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RESUMEN: El liquen plano oral es una enfermedad inflamatoria crónica mucocutánea, de etiología desconocida y se asocia principalmente a una respuesta de inmunidad celular. En los años 70, se comienza a involucrar a las inmunoglobulinas en la etiopatogenia de la enfermedad y hasta la fecha la evidencia científica nos ofrece información reducida, muy variada y con resultados discutibles que hacen necesario una detallada evaluación de esta. Hemos encontrado poca investigación (32 artículos desde 1974 hasta el 2020) y la importancia relativa de las revistas donde han sido publicado los estudios es miscelánea (cuartiles 1, 2 ,3, 4 y no indexadas). Los artículos científicos presentan baja calidad metodológica en el 75% (24 artículos). El 25% restante, presenta calidad media (7 artículos) y de estos, solo el 9 % (3 artículos) encontraron diferencia en la presencia de inmunoglobulinas entre los grupos de casos y controles, y un solo artículo presenta calidad metodológica alta (3 %), pero sus resultados indican que no hay información suficiente. Nuestros resultados revelan que la evidencia científica existente en cuanto a la participación de inmunoglobulinas en la etiopatogenia del liquen plano oral carece de confiabilidad por presentar calidad metodológica de baja calidad. Proponemos dejar de pensar en esta posibilidad o bien mejorar sustancialmente la metodología empleada en los futuros estudios.
ABSTRACT: Oral lichen planus is a chronic mucocutaneous inflammatory disease of unknown etiology and is mainly associated with a cellular immune response. In the 1970s, immunoglobulins began to be involved in the etiopathogenesis of the disease and to date the scientific evidence offers us limited and highly varied information with controversial results that require a detailed evaluation of it. We found scarce research (32 articles from 1974 to 2020) and the relative importance of the journals where the studies have been published is miscellaneous (quartile 1, 2, 3, 4 and not indexed). Scientific articles present low methodological quality in 75% (24 articles). The remaining 25% presented medium quality (7 articles) and of these, only 9% (3 articles) found a difference in the presence of immunoglobulins between the groups of cases and controls, and only one article presented high methodological quality (3%), but their results indicate that there is insufficient information. Our results reveal that the existing scientific evidence regarding the participation of immunoglobulins in the etiopathogenesis of oral lichen planus lacks reliability due to its low-quality methodological quality. We propose to stop thinking about this possibility or to substantially improve the methodology used in future studies.
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RESUMEN El liquen plano (LP)es una enfermedad inflamatoria crónica que afecta piel, mucosas y anexos. Si bien existen múltiples teorías, la etiología es aún desconocida.Clínicamente se caracteriza por pápulasplanas poligonaleso placas brillantes, violáceas,con descamacióny pruriginosas. La variante unilateral es infrecuente y más común en población pediátrica. Se presenta el caso de una paciente de sexo femenino, de 41 años de edad,con un LPvariante unilateral, sin una distribución definida.
ABSTRACT Lichen planus is a chronic inflammatoryimmune-mediateddisease that affects skin, mucous membranes, nails and hair. It affects most commonly adult patients. There is an extended classification of the lichen planus variants.The classic type is characterized by pruriticpolygonal, flat-topped, violaceous papules and plaques, reticulated, with fine white scale Wickham'sstriae. It usually affects wrists and forearms, trunk, anterior aspect of thelegs and oral mucous. The unilateral variant is rare and more common in pediatric patients.When this variant is present, the clinical features are similar to the classic one. The unilateral lesions can be seenwith a methameric distribution (zosteriformdermatosis) or along the Blaschko lines (Blaschkoiddermatosis). A 41-year-old female presented a history of pruritic lesions in trunk and left limb that had appeared 4 months earlier.
