GRINSPAN’S SYNDROME

Abstract

Aim of the study Oral lichen planus is a chronic inflammatory condition, etiologically obscure, affecting 0.1- 4% of the general population. The erosive form of oral lichen planus is most severe, often unresponsive to systemic and topical therapies. A rare association between this form, diabetes mellitus and hypertension was first reported by Grinspan in 1966. The increased prevalence of diabetes mellitus and carbohydrate intolerance observed in patients with oral lichen planus suggests a possible pathogenic role of the metabolic disorder. Also, a pathogenic link may exist between dyslipidemia and oral lichen planus. Case report A 56 years old woman, presented with eroded and ulcerated extremely painful lesions all over the oral mucosa, but predominantly localized on the tongue, palate, buccal mucosa and attached gingiva, associated with white patches and evolving for 3 years. She was also suffering of type 2 diabetes mellitus, hypertension, gastric ulcer and chronic virus C hepatitis. Histopathological findings sustained the clinical diagnosis of erosive oral lichen planus. Laboratory data revealed high plasma levels of glucose, moderate liver cytolyses, increased levels of tryglicerides, an abnormal level of HDL-cholesterol with an aterogenic Castelli index of 3,09 and positive serological test for virus C hepatitis. The treatment we chose was topical tacrolimus 0.1% ointment twice a day and hyaluronic acid gel with satisfactory results after 4 weeks. Discussions Oral lichen planus represents a cell-mediated immune response with infiltrating T4 and T8 lymphocytes. The exact nature of the correlation between erosive oral lichen planus, diabetes mellitus, hypertension and dyslipidemia is not yet clarified but it is very well known that systemic inflammation is a contributor to ateromatosis. Also the nature of the correlation between oral lichen planus and chronic liver disorders is not yet fully understood. Conclusions All patients with oral lichen planus and particularly those with the erosive form should be examined in order to identify a metabolic syndrome and to initiate an early treatment to avoid future cardiovascular problems. The prognostic of our case correlates with the response of oral lesions to treatment (these lesions should be periodically clinically and histopathologicaly monitored for the malignant transformation risk), with the evolution of chronic virus C hepatitis, of diabetes mellitus and cardiovascular diseases.

Keywords

• Grinspan’s syndrome