{"id":1979,"date":"2021-11-01T19:20:38","date_gmt":"2021-11-01T19:20:38","guid":{"rendered":"https:\/\/opmdcare.com\/oralni-lihen-planus\/"},"modified":"2022-04-08T17:15:25","modified_gmt":"2022-04-08T17:15:25","slug":"oralni-lihen-planus","status":"publish","type":"post","link":"https:\/\/opmdcare.com\/oralni-lihen-planus\/?lang=hr","title":{"rendered":"Oralni lihen planus"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\" id=\"E841\"><strong>Oralni Lihen Planus i Oralne Lihenoidne Lezije<\/strong><\/h2>\n\n<p id=\"E843\">Oralni lihen planus (OLP) i oralne lihenoidne lezije (OLL) su skupina poreme\u0107aja oralne sluznice koji vjerojatno predstavljaju obrazac uobi\u010dajenih reakcija kao odgovor na ekstrinzi\u010dne antigene, promijenjene autoantigene i superantigene.<\/p>\n\n<p id=\"E843\">Povijesno gledano, vezano za terminologiju OLP i OLL, nakon brojnih nerazrije\u0161enih rasprava i kontroverzi, jo\u0161 uvijek nedostaju definitivni klini\u010dki dijagnosti\u010dki i histolo\u0161ki kriteriji za razlikovanje OLP-a od OLL-a. Tako\u0111er ne postoji konsenzus o mogu\u0107im klini\u010dkim i bihevioralnim razlikama u pogledu rizika zlo\u0107udne transformacije izme\u0111u OLP-a i OLL-a.<\/p>\n\n<p id=\"E843\">Prema klasifikaciji iz 2005. godine OLP je uvr\u0161ten kao potencijalno zlo\u0107udni poreme\u0107aj, \u0161to je potvr\u0111eno i na nedavnoj radionici Svjetske zdravstvene organizacije &#8211; &#8220;Collaborating Center for oral Cancer Workshop &#8221; &#8211; odr\u017eanoj u Ujedinjenom Kraljevstvu 2020. godine.<\/p>\n\n<div style=\"margin: auto; width: 100%; \"><h3 class='azc_tsh_toggle' style='border: 1px solid #ebf7fa; '><a href='#' style='color: #05b3f4; font-size: 18px; font-weight: 600; '>Oralni Lihen Planus<\/a><\/h3><div class='azc_tsh_toggle_container' style='border: 1px solid #ebf7fa; '><\/p>\n\n<p id=\"E868\">OLP se definiran kao \u201ekroni\u010dni upalni poreme\u0107aj nepoznate etiologije s karakteristi\u010dnim relapsima i remisijama, a koji se pojavljuje u obliku bijelih retikularnih lezija, koje mogu biti pra\u0107ene atrofi\u010dnim, erozivnim i ulcerativnim i\/ili plakoznim podru\u010djima.\u201d Lezije su \u010desto bilateralno simetri\u010dne. Mo\u017ee biti prisutan i deskvamativni gingivitis. <\/p>\n\n<h4 class=\"wp-block-heading\" id=\"E875\"><strong>Prevalencija:<\/strong><\/h4>\n\n<ul><li>Procijenjena prevalencija u populaciji kre\u0107e se od 1-3%. OLP je naj\u010de\u0161\u0107a mukokutana bolest usne \u0161upljine.<\/li><li>Preferencija prema \u017eenskom spolu<\/li><li>Pove\u0107an rizik od nastanka OLP-a je nakon 40 -te godine starosti, s prosje\u010dnom dobi pojavljivanja od 50-55 godina.<\/li><\/ul>\n\n<h4 class=\"wp-block-heading\" id=\"E903\"><strong>Zlo\u0107udna Preobrazba:<\/strong><\/h4>\n\n<p id=\"E908\">U analizi koja je uklju\u010divala isklju\u010divo visoko kvalitetne publikacije, autori su zabilje\u017eili<strong>stopu zlo\u0107udne preobrazbe od 2.28% za OLP<\/strong>.<\/p>\n\n<p id=\"E913\"><strong>Rizi\u010dni \u010cimbenici:<\/strong><\/p>\n\n<ul><li>lokalizacija na jeziku<\/li><li>prisutnost atrofi\u010dnih\/erozivnih lezija<\/li><li>konzumacija duhana i alkohola<\/li><li>humani papiloma virus<\/li><li>hepatitis C virus (HCV)<\/li><li>prisutnost aneuploidije<\/li><\/ul>\n\n<p id=\"E929\">Najve\u0107i rizik za razvoj oralnog karcinoma je izme\u0111u 3. i 6. godine od prve dijagnoze OLP-a.<\/p>\n\n<p id=\"E935\">Bolesnici s OLP i OLL mogu razviti vi\u0161estruke zlo\u0107udne lezije, koje ne nastaju uvijek na mjestu ve\u0107 postoje\u0107ih lezija. Oralni planocelularni karcinom koji se razvija u bolesnika s OLP i OLL pokazuje povoljne prognosti\u010dke parametre, posebice u pogledu stope mortaliteta.