Oral Lichen Ruber (OLR) Epidemiology and Clinical Findings in 143 Cases

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1 Oral Lichen Ruber () Epidemiology and Clinical Findings in 4 Cases Berislav Topic Ana Cekić-Arambašin Slavka Malčić Oralni lichen ruber () epidemiologija i klinički nalaz 4 slučaja Summary All cases o f during a period o f five years in the Department o f Oral Pathology are analyzed. The aim o f this study was. - to present epidemiological and clinical findings o f - to determine if Grinspan syndrome exist and if so in what percentage. affected women more frequently (7.%) then men (7.7%), and after the age o f 4 is more frequent. The ratio o f lichen ruber planus and erosivus was 8.% :.%. DM is present in.%, hypertension in.%, Grinspan syndrome in 4.% cases. All the six cases o f Grinspan sy ndrome had the erosive form o f lichen. There is also significant correlati on o f with gastrointestinal disease (8.%), where, gastritis and hepathobiliar diseases prevail. Key words: Oral lichen ruber, diabetes mellitus, hypertension, Grinspan syndrome Introduction Lichen ruber is a chronic inflammatory disease of the mucosa and the skin. It is a mucocutan auto immune disorder which, due to possible outcomes can become a precancerous lesion. The incidence of this disease ranges from.% to.% in the gene ral population (). It more often affect women than men, and most often between the age of forty and sixty. In one third of the cases oral lesions are fol lowed by skin disorders (). Basic characteristics of lichen are inflammation and occurrence of hypekeacta Stomatol Croat, Vol., br., 99. mm Department of Oral Pathology School of Dental Medicine Universitiy of Zagreb Zagreb, Croatia Acta Stomatol Croat 99; 9. ORIGINAL SCIENTIFIC PAPER Received: July,, 99. Primljeno:. srpnja 99. ratotic papule which are confluent, giving thus a dif ferent clinical picture. There are three basic forms of lichen ruber:. lichen ruber planus,. lichen ruber erosivus,. lichen ruber bullosus. Lichen ruber planus is the most frequent of the three (7-8%) and is manifested in different cli nical forms: reticularis, annularis, plaquosus, atrop hicans, hypertrophicans and pigmentosus. in

2 Lichen often associates with systemic diseases such as: diabetes mellitus (,,4), hypertension (), rheumatic collagen diseases (), chronic stress sy ndrome (7), drug allergy (8), and HLA predisposi tion (8). The real cause of the development of lic hen remains undefined (9). The purpose of this study was to present the epi demiological data and clinical findings of five ye ars research of oral lichen ruber () in the De partment of Oral Pathology, School of Dental me dicine, University of Zagreb, and to establish whet her Grinspan syndrome exists and in what percen tage. M aterials and methods The research was done retrospectively. From the medical card files of the Department of the Oral Pat hology, the cards were selected of patients who were diagnosed in the five year period - form..99. to..99. The case histories consist of a dental medical card for specialist check-ups with relevant clinical and lab. findings, and a record of the treatment given on different occasions. The following data were taken: sex, age, profession, cli nical diagnosis of, duration of the disease, blo od sugar level, blood pressure value, clinical diag nosis of skin changes, changes in the gastrointesti nal system, complete blood count (CBC) and aller gy- Table groups Tablica. Dobne skupine up to: Men Women 4 8 Relation m range L.R. Eresoisuv L.R. Planus Reticularis Annularis Plaquosus Atrophicans Hypertrophicans Pigmentosus Table Sex and Distribution od patients Tablica. Raspodjela bolesnika po spolu L.R. Buhosus Table 4, diabetes mellitus (DM), hpertension (H) Tablica 4., diabetes mellitus (DM), hipertenzija (H) Table shows the number of patients in each ten year age group. occurs most frequently at the age of 4 and before the age of 7. Values outside this range are low. Since it is difficult to establish when the disease begins, it is hard to determine how long the patient has been affected. As the illness initially has an asy mptomatic course, it obviously began much earlier then was confirmed. Morphologically, L.R. planus prevails in the cli nical picture of with 8.%, and its entity re ticularis with.%. The erosive from in this sam ple prevails with.%. No incidence of the bullous form was recorded, probably because bulla, as an efflorescence, is not stable in the mouth, as the functions of chewing, swallowing and speaking cause its rapid rupture. If there had been a case of bulla, it soon passed into its erosive form. No case of hypertrophic or pigmentous forms of lichen were recorded. Grinspan syndrome is characterized by, di abetes mellitus (DM) and hypertension (H). Table 4 gives the relation of clinical findings in Grinspan trias. There were 4 patients with diagnosed. Table shows sex and age distribution of patients. Men Women Table Clinical morphological variations of Tablica. Kliničko-morfološke inačice Results Sex No. of. cases Uč 4.4 DM H DM+H Acta Stomatol Croat, Vol., br., 99.

