Líquen plano oral: relação clínico-histopatológica, imunofluorescência direta, associação com medicação sistêmica e terapêutica

Liquen plano (LP) e doenca inflamatoria cronica de envolvimento mucocutâneo. Lesoes orais do liquen plano (LPO) sao frequentes e classicamente reconhecidas pela sua distribuicao simetrica e bilateral na mucosa oral. As pesquisas atuais concentram-se sobre criterio de diagnostico do LPO em razao da sua caracterizacao como doenca potencialmente cancerizavel. O assunto e controverso, isto porque alguns casos relatados com transformacao maligna de LPO nao apresentavam caracteristicas explicitas de LPO, mas, sim, de outras doencas, particularmente a displasia liquenoide. O objetivo deste presente estudo foi investigar correlacoes clinico-histopatologicas e de imunofluorescencia direta (IFD) em pacientes com lesoes LPO. Um grupo controle para IFD tambem foi incluido. Adicionalmente, foi investigada a associacao do LPO com medicacoes sistemicas, e a analise da resposta terapeutica do LPO. Cinquenta e nove pacientes (44 mulheres e 15 homens; media de idade 51,7 anos) com lesoes sugestivas de LPO foram examinados. O diagnostico clinico e histopatologico de LPO foram definidos de acordo os criterios estabelecidos pela WHO (1978); a IFD – como suporte ao diagnostico de LPO – foi definida pela reacao fluorescente exclusivamente para anti-fibrinogenio na zona da membrana basal (ZBM). Informacoes correspondentes a historia clinica, medicacoes sistemicas, lesoes extra-orais e habitos foram registradas; casos sintomaticos foram tratados preferencialmente com corticosteroides topicos, mas outras formas terapeuticas foram incluidas. Os resultados mostraram que o diagnostico clinico caracteristico de LPO foi obtido em 37 pacientes, enquanto em 22 casos o diagnostico foi LPO versus outra(s) doenca(s). Os achados histopatologicos mostraram que 30 casos foram conclusivos de LP, 21 compativeis com LP e 8 nao-LP. Nao houve diferenca estatisticamente significante entre categorias de diagnosticos clinicos, distribuicao uni ou bilateral das lesoes e achados histopatologicas (P > 0,05)... Lichen planus (LP) is a chronic inflammatory disease involving skin and/or mucosa. Oral lesions of lichen planus (OLP) are frequent and recognized by their symmetrical and bilateral distribution in the oral mucosa. Currently, most studies are concerned with the criteria for the diagnosis of OLP, mainly to fact that this disease has been characterized as a pre-malignant condition. This issue is controversial since some cases reported as showing malignant transformation were not in fact OLP, but other diseases, mainly lichenoid dysplasia. The aim of this present study was to investigate clinico-histopathologic correlation and direct immunofluorescence (DIF) in patients with OLP lesions. A control group was also included for DIF analysis. Additionally, data for the association of systemic medication and management of OLP lesions were also provided. Fifty-nine patients (44 women and 15 men; mean age 51.7 years) with suggestive lesions of OLP were examined. Characteristic clinical and histopathologic diagnoses of OLP were made according to the criteria established by WHO (1978). DIF for supporting diagnosis in OLP lesions was defined for positive reaction exclusively with anti-fibrinogen along the basement membrane zone (BMZ). Information regarding medical history, systemic medication, extra-oral lesions and habits were registered; symptomatic lesions were mainly treated with topical corticosteroids, but other forms of treatment were also used. The results showed that clinical diagnosis characteristic of OLP was obtained in 37 patients; whereas in 22 cases the diagnosis was OLP versus other lesion(s). The histopathologic findings showed that 30 cases were conclusive of LP, 21 compatible with LP, and 8 were non-LP; there being no significant difference in respect to the clinical diagnostic categories, unilateral or bilateral distribution of lesions, and histopathologic findings (P > 0.05). DIF in 20 OLP patients, 7 histopathologically conclusive of LP...