Two cases of erosive oral lichen planus with autoantibodies to desmoglein 3

Abstract

Oral lichen planus (OLP) is a chronic inflammatory disorder of the oral mucosa of unknown etiology. Clinically, the erosive type of OLP (erosive OLP) can show features similar to those of pemphigus vulgaris (PV), an autoimmune blistering disorder in which desmoglein (Dsg)3 is targeted. In addition to clinical and histopathological findings, immunological studies, including direct immunofluorescence (IF), indirect IF and enzyme-linked immunosorbent assay (ELISA) that detect autoantibodies to Dsg3, are helpful in differentiating erosive OLP from PV. Here, we show two cases of erosive OLP with autoantibodies to Dsg3. Patient 1 was a 68-year-old woman with chronic erosions of the oral mucosa, in which elevated levels of immunoglobulin (Ig)G autoantibodies to Dsg1 and Dsg3 were detected by ELISA. Patient 2 was an 85-year-old woman with white striae with erosions on the lateral sides of the buccal mucosa with elevated levels of IgG autoantibodies to Dsg3 detected by ELISA. Histopathological findings from both cases showed lichenoid dermatitis, and both direct and indirect IF showed no tissue-bound IgG autoantibodies. From these findings, the diagnosis of erosive OLP was made. Immunological assays revealed both cases to have IgG-directing calcium-independent linear epitopes on Dsg3, which are suggestive of non-pathogenic autoantibodies. In addition, autoantibodies to Dsg3 in patient 2 reacted with a prosequence-possessing precursor form of Dsg3 but not with the mature form of the molecule. The present study suggests that erosive OLP may develop anti-Dsg3 autoantibodies, which should be carefully assessed.

A Case of Concomitant Pemphigus Foliaceus and Oral Pemphigus Vulgaris

“…Furthermore, within the PV buccal mucosa biopsy there was a distinct area of hyperkeratosis with an associated band-like infiltrate resembling a lichenoid tissue reaction, however the significance of this is unknown. Interestingly, within the literature there are cases of oral lichen planus with circulating anti-Dsg3 antibodies, which are typically characteristic of PV [ 35 , 36 ]. The pathogenic role of these antibodies in lichen planus however, is not yet understood.…”

Diseases presenting with vesicular and erosive lesions of oral mucous membranes

“…It occurs most commonly in the fifth and sixth decades of life, however is may develop practically at any age. The condition affects women twice as often as men [1,2].…”

“…amalgam), colourants, preservatives and fragrances, herbs, propolis, fluorine contained in toothpaste, dental floss and mouthwash formulations, as well as soft drinks and food products [3,4]. Medications with a potential to contribute to the development of LP include arsenic, mercury, gold and lithium compounds, angiotensin-converting-enzyme inhibitors, βblockers, ibuprofen and furosemide [1,2].…”

“…Najczęściej pojawia się w 5. i 6. dekadzie życia, jednak można ją stwierdzić w każdym wieku. Schorzenie to dotyczy ponad 2krotnie częściej kobiet niż mężczyzn [1,2].…”

“…amalgamat), związki koloryzujące, konserwujące, zapachowe, zioła, propolis, fluor -obecne w pastach do zębów, niciach dentystycznych, płynach do płukania jamy ustnej, napojach kolorowych oraz produktach pokarmowych [3,4]. Do leków mogących przyczynić się do wystą-pienia LP zalicza się: związki arsenu, rtęci, złota, litu, inhibitory konwertazy angiotensyny, βadrenolityki, ibuprofen oraz furosemid [1,2]. W 1978 r. Światowa Organizacja Zdrowia (WHO) wyróżniła 6 postaci LP błony śluzowej jamy ustnej: siateczkową, pęcherzykową, nadżerkową, plamkową, zanikową i wrzodziejącą [5].…”