ORAL LICHEN PLANUS R. Laeijendecker Dit proefschrift is tot stand gekomen zonder enige vorm van externe financie- ring of sponsoring. Academic thesis to obtain Ph.D. degree in Medical Sciences at the Erasmus University Rotterdam. Photograph on the cover: ‘La Bocca della Verità’. ‘The Mouth of Truth’. In the portico of the church of Santa Maria in Cosmedin, Rome, ITALY. ISBN 90-5335-068-3 © 2005, R. Laeijendecker Lay-out: Grafische Vormgeving Kanters, Sliedrecht Printed by Drukkerij Ridderprint B.V., Ridderkerk No part of this thesis may be reproduced or transmitted in any forms by means, elec- tronic or mechanical, including photocopying, recording or any information storage and retrieval system, without permission in writing from the publisher (R. Laeijen- decker, dermatologist, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands). ORAL LICHEN PLANUS Orale lichen planus Proefschrift ter verkrijging van de graad van doctor aan de Erasmus Universiteit Rotterdam op gezag van de rector magnificus Prof.dr. S.W.J. Lamberts en volgens besluit van het College voor Promoties. De openbare verdediging zal plaatsvinden op donderdag 17 november 2005 om 13.30 uur door Ronald Laeijendecker geboren te Dordrecht Promotiecommissie Promotor: Prof.dr. H.A.M. Neumann Overige leden: Prof.dr. J.W. Oosterhuis Prof.dr. E.P. Prens Prof.dr. I. van der Waal Copromotor: Dr. B. Tank “Si tibi videtur quod multa scis, et satis bene intellegis, scito tamen quia sunt multo plura quae nescis”. “Als het u schijnt, dat gij veel weet, en vrij goed begrijpt, weet dan, dat er nog veel meer is, dat gij niet weet”. Thomas A Kempis (1380-1471), De imitatione Christi 1. 2. 3. “Artes serviunt vitae, sapientia imperat”. “Wetenschappen dienen het leven, wijsheid beheerst het”. Lucius Annaeus Seneca (3 B.C.-65), Epistulae 85. 32. Voor de zorg van de patiënten met OLP Voor Marjon, Annelien, Michiel en Esther Voor mijn ouders In herinnering: mijn broer Erik CONTENTS List of abbreviations 9 Chapter 1 General introduction and aim of the thesis 13 Chapter 2 Oral lichen planus: A review of the literature 25 Chapter 3 A: Oral lichen planus and allergy to dental amalgam restorations 109 B: Lichenoid contact stomatitis (Editorial) 123 Chapter 4 A: Oral manifestations of gold allergy 129 B: An update on gold allergy 141 Chapter 5 Premalignant nature of oral lichen planus 147 Chapter 6 Oral lichen planus and hepatitis C virus infection 159 Chapter 7 Oral lichen planus in childhood 167 Chapter 8 A comparison of treatment of oral lichen planus with topical tacrolimus and triamcinolone acetonide ointment 179 Chapter 9 Clinical guidelines on the management of oral lichen planus 187 Chapter 10 Summary, general discussion and recommendations for further research 195 Chapter 11 Samenvatting, algemene discussie en aanbevelingen voor verder onderzoek 207 Figures and legends to the figures 219 Dankwoord 229 Curriculum vitae 233 Bibliography 237 LIST OF ABBREVIATIONS ALAT Alanine aminotransferase Alc in alcohol 70% (ethanol) ALP Alkaline phosphatase ANA Anti-nuclear antigen ANOVA (Statistical) Analysis of Variance Aq Aqueous solution ASAT Aspartate aminotransferase Au Gold B-cells “Bursa of Fabricius” (Bone marrow-dependant) cells BCG Bacille Calmette-Guérin Bis-GMA 2,2-bis[4-(2-hydroxy-3-methacryloxypyloxy)phenyl]- propane BMS Burning mouth syndrome BMZ Basal membrane zone C Complement CD Cluster determinant or cluster of differentiation antigen cm centimeter(s) Cl Chloride CLP Cutaneous lichen planus CO2 Carbon dioxide COX Cyclooxygenase DNA Deoxyribonucleic acid ELISA Enzyme-linked immunosorbent assay F Female FSH Follicle-stimulating hormone G0 no growth in the cell cycle G1 post-mitotic growth phase GGT Gamma-glutamyl transpeptidase GVHD Graft-versus-host disease HAV Hepatitis A virus HBV Hepatitis B virus HCV Hepatitis C virus HDL High density lipoprotein HE Hematoxylin and Eosin HEMA Hydroxyethyl methacrylate HIV Human immunodeficiency virus HLA Human leukocyte antigen (or Human leukocyte system A) 9 HSP Heat shock protein GM-CSF Granulocyte-macrophage colony-stimulating factor I International ICAM Intercellular adhesion molecule IF Immunofluorescence IFN Interferon Ig Immunoglobulin IL Interleukin KDa kilodalton Kg kilogram LDE(s) Lichenoid drug eruption(s) LDH Lactate dehydrogenase LDL Low density lipoprotein LE Lupus erythematosus LFA Lymphocyte function-associated antigen LH Luteinizing hormone LP Lichen planus (OLP + CLP) LPSA Lichen planus-specific antigen M (or M in TNM-system) Male (or distant metastases) M. Morbus MHC Major Histocompability Complex mg milligram(s) ml milliliter(s) MTX Methotrexate N Lymph nodes ND:YAG Neodynium: yttrium-aluminium-garnet nm nanometer OLP Oral lichen planus OLPa Oral lichen planus in adulthood (age older than 17 