Analysis of a Clinical Case of a Patient With Red Flat Lichen of the Oral Mucosa Associated With the Epstein-Barr Virus

Abstract

Subject. Lichen planus is a chronic inflammatory disease of the skin and mucous membranes, less commonly affecting nails and hair, the typical elements of which are papules. In the structure of diseases localized on the oral mucosa, chronic lichen planus is up to 35―40 %. A number of authors indicate the nature of the development of lichen planus in the oral cavity caused by herpes, in particular type 4 herpes virus (Epstein―Barr).
 The goal is to increase the efficiency of diagnosis and treatment of patients with lichen planus associated with the Epstein―Barr virus.
 Methodology. This article illustrates the experience of managing a patient with exudative-hyperemic form of lichen planus associated with Epstein―Barr virus and the inclusion of antiviral drugs in the treatment regimen. The paper used clinical and laboratory methods for diagnosing the conditions under study.
 Results. In the course of the observation, a positive clinical and laboratory dynamics of the conditions under study was revealed when applying the modernized treatment plan for lichen planus. The appointment of systemic and local antiviral therapy can reduce the treatment time for lichen planus on the mucous membrane of the oral cavity and not resort to the appointment of local hormone therapy.
 Conclusions. In order to increase the effectiveness of the therapy for lichen planus, it is necessary to conduct a study to identify specific DNA not only for Epstein―Barr virus, but also for all herpes viruses due to immunotropy and persistence mainly in the cells of the oral mucosa. The use of a systemic antiviral component reduces the treatment time for dental manifestations of lichen planus and eliminates the need for corticosteroid therapy, which improves the quality of life of patients.

Problems of diagnostics of oral lichen planus

“…Провоцировать обострение дерматоза могут вирусы (папилломы человека, Эпштейна-Барр, герпеса человека, иммунодефицита человека, гепатитов B и С), микроорганизмы (Helicobaсter pylori, Сandida albicans), пародонтопатогены, такие как Aggregatibacter actinomycetemcomitans (Actinobacillus actinomycetemcomitans), Tannerella forsythia (Bacteroides forsythus), Porphyromonas gingivalis. Среди триггерных факторов отдельно выделяют антигипертензивные препараты (ингибиторы ангиотензинпревращающего фермента), нестероидные противовоспалительные, противодиабетические и противомалярийные препараты [8][9][10].…”

“…Факт «омоложения» заболевания в последнее время объясняется возросшим контактом лиц всех возрастов с вирусной инфекцией, существенным изменением реактивности организма, а также повышенной частотой психоэмоциональных состояний [14,15]. Таким образом, в настоящее время КПЛ слизистой оболочки полости рта приобрёл не только медицинскую, но и социальную и психологическую значимость [8].…”