No abstract

Patients with oral lichen planus (OLP) often relate the onset and aggravation of oral symptoms to increased levels of stress. Under normal conditions, stress induces increased cortisol secretion that counteracts inflammatory reactions. The objective of the present study was to assess whether patients with OLP have an impaired capacity to elevate their cortisol concentrations as a response to stress. Saliva samples were collected for cortisol analysis from 10 OLP patients once every 15 min during a 2-h test period. In order to induce stress during a part of this test period, the patients were confronted with a computerised device specifically developed for the induction of transient stress. A visual analogue scale (VAS) and a mood adjective check list (MACL) were used to estimate the degree of permanent stress. A control group of patients was matched for age and sex. The OLP patients did not present with different stress scores when a psychometric test (MACL) was used. No statistically significant correlation between cortisol concentration and stress level was observed. Thus, no support for an impaired capacity of OLP patients to suppress an immune response through cortisol induction in conjunction with experimental stress was revealed.

Objective: Glucocorticoid (GC) treatment suppress the hypothalamic-pituitary-adrenal axis, which may lead to tertiary adrenal insufficiency. This study aimed to investigate the prevalence of tertiary adrenal insufficiency among patients with oral lichen planus treated with topical GC (clobetasol propionate) in the oral cavity, a standard treatment option for this condition. Methods: In this cross-sectional study, we included 24 patients with oral lichen planus receiving long-term (> 6 weeks) clobetasol propionate treatment. Adrenal function was assessed by measuring serum cortisol between 8–9 AM, after a withdrawal of treatment for 48 hours. For patients with serum cortisol concentrations below 280 nmol/L (10 µg/dL), a 250 µg corticotropin stimulation test was performed. Results: Twenty patients had normal serum cortisol concentrations (range 280–621 nmol/L), whereas four patients had low serum cortisol concentrations (13, 45, 63, and 229 nmol/L, respectively). A corticotropin stimulation test revealed partial adrenal insufficiency in two patients (serum cortisol peak level 350 nmol/L and 360 nmol/L) and severe adrenal insufficiency in another two patients (serum cortisol peak level 150 nmol/L and 210 nmol/L). Conclusion: In this small study, approximately 20% of patients receiving chronic topical GCs treatment for oral lichen planus had tertiary adrenal insufficiency. It is essential to be aware of this potential risk and to inform patients about the need for GC stress-doses during an intercurrent illness episode.