<\/p>\n\n<h4 class=\"wp-block-heading\" id=\"E945\"><strong>Klini\u010dka Slika:<\/strong><\/h4>\n\n<p id=\"E949\">Prepoznatljive klini\u010dke karakteristike OLP-a podrazumijevaju prisutnost <strong>bijelih papula koje se pove\u0107avaju i spajaju formiraju\u0107i retikularni, prstenasti ili uzorak nalik plaku<\/strong>, takozvane Wickhamove strije.<\/p>\n\n<ul><li>Opisano je 6 klini\u010dkih podtipova OLP-a, koji se mogu pojaviti pojedina\u010dno ili u kombinaciji: retikularni, plakozni, atrofi\u010dni, erozivni\/ulcerozni, papularni i bulozni. Raspravljamo o 2 podtipa <strong>(keratoti\u010dni\/bijeli i eritematozni\/crveni)<\/strong>.<\/li><li>Obi\u010dno je istovremeno prisutno vi\u0161e podtipova.<\/li><li>Naj\u010de\u0161\u0107e zahva\u0107ena podru\u010dja su obrazna sluznica, dorzum i lateralne strane jezika te gingiva.<\/li><li>Gotovo uvijek je prisutna manje vi\u0161e simetri\u010dna bilateralna distribucija<\/li><li>Tijek bolesti karakteriziraju periodi recidivia i remisije, s razmacima od nekoliko tjedana ili mjeseci te klini\u010dkim znakovima i simptomima.<\/li><\/ul>\n\n<h4 class=\"wp-block-heading\" id=\"E991\"><strong>Keratoti\u010dni\/Bijeli Oralni Lihen Planus:<\/strong><\/h4>\n\n<ul><li>Naj\u010de\u0161\u0107i oblik OLP-a, karakteriziran je pojavom simetri\u010dnih bijelih retikularnih lezija (Wickhamove strije), a rje\u0111e bijelih papula ili plakova (Slika 1.).<\/li><li>Plakozni oblik OLP-a izgleda kao homogeni, blago povi\u0161eni, multifokalni bijeli plak, koji tipi\u010dno zahva\u0107a jezik i obraznu sluznicu (Slika 2c).<\/li><li>Op\u0107enito asimptomatski &#8211; obi\u010dno slu\u010dajan nalaz tijekom rutinskog pregleda usne \u0161upljine od strane stomatologa.<\/li><\/ul>\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-1.jpg\"><img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"372\" src=\"https:\/\/opmdcare.com\/wp-content\/uploads\/\/oral-lichen-planus-fig-1-1024x372.jpg\" alt=\"\" class=\"wp-image-489\" srcset=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-1-1024x372.jpg 1024w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-1-300x109.jpg 300w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-1-768x279.jpg 768w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-1-1536x559.jpg 1536w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-1.jpg 1980w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><figcaption>Slika 1: Retikularni oralni lihen planus<\/figcaption><\/figure>\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-layout-1 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-2.jpg\"><img decoding=\"async\" width=\"1024\" height=\"246\" src=\"https:\/\/opmdcare.com\/wp-content\/uploads\/\/oral-lichen-planus-fig-2-1024x246.jpg\" alt=\"\" class=\"wp-image-495\" srcset=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-2-1024x246.jpg 1024w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-2-300x72.jpg 300w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-2-768x185.jpg 768w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-2-1536x369.jpg 1536w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-2.jpg 1980w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><figcaption>Slika 2: a,b) Retikularne, i c) plakozne lezije lihena u istog pacijenta.