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Recent studies have noticed significant role of interleukin (IL)-17, 22, 23, Foxp3, interferon-gamma (IFN-γ) and Wnt5a in oral and cutaneous lichen planus (LP). This study was undertaken to assess whether similar expression exists in lichen planus pigmentosus (LPP). We recruited 30 patients of treatment-naïve 'LPP' (in absence of cutaneous/mucosal LP elsewhere, group 1), 10 patients having active treatment-naïve cutaneous 'LP' (group 2), 10 patients having 'post-LP' hyperpigmentation (in absence of active LP and off treatment for at least past 3 months, group 3), and 10 controls. Quantitative real-time polymerase chain reaction (qRT-PCR, peripheral blood mononuclear cells [PBMCs] and skin) and immunohistochemistry (IHC, skin) was performed. mRNA expression (in PBMCs) of IL-17A, IL-22, IL-23A, IFN-γ and Foxp3 was significantly decreased in group 1 and 3 as compared to group 2 (p < 0.05). Wnt5a expression was maximal in controls; and while there was no difference between group 1 and 2; whereas expression in group 3 was significantly lesser than group 1 and 2 (p < 0.05). qRT-PCR (skin) and IHC (skin) revealed similar results; and mRNA expression and mean fluorescence intensity of IL-17A, IL-22, IL-23A/R was significantly increased in group 2 and 3 compared to group 1 (p < 0.05). Mean fluorescence intensity and mRNA expression of IFN-γ, Foxp3 and Wnt5a were significantly increased in group 2 compared to group 1 (p < 0.05); whereas the difference between group 1 and 3 was not significant. Mean fluorescence intensity and mRNA expression of IL-17A, 1L-22 and IFN-γ showed no difference between group 2 and 3; whereas that of IL-23A/R, foxp3 and wnt5a were significantly higher in group 2 than group 3 (p < 0.05). Overall, maximal expression of IL-17A, IL-22, IL-23A, IFN-γ and Foxp3 (mRNA PBMCs) was observed in LP. Minimal expression of IL-17A, IL-22, IL-23A/R, IFN-γ and Foxp3 (mRNA skin and IHC skin) was seen in LPP patients. In contrast to LP, LPP lacks the expression of IFN-γ, Foxp3 and the cytokines representing Th17 pathway, and thus seems to have a distinct pathogenesis.
Asunto(s)
Liquen Plano/diagnóstico , Trastornos de la Pigmentación/diagnóstico , Piel/patología , Adolescente , Adulto , Biomarcadores/análisis , Biomarcadores/metabolismo , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Factores de Transcripción Forkhead/análisis , Factores de Transcripción Forkhead/metabolismo , Humanos , Interferón gamma/análisis , Interferón gamma/metabolismo , Interleucina-17/análisis , Interleucina-17/metabolismo , Subunidad p19 de la Interleucina-23/análisis , Subunidad p19 de la Interleucina-23/metabolismo , Interleucinas/análisis , Interleucinas/metabolismo , Liquen Plano/patología , Masculino , Persona de Mediana Edad , Trastornos de la Pigmentación/patología , Estudios Prospectivos , Pigmentación de la Piel , Adulto Joven , Interleucina-22RESUMEN
Immune mediated diseases of oral cavity are uncommon. The lesions may be self-limiting and undergo remission spontaneously. Among the immune mediated oral lesions the most important are lichen planus, pemphigus, erythema multiformi, epidermolysis bullosa, systemic lupus erythematosis. Cellular and humoral mediated immunity play a major role directed against epithelial and connective tissue in chronic and recurrent patterns. Confirmatory diagnosis can be made by biopsy, direct and indirect immunoflouresence, immune precipitation and immunoblotting. Therapeutic agents should be selected after thorough evaluation of immune status through a variety of tests and after determining any aggravating or provoking factors. Early and appropriate diagnosis is important for proper treatment planning contributing to better prognosis and better quality of life of patient.
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Turmeric is dried rhizome of the perennial herbs curcumalonga. It is called Haldi in Hindi, turmeric in English, ukon in Japanese. It has been used in Asian Medicine since the second millennium BC. It's utility is referred to in the ancient Hindu script the Ayurveda. Pathogenesis of the OLP should be taken in consideration for the treatment point of view. The Cell mediated immunity to secondary antigenic change in oral mucous membrane is thought to play a major role in its pathogenesis modified keratocyte surface antigens are the primary target for cytotoxic cellular response. Curcumin also been shown to have immune modulatory effect involving activation of host macrophages and natural killer cells and modulation of lymphocytes mediated function.