusion:</i></b> While there are some differences in the clinicopathological features between OLE, OLP, as well as other OLLs, a significant overlap remains. The quantity and distribution pattern of CD123 immunohistochemical staining has a diagnostic implication in differentiating OLE from OLP and other OLLs.

Direct Immunofluorescence as a Helpful Tool for the Differential Diagnosis of Oral Lichen Planus and Oral Lichenoid Lesions

2018 ◽  
Vol 40 (7) ◽  
pp. 491-497 ◽  
Author(s):  
Yasmin Yamanaka ◽  
Maurício Yamashita ◽  
Lara M. A. Innocentini ◽  
Leandro D. Macedo ◽  
Fernando Chahud ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Lichen Planus ◽  
Oral Lichen Planus ◽  
Direct Immunofluorescence ◽  
Helpful Tool ◽  
Oral Lichenoid Lesions ◽  
Oral Lichen

Oral Lichenoid and Lichen Planuslike Lesions

2016 ◽  
Vol 5 (1) ◽  
pp. 34-39 ◽  
Author(s):  
Helen Mcparland
Keyword(s):  
Lichen Planus ◽  
Lupus Erythematosus ◽  
Oral Lichen Planus ◽  
Maxillofacial Surgery ◽  
Discoid Lupus Erythematosus ◽  
Clinical Appearance ◽  
Oral Lichenoid Lesions ◽  
Appropriate Treatment ◽  
Surgery Department ◽  
Oral Lichen

Many red and white lesions of the mouth are clinically indistinguishable from those of oral lichen planus (OLP). These lesions, often referred to as oral lichenoid lesions (OLL), can occur as a result of contact sensitivity (lichenoid contact reactions), drug reactions or as part of chronic graft versus host disease (GVHD). Oral lesions in discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE) can also have a similar clinical appearance to OLP. Distinguishing oral lichen planus from oral lichenoid lesions, lupus lesions, or other red and white lesions of the mouth can be difficult (even impossible) but it is important, for optimal management of each condition. All patients with red and white pathological lesions should be referred to an oral medicine or a local oral or maxillofacial surgery department, where a biopsy and other investigations can help to establish a diagnosis, and appropriate treatment and monitoring can be commenced. Dentists and other members of the dental team, such as hygienists and dental therapists, should also equip themselves with the knowledge to be able to explain different pathologies of the mouth to their patients and discuss risk factors.

scholarly journals A Rare Presentation of Toxic Epidermal Necrolysis – Like Acute Systemic Lupus Erythematosus

2018 ◽  
Vol 2 (2) ◽  
pp. 144-149
Author(s):  
Brandon T Beal ◽  
Taryn Blaha ◽  
David D Xiong ◽  
Sarah H Schneider ◽  
Steven D Billings ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Toxic Epidermal Necrolysis ◽  
Lupus Erythematosus ◽  
Stevens Johnson Syndrome ◽  
Direct Immunofluorescence ◽  
Systemic Lupus ◽  
Rare Presentation ◽  
Johnson Syndrome ◽  
Perivascular Infiltrate ◽  
Erythematous Plaques

A 25-year-old woman with a history of systemic lupus erythematosus (SLE) was transferred from an outside hospital with a worsening painful generalized rash and oral ulcerations for the prior 3 weeks due to concern for Stevens-Johnson Syndrome / toxic epidermal necrolysis (TEN). Exam revealed denuded erythematous plaques covering over 80% of the patient’s body surface area and a 4.2 x 2.6 cm ulcerated plaque of the superior hard palate. Histology demonstrated parakeratosis and compact hyperkeratosis overlying an atrophic epidermis with vacuolar interface change, prominent keratinocyte dyskeratosis, and a thickened basement membrane zone (BMZ). The superficial dermis had a mild predominantly lymphocytic perivascular infiltrate and superficial dermal mucin deposition. Direct immunofluorescence was positive for IgG (granular, BMZ), C3 (granular, BMZ), and IgA was negative. Labs were remarkable for positive ANA (1:160), ds-DNA, anti-Smith, anti-RNP, low C3/C4, with negative anti-SSA/SSB. The clinicopathological correlation was most consistent with the diagnosis of TEN-like acute systemic lupus erythematosus (TEN-like ASLE). Our patient improved with treatment for her ASLE. This case highlights a challenging clinicopathologic differential diagnosis.

