A Case Series of Psychological Stress Evaluation as a Risk Factor for Oral Lichen Planus

Abstract

Introduction. Oral lichen planus (OLP) is a chronic inflammatory disease of the oral mucosa with unknown etiology. Suggested predisposing factors for the development of OLP include genetic factors, viral infections, psychological stress, trauma, drug intake, and some systemic diseases. This serial case aimed to evaluate the psychological stress in triggering various types of OLP and its management. Case Report. Six patients, four females and two males with an age range from 23 to 57 years, came to an oral medicine clinic with chief complaints of chronic pain and burning sensations in the oral cavity. All cases showed typical clinical features of OLP on the oral mucosa, including reticular, plaque-like, erosive, and ulcerative lesions. An incisional biopsy was performed in some cases and the histopathology features confirmed the diagnosis of OLP with no signs of dysplasia/malignancy. According to the Depression, Anxiety, Stress Scale (DASS)-21, the patients had different levels of depression ranging from mild to severe; 3 patients were considered to have moderate anxiety and others had severe anxiety; and 5 patients experienced mild stress and 1 patient had moderate stress. The patients were given corticosteroids, supportive therapy, and psychological counseling. All patients experienced significant improvement of the lesions after treatment. Conclusion. Psychological stressors play an essential role as a risk factor in the development of OLP. Therefore, management of OLP encompasses not only an appropriate treatment of the lesions but also psychological intervention.

Classification of psychodermatological disorders: Proposal of a new international classification

“…In the main group ‘primary skin disorders linked with mental health’, the pathophysiological link with psychological stress was documented in the following disorders: some autoimmune bullous dermatoses (pemphigus vulgaris), 46 acne, 47 alopecia areata, 48 atopic dermatitis, 49 chronic spontaneous urticaria, 50 dermatomyositis, 51 hyperhidrosis, 52 infectious diseases (herpesviruses and warts), 53,54 lichen planus, 55 lupus erythematosus, 56 psoriasis, 57 rosacea, 58 systemic sclerosis, 59 seborrheic dermatitis, 60 telogen effluvium 61 and vitiligo 62 . These primary dermatoses are also associated with secondary psychiatric comorbidities which is a relevant aspect in other primary dermatoses that do not seem to present a pathophysiological link with stress, such as some examples of autoimmune bullous dermatoses (dermatitis herpetiformis, IgA bullous dermatosis), androgenetic alopecia, hidradenitis suppurativa, lichen sclerosus, toxic epidermal necrolysis, Stevens–Johnson syndrome, genodermatoses and cicatricial alopecias, particularly, primary neutrophilic cicatricial alopecias, such as folliculitis decalvans and dissecting cellulitis of the scalp 63–66 .…”

Oral lichen planus in children: An Italian case series

“…According to a recent systematic review, the oral mucosa is involved in 22% of pediatric patients, compared to 30%–70% of adult patients 2 . The low incidence of OLPc seems to be related to factors such as low incidence of systemic and autoimmune diseases, low levels of stress (considered a exacerbation trigger factor in adults), less usage of amalgam and orthodontic materials, which were recognized precipitating factors 3,4 in adults, as well as no tobacco consumption, which is a known risk factor for oral LP, 5 and fewer symptoms, leading to a number of undiagnosed cases 6–9 . This study reports clinical findings, treatments, and outcomes of 13 Italian patients with OLPc diagnosed between 2001 and 2021.…”

“…2 The low incidence of OLPc seems to be related to factors such as low incidence of systemic and autoimmune diseases, low levels of stress (considered a exacerbation trigger factor in adults), less usage of amalgam and orthodontic materials, which were recognized precipitating factors 3,4 in adults, as well as no tobacco consumption, which is a known risk factor for oral LP, 5 and fewer symptoms, leading to a number of undiagnosed cases. [6][7][8][9] This study reports clinical…”