Oral lichen sclerosus: a systematic review of reported cases and two new cases

Abstract

Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous disease with uncertain etiology. It occurs as white plaque-like lesions mostly in the anogenital skin. Oral mucosal involvement is extremely rare. This study aims to summarize the features of published oral lichen sclerosus (OLS) and two new cases. A systematic search of the English literature from 1955 to 2016 was performed in MEDLINE, Scopus, and Web of Science, and cross-references were searched manually. Search phrases included "lichen sclerosus," "mouth," "oral," "lip," "palate," "floor of mouth," "tongue," "gingiva," "buccal mucosa," and "mouth diseases." Cases with clinical and histopathological confirmation of diagnosis of OLS were included. A total of 41 (39 published and 2 new) histologically confirmed OLS cases were available. The median age of OLS patients was 31 years, and 66% of the patients were female. Most of the OLS lesions were asymptomatic. They were located in the labial mucosa (n = 20), lip (n = 15), buccal mucosa (n = 14), gingiva (n = 12), tongue (n = 12), and palate (n = 7). OLS is rare and typically presents as asymptomatic, white, plaque-like lesions. Malignant transformation of preexisting OLS has not been reported.

Oral submucous fibrosis presenting with histopathological lichenoid changes as predominant feature: Report of five cases and review of the literature

“…However, in lichen sclerosus, there is a restriction of the hyalinization to the upper portion of the lamina propria and the band-like chronic inflammatory infiltrate is located right beneath the subepithelial hyalinized layer, whereas OSF exhibits deeper hyalinization and superficial perivascular lymphocytic infiltrates. 17,18 In our series, clear histopathological features of lichenoid mucositis such as hydropic degeneration of the basal layer, subepithelial lymphocytes, pigment deposits, and intraepithelial apoptotic bodies were present in four patients. In such cases, a wrong diagnosis of oral lichen planus may be reached by the unwary pathologist.…”

“…Additionally, both entities exhibit dense collagenization of the lamina propria with loss of elastic fibers. However, in lichen sclerosus, there is a restriction of the hyalinization to the upper portion of the lamina propria and the band‐like chronic inflammatory infiltrate is located right beneath the subepithelial hyalinized layer, whereas OSF exhibits deeper hyalinization and superficial perivascular lymphocytic infiltrates 17,18 …”

A 7‐year‐old with an acquired lip lesion

“…Impaired tooth mobility, gingival recession, and periodontal attachment loss have also been reported. 5 Most patients present with multiple lesions which are more commonly located on the lower lip, followed by buccal mucosa, upper lip, tongue, and buccal fold. Oral LS typically presents with welldemarcated white macular or papular lesions, which often begin as small flat-topped erythematous papules that may coalesce to form an ivory-white plaque.…”

Lichen sclerosus

“…The disease rarely affects the oral mucosa, but this localization can be the only manifestation of LS, which brings additional difficulty to making a clear diagnosis without a histopathological examination. Oral LS most frequently appears as solitary whitish plaque on the labial mucosa, buccal mucosa, lip, gingiva, or tongue [36]. Also, there have been reported cases of nail and eyelid involvement [37,38] (figs.…”

“…Choroba rzadko powoduje zajęcie błon śluzowych jamy ustnej, ale w tym umiejscowieniu mogą także występować izolowane objawy LS, co dodatkowo utrudnia ustalenie jednoznacznego rozpoznania bez badania histopatologicznego. Liszaj twardzinowy jamy ustnej najczęściej ma postać pojedynczej blaszki o białawym zabarwieniu, zlokalizowanej na błonie śluzowej warg, policzków, dziąseł lub języka [36]. W przebiegu LS obserwowano również przypadki zajęcia paznokci i powiek [37,38] (ryc.…”