<\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-3.jpg\"><img decoding=\"async\" width=\"1024\" height=\"228\" src=\"https:\/\/opmdcare.com\/wp-content\/uploads\/\/oral-lichen-planus-fig-3-1024x228.jpg\" alt=\"\" class=\"wp-image-501\" srcset=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-3-1024x228.jpg 1024w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-3-300x67.jpg 300w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-3-768x171.jpg 768w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-3-1536x342.jpg 1536w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-3.jpg 1980w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><figcaption>Slika 3: Plakozne lezije na dorzumu i lateralnoj strani jezika. Histopatolo\u0161ki potvr\u0111en kao oralni lihen planus bez epitelne displazije.<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n<h4 class=\"wp-block-heading\"><strong>Eritematozni\/Crveni Oralni Lihen Planus:\u00a0<\/strong><\/h4>\n\n<ul><li>Mo\u017ee se pojaviti kao podru\u010dje atrofi\u010dne sluznice ili kao crvene lezije zbog hiperemije oralne sluznice.<\/li><li>Podru\u010dja eritema mogu biti popra\u0107ena ulceracijom i \u010desto uz prisutnost bijelih keratoti\u010dnih strija (Slika 4.).<\/li><li>Simptomi variraju od blagog osje\u0107aja peckanja do jake boli. Lezije mogu ote\u017eavati govor, \u017evakanje i gutanje.<\/li><\/ul>\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-layout-2 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-medium\"><a href=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-4.jpg\"><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"109\" src=\"https:\/\/opmdcare.com\/wp-content\/uploads\/\/oral-lichen-planus-fig-4-300x109.jpg\" alt=\"\" class=\"wp-image-507\" srcset=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-4-300x109.jpg 300w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-4-1024x373.jpg 1024w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-4-768x280.jpg 768w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-4-1536x559.jpg 1536w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-4.jpg 1980w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><figcaption>Slika 4: Bilateralni atrofi\u010dni\/erozivni oralni lihen planus na obraznoj sluznici<\/figcaption><\/figure><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-medium\"><a href=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-5.jpg\"><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"104\" src=\"https:\/\/opmdcare.com\/wp-content\/uploads\/\/oral-lichen-planus-fig-5-300x104.jpg\" alt=\"\" class=\"wp-image-513\" srcset=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-5-300x104.jpg 300w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-5-1024x355.jpg 1024w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-5-768x266.jpg 768w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-5-1536x532.jpg 1536w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-5.jpg 1980w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><figcaption>Slika 5: Bilateralni atrofi\u010dni\/erozivni oralni lihen planus na obraznoj sluznici<\/figcaption><\/figure><\/div>\n<\/div>\n<\/div>\n\n<h4 class=\"wp-block-heading\"><strong>Deskvamativni Gingivitis:\u00a0<\/strong><\/h4>\n\n<ul><li>Erozivni lihen planus lokaliziran na gingivi u obliku deskvamativnog gingivitisa (Slika 6.)<\/li><li>OLP je naj\u010de\u0161\u0107i uzrok deskvamativnog gingivitisa nakon pemfigoida i pemfigusa (23).<\/li><li>Naj\u010de\u0161\u0107e je zahva\u0107ena gingiva s bukalne strane.