Photodynamic therapy in the treatment of oral lichen planus with moderate-to-severe dysplasia: A case report
Photodynamic therapy in the treatment of oral lichen planus with moderate-to-severe dysplasia: A case report
复制标题
光动力疗法治疗中度至重度不典型增生的口腔扁平苔藓：一例报告
DOI：
10.1111/dth.14490
复制
发表时间：
2020
影响因子：
3.6
通讯作者：
Chen Qianming
中科院分区：
文献类型：
--
作者：
Shang Qianhui;Wang Zhen;Dong Yunmei;Cai Luyao;Mao Fei;Deng Jiaxin;Dan Hongxia;Zeng Xin;Zhou Yu;Chen Qianming
患者女，47岁，主诉说话时舌头轻微疼痛，进食辛辣食物4个月。除慢性胃炎外，患者否认全身性疾病。她否认长期吸毒、吸烟、饮酒史，否认食用肉桂或含肉桂酸的产品。临床检查显示右舌尖局部充血，双侧侧缘和舌腹侧有模糊和树枝状白色花边条纹（图1A，B）。在右舌腹中部发现一个平坦的白色斑块，边缘清晰，并且柔软（图1A和2A）。双侧下颌后牙颊粘膜、前庭沟、牙龈见网状珍珠状白色花边条纹，轻度充血，无糜烂（图1D、E）。口腔内未见牙体修复体。指甲、脚趾和皮肤均未见异常表现。组织病理学结果与OLP伴右舌腹侧中度至重度上皮异型增生和右颊粘膜OLP一致雅阁（图1C、F和2B）。直接免疫荧光结果显示免疫球蛋白（IG）M沿着右舌腹侧基底膜局灶性沉积，右侧颊粘膜上未检测到伊加、IgM、IgG或补体C3。血常规、血糖、肝肾功能正常。沙利度胺治疗20天后，临床症状没有改善（图2C）。在患者同意下，使用PDT治疗右舌腹侧前后病变（图2D）。20%的5-氨基乙酰丙酸（5-ALA）混合液由118 mg/瓶5-ALA（上海复旦张江）和0.5 mL注射用水组成，4 ℃保存。将与棉片组合的混合物在右腹侧舌上孵育3 h，并每小时更换敷料。随后，使用630 nm发光二极管（100 J/cm）照射病灶，持续18 min。一个月后，我们再次用PDT治疗（图2 E）。在1个月随访时，我们发现右舌腹侧的白色斑块消退，在舌腹侧观察到少量网状珍珠状白色花边条纹（图2F）。在5个月随访时，初始病变明显消失，偶尔出现疼痛（图2G）。在1年随访时，右腹侧舌无异常且无疼痛（图2 H）。患者对PDT治疗满意，未发现任何副作用。
A 47-year-old female, complained mild pain on the tongue when she was speaking, eating hot or spicy food for 4 months. The patient denied systemic disease except chronic gastritis. She denied the history of long-term drugs, smoking, alcohol consumption, and denied eating cinnamon or cinnamic aldehyde-containing products. Clinical examination revealed local hyperemia on the right tip of the tongue, nebulous and dendritic white lacy streaks on the bilateral lateral border and ventral tongue (Figure 1A,B). A flat white patch was found on the middle right ventral tongue with clear margin and was soft (Figures 1A and 2A). Reticular pearl white lacy streaks were seen on bilateral buccal mucosa, vestibular groove and gingiva of bilateral mandibular posterior teeth with mild hyperemia and none erosion (Figure 1D,E). No dental restoration was found in oral cavity. No abnormal performance was found on the fingernails, toes and skin. The histopathological findings were in accord with OLP with moderate-to-severe epithelial dysplasia of the right ventral tongue and OLP of the right buccal mucosa (Figures 1C,F and 2B). The results of direct immunofluorescence exhibited focal deposition of immunoglobulin (Ig) M along the basement membrane of the right ventral tongue and no detection of IgA, IgM, IgG, or complement C3 on the right buccal mucosa. Blood routine examination, blood sugar, and liver and kidney function were normal. After the treatment of thalidomide for 20 days, there was no improvement in clinical symptoms (Figure 2C). Under the agreement on the patient, PDT was used to treat the lesions of anterior and posterior of right ventral tongue (Figure 2D). 20% mixture of 5-aminolevulinic acid (5-ALA) was consisted of 118 mg/bottle 5-ALA (Fudan-Zhangjiang, Shanghai, China) and 0.5 mL water for injection and stored at 4 C in our study. The mixture combined with cotton sheet was incubated on the right ventral tongue for 3 h and changed dressing every hour. Subsequently, a 630 nm light emitting diode (100 J/cm) was used to irradiate the lesions and continued for 18 min once. One month later, we treated with PDT again (Figure 2E). At the 1-month follow-up, we found white patches of right ventral tongue were faded away, few reticular pearl white lacy streaks were observed in the ventral of tongue (Figure 2F). At the 5-month follow-up, the initial lesions were obviously disappeared with occasional bouts of pain (Figure 2G). There were no abnormal and no pain in the right ventral tongue at the 1-year follow-up (Figure 2H). The patient was satisfied with the treatment of PDT and no side-effects were noticed.