Lupus erythematosus overlapping lichen planus.

1984 ◽  
Vol 46 (3) ◽  
pp. 698-703 ◽  
Author(s):  
Taizo KOHNO ◽  
Yasue YOKOYAMA ◽  
Shuichi INADA
Keyword(s):  
Lichen Planus ◽  
Lupus Erythematosus

scholarly journals Inter-Observer and Intra-Observer Variations in the Assessment of Epithelial Dysplasia in Oral Lichenoid Diseases

2021 ◽  
Vol 8 (2) ◽  
pp. 84-88
Author(s):  
Marwa Zohdy ◽  
Simone Cazzaniga ◽  
Helga Nievergelt ◽  
Roland Blum ◽  
Valérie G. A. Suter ◽  
...  
Keyword(s):  
Lichen Planus ◽  
Oral Lichen Planus ◽  
Epithelial Dysplasia ◽  
Observer Variability ◽  
Oral Lichenoid Lesions ◽  
Inter Observer Variability ◽  
Oral Lichen

Oral lichen planus (OLP) and oral lichenoid lesions (OLL) can both present with histological dysplasia. Despite the presence of WHO-defined criteria for the evaluation of epithelial dysplasia, its assessment is frequently subjective (inter-observer variability). The lack of reproducibility in the evaluation of dysplasia is even more complex in the presence of a lichenoid inflammation. We evaluated dysplasia in 112 oral biopsies with lichenoid inflammation in order to study the inter-observer and the intra-observer variability.

Urine β-2-glycoprotein 1 as a biomarker for diagnosis of systemic lupus erythematosus

Lupus ◽  
2021 ◽  
pp. 096120332110142
Author(s):  
Jung Sun Lee ◽  
Eun-Ju Lee ◽  
Jeonghun Yeom ◽  
Ji Seon Oh ◽  
Seokchan Hong ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Medical Center ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Urine Samples ◽  
Enzyme Linked Immunosorbent Assay ◽  
Systemic Lupus ◽  
Asan Medical

Objective The need for a biomarker with robust sensitivity and specificity in diagnosing systemic lupus erythematosus (SLE) remains unmet. Compared with blood samples, urine samples are more easily collected; thus, we aimed to identify such a biomarker based on urinary proteomics which could distinguish patients with SLE from healthy controls (HCs). Methods Urine samples were collected from 76 SLE patients who visited rheumatology clinic in 2019 at Asan medical center and from 25 HCs. Urine proteins were analyzed using sequential windowed acquisition of all theoretical fragment ion spectra-mass spectrometry, and the candidate marker was confirmed by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic curve analysis was used to determine the diagnostic value of the candidate biomarker. Results Of 1157 proteins quantified, 153 were differentially expressed in urine samples from HCs. Among them were previously known markers including α-1-acid glycoprotein 1, α-2-HS-glycoprotein, ceruloplasmin, and prostaglandin-H2 D-isomerase. Moreover, the amount of β-2 glycoprotein (APOH) was increased in the urine of patients with SLE. The ELISA results also showed the level of urine APOH was higher in patients with SLE than in HCs and patients with rheumatoid arthritis. Moreover, the level was not different between SLE patients with and without nephritis. The urine APOH had an area under the curve value of 0.946 at a cut-off value of 228.53 ng/mg (sensitivity 91.5%, specificity 92.0%) for the diagnosis of SLE. Conclusion The results indicate that the urine APOH level can be an appropriate screening tool in a clinical setting when SLE is suspected.

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