<\/li><\/ul>\n\n<h4 class=\"wp-block-heading\"><strong>Ekstraoralne Manifestacije:<\/strong><\/h4>\n\n<ul><li>15% bolesnika s OLP-om razvije ko\u017eni lihen planus, do 60% bolesnika s ko\u017enim lihenom planusom ima oralne manifestacije<\/li><li>Pojavljuje se kao papuloskvamozni osip s <strong>ljubi\u010dastim izbo\u010dinama ravnog vrha, razli\u010dite veli\u010dine, koji se \u010desto opisuje kao &#8220;6 Ps&#8221; (ljubi\u010dasti, svrbe\u017e, poligonalni, ravni, papule i plakovi),<\/strong> karakteriziran klasi\u010dnim Wickhamovim strijama<\/li><li>Tipi\u010dno je lokaliziran na ekstremitetima (slika 7), ali povremeno mo\u017ee biti generaliziran  i zahva\u0107ati vlasi\u0161te i nokte.<\/li><li>Ostale anatomske lokalizacije koje mogu biti zahva\u0107ene uklju\u010duju genitalnu sluznicu, te sluznicu jednjaka, oka, mokra\u0107nog sustava, nosa, grkljana, uha, \u017eeluca i analne regije.<\/li><\/ul>\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-6-.jpg\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"456\" src=\"https:\/\/opmdcare.com\/wp-content\/uploads\/\/oral-lichen-planus-fig-6--1024x456.jpg\" alt=\"\" class=\"wp-image-525\" srcset=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-6--1024x456.jpg 1024w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-6--300x134.jpg 300w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-6--768x342.jpg 768w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-6--1536x684.jpg 1536w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-6-.jpg 1980w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><figcaption><em>Slika 6: Zahva\u0107ena ko\u017ea u bolesnika s oralnim lihenom planusom (Slika 1). Papularne lezije na a-c) stopalima, d-f) zape\u0161\u0107u i \u0161akama.<\/em><\/figcaption><\/figure>\n\n<p><\/p>\n\n<h4 class=\"wp-block-heading\"><strong>Povezanost sa sistemskim bolestima:<\/strong><\/h4>\n\n<p>OLP se povezuje s razli\u010ditim sistemskim bolestima, uklju\u010duju\u0107i hepatitis C, hipertenziju, dijabetes i bolesti \u0161titnja\u010de<br\/>Postoje \u010dvrsti dokazi o povezanosti HCV s OLP-om te o njegovoj vjerojatnoj uklju\u010denosti u patogenezu. \u010cini se kako bi bilo razborito od bolesnika s OLP-om dobiti informaciju o \u010dimbenicima rizika povezanim s HCV-om te zatra\u017eiti odre\u0111ivanje HCV antitijela ukoliko je opravdano.<\/p>\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-7.jpg\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"967\" src=\"https:\/\/opmdcare.com\/wp-content\/uploads\/\/oral-lichen-planus-fig-7-1024x967.jpg\" alt=\"\" class=\"wp-image-536\" srcset=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-7-1024x967.jpg 1024w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-7-300x283.jpg 300w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-7-768x725.jpg 768w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-7-1536x1450.jpg 1536w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-7.jpg 1980w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><figcaption><em>Slika 7: Deskvamativni gingivitis u bolesnika s oralnim lihenom planusom a) prije i b) nakon lije\u010denja s 0,3% triamcinolon acetonidom u individualnim udlagama.<\/em><\/figcaption><\/figure>\n\n<h4 class=\"wp-block-heading\"><strong>Diferencijalna Dijagnoza:\u00a0<\/strong><\/h4>\n\n<ul><li>Retikularne i eritematozne lezije: OLL i diskoidni eritemsku lupus<\/li><li>Atrofi\u010dni i ulcerozni oblici: pemphigus vulgaris, pemfigoid i linearna IgA bolest (diferencira se po prisutnosti retikularne mre\u017eice).<\/li><li>Plakozni oblik: oralna leukoplakia, proliferativna verukozna leukoplakija (PVL)<\/li><\/ul>\n\n<p>Bez obzira na po\u010detnu dijagnozu, bolesnike s bijelim multifokalnim lezijama treba pa\u017eljivo pratiti zbog rane detekcije zlo\u0107udne preobrazbe.