Oral lichenoid tissue reactions: diagnosis and classification

Abstract

The concept of lichenoid tissue reaction/interface dermatitis was introduced in dermatology to define a number of diverse inflammatory skin diseases linked together by the presence of common histopathological features. Similarly to the skin, the oral mucosa is affected by a variety of oral lichenoid lesions. Oral LTRs (OLTRs) include: oral lichen planus; oral lichenoid contact lesion; oral lichenoid drug reaction; oral lichenoid lesions of graft-versus-host disease; oral discoid lupus erythematosus; oral lesions of systemic lupus erythematosus; erythema multiforme; paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome; chronic ulcerative stomatitis and lichen planus pemphigoid. Traditionally, diagnosis of OLTRs relies on clinical and histological correlation but in several instances this approach fails to provide a reliable diagnosis. Inclusion of molecular techniques may refine our ability to differentiate OLTRs.

Keywords::

• chronic ulcerative stomatitis
• discoid lupus erythematosus
• erythema multiforme
• graft-versus-host disease
• lichen planus pemphigoid
• lichen planus
• lichenoid lesions
• oral lichen planus
• paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome
• systemic lupus erythematosus

Financial & competing interests disclosure

AS Khudhur is recipient of sponsorship from the Iraq government. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• There is a paucity of good epidemiological studies on oral lichen planus (OLP), mainly due to the difficulty in distinguishing this disease from a range of OLP-like lesions, defined as oral lichenoid tissue reactions (OLTRs).

• OLTRs frequently share similar clinical and histological appearances.

• No representative animal model exists for OLP.

• The only OLTRs that could be differentiated from OLP without further investigations are possibly oral graft-versus-host reaction.

• Techniques such as immunoprecipitation using radiolabeled cultured keratinocytes, immunoblotting and ELISA can assist the diagnosis, particularly in case of paraneoplastic pemphigus, chronic ulcerative stomatitis and lichen planus pemphigoid.

• New technologies continue to emerge to refine the diagnosis of systemic lupus erythematosus.

• Some of the above-mentioned techniques are either not universally or commercially available.

• For some other OLTRs such as discoid lupus erythematosus, oral lichenoid contact lesions and oral lichenoid drug reactions, reliable diagnostic tests are lacking.

Notes