Disease severity scoring systems in mucosal lichen planus: A systematic review

Abstract

Several scoring systems have been developed to evaluate disease severity in mucosal lichen planus, but only a few have been validated to ensure reproducible and accurate assessment of disease severity. The current systematic review was undertaken to identify clinical severity scoring systems in mucosal lichen planus that have undergone validity or reliability testing and to describe their operating characteristics. We performed a bibliographic search in five databases from their inception to October 2022 for severity scoring systems in mucosal lichen planus that have undergone validity or reliability tests. Quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal tools. We have included 118 studies and identified 11 clinical severity scoring systems for oral lichen planus that have undergone validity or reliability testing. Of these, the most reported were the Thongprasom score, the Oral Disease Severity Score (ODSS) and the REU (Reticular/hyperkeratotic, Erosive/erythematous, Ulcerative) scoring systems. We did not identify clinical scoring systems for extraoral mucosal lichen planus that have undergone validity or reliability testing. The ODSS and REU scoring systems have undergone the highest number of validation attempts and reliability assessments for oral lichen planus respectively. However, we have identified numerous factors that have hampered the universal adoption of a standardised scoring system. There is a need for the development and validation of scoring systems for extraoral mucosal lichen planus.

Vitamin D is a biomarker of clinical disease severity in oral lichen planus

“…NCT05330572. Patients presenting with OLP diagnosed using Van The ODSS is considered the most validated grading tool of disease activity in OLP, according to a recent systematic review (Unnikrishnan et al 2023). ODSS assesses the site score and severity score of OLP-related lesions at seventeen oral mucosal subsites (Escudier et al 2007).…”

“…Gingival disease severity scores were calculated as the sum of site and activity scores (Escudier et al 2007), confined to gingival sextants. The REU scoring system is one of the most reported scoring systems and has undergone the highest number of reliability assessments (Unnikrishnan et al 2023). The total REU score, calculated as the weighted sum of reticulation, erythematous, and ulcerative scores (1, 1.5, and 2, respectively), reflects the extent of these clinical phenotypes across ten oral sites (Piboonniyom et al 2005).…”

“…Therapeutic interventions for OLP evaluated in clinical trials, include topical and systemic corticosteroids, topical calcineurin inhibitors, retinoids and photochemotherapy, primarily with the goal of pain reduction (Lodi et al 2012). However, these treatments are not effective in all OLP patients, notwithstanding that standardised measurement of efficacy is hampered by the lack of universal severity indicators (Unnikrishnan et al 2023). Diversity of response to treatment is attributable to differences in host-related clinical and molecular factors.…”

Preliminary analysis of the buccal mucosal fungal microbiome in oral lichen planus patients

“…A semi-quantitative reticulation/erythema/ ulceration (REU) scoring system has been widely recognized and used to assess the severity of OLP. 4,5 The specific etiology and pathogenesis of OLP still remain obscure, which has hindered the development of etiological therapies. 6,7 Several external and internal factors are thought to be associated with OLP, including infections, trauma, certain medications, genetic predisposition, and psychological problems.…”

“…With increasing disease severity, the erosive and ulcerative lesions caused by the thinning, and even the complete loss, of the epithelium are observed. A semi‐quantitative reticulation/erythema/ulceration (REU) scoring system has been widely recognized and used to assess the severity of OLP 4,5 …”