<\/p>\n\n<h4 class=\"wp-block-heading\"><strong>Dijagnoza:<\/strong><\/h4>\n\n<ul><li>Uklju\u010duje procjenu klini\u010dke slike<\/li><li>Za potvrdu dijagnoze potrebno je napraviti biopsiju i patohistolo\u0161ki nalaz zbog potrebe dugotrajnog lije\u010denja i rizika od zlo\u0107udne preobrazbe<\/li><\/ul>\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td>Tip<\/td><td>Nalazi<\/td><\/tr><tr><td>Klini\u010dki kriteriji<\/td><td>Prisutnost bilateralnih, manje ili vi\u0161e simetri\u010dnih bijelih lezija koje zahva\u0107aju obraznu sluznicu, jezik, usne i\/ili gingivu. Prisutnost bijelih papuloznih lezija i \u010dipkaste mre\u017ee blago podignutih bijelih linija (retikularni, prstenasti ili linearni uzorak) sa ili bez erozija i ulceracija. Ponekad se manifestira kao deskvamativni gingivitis. <\/td><\/tr><tr><td>Histopatolo\u0161ki kriteriji<\/td><td>Prisutnost dobro definiranog vrp\u010dastog, prete\u017eno limfocitnog infiltrata koji je ograni\u010den na povr\u0161inski dio vezivnog tkiva. Znakovi vakuolarne degeneracije bazalnih i\/ili suprabazalnih slojeva stanica s apoptozom keratinocita. Kod atrofi\u010dnog tipa dolazi do stanjivanja epitela, a ponekad i do ulceracija uzrokovanih neuspjehom regeneracije epitela kao posljedica razaranja bazalnih stanica. Mo\u017ee biti prisutan i mje\u0161oviti upalni infiltrat.<\/td><\/tr><\/tbody><\/table><figcaption><br\/>Table 1: Dijagnosti\u010dki kriterij za Oralni lihen planus (Prilago\u0111eno prema Warnakulasuriya i sur., 2020)<\/figcaption><\/figure>\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-8.jpg\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"371\" src=\"https:\/\/opmdcare.com\/wp-content\/uploads\/\/oral-lichen-planus-fig-8-1024x371.jpg\" alt=\"\" class=\"wp-image-542\" srcset=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-8-1024x371.jpg 1024w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-8-300x109.jpg 300w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-8-768x278.jpg 768w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-8-1536x557.jpg 1536w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-8.jpg 1980w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><figcaption><em>Slika 8: OLP histopatolo\u0161ki nalazi (a) Akantoza, odebljanje bazalne membrane i subepitelni vrp\u010dasti limfocitni infiltrat; (b) Epitel pokazuje skvamatizaciju bazalnog sloja, blagu spongiozu, egzocistozu leukocita &amp; koloidna\/Civatte tjele\u0161ca (vrh strelice)<\/em><\/figcaption><\/figure>\n\n<p><\/p>\n\n<h4 class=\"wp-block-heading\"><strong>Lije\u010denje:<\/strong><\/h4>\n\n<ul><li>Glavni cilj lije\u010denja OLP je ubla\u017eavanje simptoma &#8211; bolesnici s retikularnim lezijama i drugim asimptomatskim lezijama ne trebaju lije\u010denje<\/li><li>Najprije treba identificirati i isklju\u010diti okida\u010de i ote\u017eavaju\u0107e \u010dimbenike (o\u0161tri ili slomljeni zubi, lo\u0161e postavljena proteza itd.).<\/li><li>Bolesnike treba savjetovati da prestanu s konzumiranjem duhana i alkohola jer isti mogu pove\u0107ati rizik od zlo\u0107udne transformacije. Bolesnike tako\u0111er treba pou\u010diti da odr\u017eavaju dobru oralnu higijenu, jer smanjenje zubnih naslaga mo\u017ee imati povoljan u\u010dinak na gingivne lezije.<\/li><li>Natrij-lauril sulfat (SLS) je sredstvo za stvaranje pjene koje se dodaje zubnim pastama a mo\u017ee pogor\u0161ati simptome, te se stoga preporu\u010da kori\u0161tenje paste za zube bez SLS-a.<\/li><li>Olak\u0161anje simptoma mo\u017ee se posti\u0107i upotrebom lokalnih anestetika kao \u0161to je 0,15% benzidamin hidroklorid (kao sprej ili teku\u0107ina za ispiranje usta) ili lidokain gel.