years) OLPc Oral lichen planus in childhood (age younger than 18 years) OSCC Oral squamous cell carcinoma p the short arm of a chromosome P Probability PAS Periodic acid-Schiff Pet in Petrolatum PLEVA Pityriasis lichenoides et varioliformis acuta PPDA Paraphenylenediamine (P)UVA (Psoralens and) ultraviolet-A RNA Ribonucleic acid T Primary tumor TB Total bilirubin 10 T3 Triiodothyronine T4 Thyroxin T-cells Thymus-dependant cells TCR T-cell receptor TEGDMA Triethyleneglycol dimethacrylate TEN Toxic epidermal necrolysis TNF Tumor necrosis factor TSH Thyroid-stimulating hormone U Units UVB Ultraviolet-B VCAM Vascular cell adhesion molecule VLDL Very low density lipoprotein VVGS Vulvovaginal-gingival syndrome WHO World Health Organization 11 CHAPTER 1 GENERAL INTRODUCTION AND AIM OF THE THESIS General introduction Oral diseases are usually local, but may also be the signs of systemic diseases, including dermatological disorders.1,2 Generally, the disorders of the oral cav- ity are studied by the dentist, the general practitioner, several dental and medi- cal specialisms such as the Oral and Maxillofacial Surgery, the Periodontology, the Otorhinolaryngology, the Internal Medicine and the Dermatology. Dermatology may be defined literally as the study of the skin and its dis- eases.3 However, today dermatology is a separate medical specialism, which is not only confined to the skin, but also includes the study of the disorders of the adjacent mucous membranes (for example, the oral cavity), many internal diseases, environmental (chemicals, plants and radiation) and psychological factors which may influence the skin, phlebology, oncology, dermatological surgery, venereology, allergology, microbiology, immunology, histopathol- ogy, genetics and pharmacotherapy.3 In the second half of the 20th century, there was a considerable increase in the dermatological knowledge especially on sophisticated research techniques in dermatology. Research techniques involving biochemistry, electron microscopy, immunology, immuno-cyto- chemistry and molecular biology have provided a better understanding of the pathogenesis and the treatment of many skin diseases.3 A short treatise on the history of medicine (historia medicinae) and dermatology “L’histoire de la science, c’est la science même”. Auguste Comte (1798-1857). The medical science is as old as the mankind itself. The same applies to the study of skin diseases.4 However, the expression “dermatology” is from more recent times.5 The important ancient nations such as Egypt, Greece, the Roman Empire, India and China have largely influenced the medical science. A clay tablet with a text in cuneiform writing on the preparation of medication from the Babylonian period (more than 4000 years ago) is perhaps one of the oldest remnants of medi- cine (nowadays in the Museum of the University of Pennsylvania, U.S.A.). More than 2000 years ago specialists on skin diseases from Egypt were invited to Rome for their expertise and knowledge. In the Bible, there are many reports on skin diseases.4 “Leprosy” in the Old Testament probably also includes disorders such as scabies, psoriasis, pellagra, tuberculosis, syphilis and vitiligo.6 Hippocrates (460-377 B.C.) from Greece has been considered to be “the father of the medical science” (Figure A). The intrinsic power of healing of an individual overcomes most diseases. The doctor is only the servant, not the master of nature (“minister non magister naturae”). Hippocrates had high ethical regard for the medical pro- 15 fession (“Officium nobile”). This is seen by the famous “Oath of Hippocrates”, which is still taken after qualifying medical examination. The hospital “Askle- pion” of Hippocrates is on the Greek island of Kos with a view of Turkey. The remnants may still be visited today.4 Several famous names in the history of medicine are Celsus, da Vinci, Para- celsus, Vesalius, Sydenham, Harvey, Virchow, Pasteur, Van Foreest, Semmel- weis, Lister, Boerhaave, Dunant, Fleming, Einthoven, Röntgen, Curie, Osler, Freud, Schweitzer and Kolff. Each of them has influenced the medical science significantly, but the exact contribution made by each is beyond the scope of this thesis.4 One exception is Albert Schweitzer (1875-1965) from the Elzas, who was a physician, theologian, philosopher, historian and a musician. He gave up a brilliant medical career to heal the poor and needy in Lambarene (Gabon in Africa). His basic principle was “the respect for all living things”. In his opinion the vocation for a doctor should be “being beneficial to the health of all patients”, which is still true today.7 G. Mercuriale (1530-1606) of Venice in Italy is credited with writing the first treatise on dermatology in 1572, also considered to be the first systematic