3 In the sample of 4 patients had hyperglyce mia, and 4 hypertension. Six of these patients had both DM and hypertension, i.e. Grinspan syndrome. In all six cases the clinical picture was that of ero sive oral lichen. Table shows the relation between and skin changes. Table and skin changes Tablica. i kolne promjene Skin L.R. Dermatitis Psoriasis Virtiligo Rosacea 4 Percent Table indicates the relation between and changes in the gastrointestinal system. Table changes in the gastrointestinal system Tablica. promjene u probavnom sustavu Gastritis Cholecystis Hepatophatia Ulcus duodeni Ulcys ventriculi Cholelitiasis Opstipatio Cholecystectomy Pancreatitis Patients with have a high percentage of ga strointestinal diseases, most frequently gastritis and diseases of the hepatobiliar tract. Hematological laboratory fendings, excluding blood sugar level, are presented in Table 7. Table 7 and haematological changes Tablica 7. i krvne promjene Anemia S.E. Lymphocytosis Leucopenia Eosinophile Thrombocytopenia 7 4 Acta Stomatol Croat, Vol., br., was present in women in 7.% of cases; and a high percentage of syderopenic anemia was also determined. Allergy was found in 9 cases i.e. 7.% of patients. The most frequent allergies: penicillin (in pa tients), dust (8), sinersul (), food (), analgetic (), sulphonamide (), pollen (), feather (), iodine (), preservatives (), paint (), sun () and sea salt (). Discussion The purpose of this work was not to elaborate the therapy of, but to evaluate epidemiologi cal characteristics of and its clinical picture, as well as to analyze controversial data from medi cal literature in Grinspan syndrome exists. Lichen ruber is a chronic inflammatory disease of the mucosa and skin with yet undefined aetilogy (9,,,, ). The finding that it is more frequ ent in women (7.%) and that it more often affec ts people over 4, corresponds to findings of other authors (4,,). In this sample, the skin changes are present in.% cases, while other authors fo und them identified than oral diseases, go to dermatological out-patient departments or to dermatological hospital departments. It is important to stress the high level of the in teraction of gastrointestinal diseases with (8.%) which is very important for diagnosis, and even more important for therapy. One of the purposes of this study was to establi sh the possible existence of Grinspan syndrome. Grinspan syndrome was present in six patients, or 4. per cent of the cases. As early as 949 Lynch () related to vascular hypertension. Grinspan et al. () postulated the association of the oral lic hen, diabetes mellitus and hypertension. Grupper and Avril (8) called this trias Grinspan syndrome. In medical literature there are controversial data on Grinspan syndrome. Non controversial data are based on isolated cases (9) or a limited number of patients (). Diabetes mellitus is more frequent in elderly persons, and so is. Borghelli et al () found in comparative groups -.% in diabetics (79 patients),.74% non-diabetics(7 examinees), and.47% ( examinees) in a general population. The differences were not significant. We should not overlook the fact that lichenous mucocutane reactions can be ca

4 used by drugs which are prescribed for diabetes and hypertension (). In the sample of 4 patients had either dia betes or hypertension, out of which had diabetes and 4 hypertension. Diabetes mellitus, hypertensi on and the erosive form of oral lichen were present in patients. Each patient with had sugar blo od level and blood pressure results. The results of the authors reset on the frequency of diabetes mellitus and is shown in Table 8. Table 8 and diabetes mellitus Tablica 8. i diabetes mellitus Diabetes mellitus Author Year References Grinspan et. al. 9 Jolly 97 Powell et. al. 974 Lowe et. al. 97 Bussel et. al. 979 Topic et. al No. No. of patients of Dental medicine, University of Zagreb, the fol lowing can be concluded:. more often affected women - 7. per cent, than men.. After the age of 4 is more frequent.. The most frequent clinical picture was lichen ruber planus - 8.% per cent: followed by lichen ruber erosivus.%, lichen ruber bullosus (. per cent). In the sub-group of lichen ruber planus the re ticular form prevailed (.%). 4. Diabetes mellitus in was present in. %, hypertension in.%, while diabetes and hyper tension was found in 4.% of cases. All the six ca ses of Grinspan syndrome had the erosive form of lichen.. In this sample skin lichen was present in.% of cases.. The association of with gastrointestinal diseases was present in 8.% of cases; gastritis and diseases of hepatobiliar tract prevailed. Conclusion 7. Haematological laboratory findings apart from blood sugar level, indicated syderopenic ana emia in.9% and raised SE in.% of cases. On the basis of a five year study of 4 cases of in the Department of Oral Pathology, School 8. Allergy to drugs, food and dust was present in 7.% of cases. ORALNI LICHEN RUBER () EPIDEMIOLOGIJA I KLINIČKI NALAZ 4 SLUČAJA Address for correspondence: Adresa za dopisivanje: Sažetak Elaborirani su svi slučajevi za vrijeme od pet godina za Zavo du za Oralnu patologiju Stomatološkog fakulteta Sveučilišta u Zagre bu. Svrha rada bila je utvrditi - epidemiologiju i klinički nalaz i - nastajanje Grinspan sindroma i ako postoji u kojem postotku je prisutan. aficira češće zene (7.%) nego muškarce (7.7%), poslije 4 godina starosti je češći. Lichen ruber planus i lichen ruber erozivus bili su u omjeru 8.% :,%. DM je prisutan u.% hipertenzija u.%, Grinspan sindrom u 4.% slučajeva. Svih slučajeva Grin span sindroma imali su erozivnu formu. Značajna je povezanost sa gastrointestinalnim bolestima (8.%) gdje preveliraju gastritis i hepatobilijarne bolesti. Ključne riječi: Oralni lichen ruber, diabetes melitus, hypertenzija, Grispan sindrom; Prof.dr.sc. Berislav Topić Department of Oral Pathology School of Dental Medicine University of Zagreb Gundulićeva Zagreb 4 Acta Stomatol Croat, Vol., br., 99.

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