<\/li><li>Prva linija terapije za OLP su topikalni kortikosteroidi. Dostupan je niz pripravaka koji se mogu koristiti kao vodice za ispiranje usta: tablete betametazon natrijevog fosfata od 500 mikrograma otopljene u 10 ml vode do \u010detiri puta dnevno, tablete prednizolona od 5 mg otopljene u 10 ml vode ili fliksonaze ampule od 400 mikrograma u 10 ml vode dva puta dnevno. Flutikazon propionat sprej (50 mikrograma\/udah) usmjeren na zahva\u0107ena podru\u010dja 3-4 puta dnevno koristan je za izolirane lezije.<\/li><li>Za deskvamativni gingivitis koriste se preparati s kortikosteroidima u obliku gela koji se nanose u individualno prilago\u0111ene udlage, izra\u0111ene od meke prozirne smole ili silikona kako bi se produ\u017eilo vrijeme kontakta.<\/li><\/ul>\n\n<h4 class=\"wp-block-heading\"><strong>Pra\u0107enje<\/strong><\/h4>\n\n<ul><li>Zbog rizika zlo\u0107udne preobrazbe, redovito pra\u0107enje je potrebno kako bi se detektirao relaps bolesti.<\/li><li>U\u010destalost kontrolnih pregleda pove\u0107ava se proporcionalno s aktivno\u0161\u0107u i simptomima bolesti.<\/li><li>Preporuka je minimalno jedan kontrolni pregled godi\u0161nje a  po mogu\u0107nosti i 2 do 4 godi\u0161nja pregleda ovisno o znakovima i simptomima OLP-a.<\/li><li>Ukoliko se tijekom kontrolnih pregleda uo\u010de nove promjene na leziji, potrebno je napraviti biopsiju i skratiti intervale pra\u0107enja.<\/li><\/ul>\n<p><\/div><\/div>\n\n<p><meta charset=\"utf-8\"\/><meta charset=\"utf-8\"\/><meta charset=\"utf-8\"\/> <div style=\"margin: auto; width: 100%; \"><h3 class='azc_tsh_toggle' style='border: 1px solid #ebf7fa; '><a href='#' style='color: #05b3f4; font-size: 18px; font-weight: 600; '>Oralne Lihenoidne Lezije<\/a><\/h3><div class='azc_tsh_toggle_container' style='border: 1px solid #ebf7fa; '><\/p>\n\n<p>Lihenoidne lezije su crvene\/bijele intraoralne lezije s retikularnim strijama izgledom sli\u010dne OLP-u, ali se povezuju s razli\u010ditim poznatim \u010dimbenicima. Lezije se mogu podijeliti na oralne lihenoidne kontaktne lezije, lijekovima izazvane OLL i GVHD-inducirane OLL. <\/p>\n\n<h4 class=\"wp-block-heading\"><strong>Oralne Lihenoidne Kontaktne Lezijes:<\/strong><\/h4>\n\n<ul><li>Oralne lihenoidne kontaktne lezije koriste se za opisivanje oralnih lezija koje klini\u010dki i histopatolo\u0161ki podsje\u0107aju na lihen planus. <\/li><li>Smatra se da je uzrokovana lokalnom reakcijom preosjetljivosti (preosjetljivost posredovana odgo\u0111enim imunitetom) na dentalni restaurativni materijal (amalgam, zlato, nikal, akrilna smola) ili druga sredstva (npr. cimet).<\/li><li>Pojavljuju se kao bijele lezije ili mje\u0161ovite crveno-bijele lezije, povremeno ulcerirane. Oralne lihenoidne kontaktne lezije su op\u0107enito manje simetri\u010dne i \u010de\u0161\u0107e jednostrane od OLP-a te im mo\u017ee nedostajati tipi\u010dni retikularni izgled OLP-a, \u010de\u0161\u0107e se pojavljuju kao plakozni ili atrofi\u010dni oblik.<\/li><li>Dijagnosti\u010dka karakteristika je topografsko mjesto u izravnom kontaktu  s suspektnim uzro\u010dnikom.<\/li><\/ul>\n\n<p><meta charset=\"utf-8\"\/><div class=\"show_more\"><p class=\"wpsm-show\" style=\"color: #05B3F4; font-size: 100%; text-align: left;\">\u00bb Show more<\/p><div class=\"wpsm-content\"><\/p>\n\n<ul><li><span style=\"font-family: -apple-system, BlinkMacSystemFont, &quot;Segoe UI&quot;, Roboto, Oxygen-Sans, Ubuntu, Cantarell, &quot;Helvetica Neue&quot;, sans-serif; veli&#x10D;ina fonta: 1rem;\"> \u010cini se kako je trajanje kontakta izme\u0111u uzro\u010dnika i oralne sluznice va\u017ean \u010dimbenik u razvoju Oralnih lihenoidnih kontaktnih lezija<\/span><\/li><li>Dijagnoza se obi\u010dno temelji na klini\u010dkim nalazima, a nestanak lezije nakon eliminacije\/zamjene restaurativnog materijala ili mogu\u0107eg uzro\u010dnika potvr\u0111uje dijagnozu.<\/li><li>Mo\u017ee se napraviti test zakrpe (&#8220;patch test&#8221;) kako bi se identificirala potencijalna reakcija preosjetljivosti; me\u0111utim, studije o njegovoj koristi za dijagnosticiranje oralnih kontaktnih lihenoidnih lezija pokazale su opre\u010dne rezultate. Provo\u0111enje testa tako\u0111er mo\u017ee biti od pomo\u0107i prilikom odabira alternativnog restaurativnog materijala.<\/li><li>Klini\u010dari bi s bolesnicima trebali raspraviti o potencijalnim prednostima i rizicima uklanjanja amalgamskih ispuna, spomenuti periodi\u010dku prirodu bolesti, koju karakteriziraju razdoblja pogor\u0161anja i spontane remisije, te nepredvidljivost postupka uklanjanja amalgama u povla\u010denju lezija.<\/li><\/ul>\n<p> <p class=\"wpsm-hide\" style=\"color: #05B3F4; font-size: 100%; text-align: left;\">\u00bb View less<\/p><\/div><\/div><\/p>\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-9.jpg\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"836\" src=\"https:\/\/opmdcare.com\/wp-content\/uploads\/\/oral-lichen-planus-fig-9-1024x836.jpg\" alt=\"\" class=\"wp-image-553\" srcset=\"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-9-1024x836.jpg 1024w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-9-300x245.jpg 300w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-9-768x627.jpg 768w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-9-1536x1254.jpg 1536w, https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus-fig-9.jpg 1980w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><figcaption><em>Figure 9: Oralna lihenoidna lezija u direktnom kontaktu s amalgamskim ispunom.<\/em><\/figcaption><\/figure>\n\n<p><\/p>\n\n<h4 class=\"wp-block-heading\">Lijekovima izazvane oralne lihenoidne lezije<\/h4>\n\n<ul><li>Uzrokovane ili povezane s izlo\u017eeno\u0161\u0107u odre\u0111enim lijekovima, rijetke su za razliku od ko\u017enih OLL<\/li><li>Duga je lista sistemskih lijekova koji se povezuju s pojavom OLL-a, a uklju\u010duje nesteroidne protuupalne lijekove, antihipertenzive, oralne hipoglikemike, antibiotike, antifungalne lijekove i monoklonska antitijela<\/li><li>Obi\u010dno vremenska povezanost izme\u0111u pojave oralnih i\/ili ko\u017enih lezija i uzimanja odre\u0111enih lijekova; me\u0111utim, reakcija na lijek se mo\u017ee pojaviti u bilo kojem trenutku, uklju\u010duju\u0107i i godine nakon njegovog uvo\u0111enja<\/li><\/ul>\n\n<p id=\"E1030\"><meta charset=\"utf-8\"\/><div class=\"show_more\"><p class=\"wpsm-show\" style=\"color: #05B3F4; font-size: 100%; text-align: left;\">\u00bb Show more<\/p><div class=\"wpsm-content\"><\/p>\n\n<ul><li>Klini\u010dki izgled je nejasan, posebno u usporedbi s drugim lihenoidnim lezijama, iako jednostrano pojava promjena mo\u017ee pomo\u0107i u postavljanju dijagnoze<\/li><li>Dijagnoza se potvr\u0111uje kada nastupi regresije lezije nakon ukidanja ili promjene mogu\u0107eg uzro\u010dnog lijeka te nakon ponovne pojave lezije uslijed ponovnog po\u010detka lije\u010denja istim lijekom<\/li><li>Lijekove treba ukinuti tek nakon savjetovanja s bolesnikovim lije\u010dnikom, a ova praksa nije uvijek izvediva u bolesnika koji uzimaju vi\u0161e lijekova<\/li><\/ul>\n<p> <p class=\"wpsm-hide\" style=\"color: #05B3F4; font-size: 100%; text-align: left;\">\u00bb View less<\/p><\/div><\/div><\/p>\n\n<h4 class=\"wp-block-heading\">Bolest presatka protiv primatelja (GVHD)<\/h4>\n\n<ul><li>GVHD je komplikacija koja se javlja u primatelja nakon transplantacije krvotvornih mati\u010dnih stanica.<\/li><li>Sistemsko stanje s razli\u010ditim znakovima i simptomima, zahva\u0107a vi\u0161e organa, uklju\u010duju\u0107i ko\u017eu, usnu \u0161upljinu, o\u010di, gastrointestinalni trakt i jetru, kao i druge sustave poput plu\u0107a, zglobova i genitourinarnog trakta.<\/li><li>Oralne promjene kod akutnog GVHD-a su iznimno rijetke, me\u0111utim, usna \u0161upljina jedno je od naj\u010de\u0161\u0107e zahva\u0107enih mjesta kod kroni\u010dnog GVHD-a.<\/li><li>Oralne promjene kod kroni\u010dnog GVHD-a klini\u010dki karakterizira pojava lihenoidne upale koja \u010desto zahva\u0107a jezik i oralnu sluznicu, ali mo\u017ee zahvatiti bilo koje mjesto u usnoj \u0161upljini i mo\u017ee varirati od ograni\u010dene bolesti sa samo blagim promjenama do opse\u017enije i simptomatske bolest.<\/li><li>Klini\u010dke promjene uklju\u010duju papule, bijele plakove i hiperkeratoti\u010dne strije koje podsje\u0107aju na Wickhamove strije kod OLP, kao i eritem te ulceracije prekrivene pseudomembranama.<\/li><li>Klini\u010dke karakteristike \u010desto su dovoljne za postavljanje dijagnoze, pod uvjetom da su prisutne u kontekstu bolesnika koji je podvrgnut alogenskoj transplantaciji krvotvornih mati\u010dnih stanica<\/li><\/ul>\n<p><\/div><\/div><\/p>\n\n<div style=\"margin: auto; width: 100%; \"><h3 class='azc_tsh_toggle' style='border: 1px solid #ebf7fa; '><a href='#' style='color: #05b3f4; font-size: 18px; font-weight: 600; '>Literatura<\/a><\/h3><div class='azc_tsh_toggle_container' style='border: 1px solid #ebf7fa; '><\/p>\n\n<p class=\"has-small-font-size\">Khudhur AS, Di Zenzo G, Carrozzo M. 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Dent Clin North Am. 2014;58(2):351-68.<\/p>\n<p><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Oralni Lihen Planus i Oralne Lihenoidne Lezije Oralni lihen planus (OLP) i oralne lihenoidne lezije (OLL) su skupina poreme\u0107aja oralne sluznice koji vjerojatno predstavljaju obrazac uobi\u010dajenih reakcija kao odgovor na ekstrinzi\u010dne antigene, promijenjene autoantigene i superantigene. Povijesno gledano, vezano za terminologiju OLP i OLL, nakon brojnih nerazrije\u0161enih rasprava i kontroverzi, jo\u0161 uvijek nedostaju definitivni klini\u010dki [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":459,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"default","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[9],"tags":[],"jetpack_featured_media_url":"https:\/\/opmdcare.com\/wp-content\/uploads\/oral-lichen-planus.png","_links":{"self":[{"href":"https:\/\/opmdcare.com\/wp-json\/wp\/v2\/posts\/1979"}],"collection":[{"href":"https:\/\/opmdcare.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/opmdcare.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/opmdcare.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/opmdcare.com\/wp-json\/wp\/v2\/comments?post=1979"}],"version-history":[{"count":2,"href":"https:\/\/opmdcare.com\/wp-json\/wp\/v2\/posts\/1979\/revisions"}],"predecessor-version":[{"id":2224,"href":"https:\/\/opmdcare.com\/wp-json\/wp\/v2\/posts\/1979\/revisions\/2224"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/opmdcare.com\/wp-json\/wp\/v2\/media\/459"}],"wp:attachment":[{"href":"https:\/\/opmdcare.com\/wp-json\/wp\/v2\/media?parent=1979"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/opmdcare.com\/wp-json\/wp\/v2\/categories?post=1979"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/opmdcare.com\/wp-json\/wp\/v2\/tags?post=1979"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}