Tiwari Shevya M, Gebauer Kurt, Frydrych Agnieszka M, Burrows Sally
Department of Dermatology, Fiona Stanley Hospital, Perth, Western Australia, Australia.
Department of Dermatology, Royal Perth Hospital, Perth, Western Australia, Australia.
Australas J Dermatol. 2018 Aug;59(3):188-193. doi: 10.1111/ajd.12692. Epub 2017 Jul 11.
BACKGROUND/OBJECTIVES: Distinguishing between oral lichen planus (LP) and lichenoid reactions to dental restorations can be impossible on clinical and histopathological grounds. Epicutaneous patch testing is an investigation that may guide patients and physicians in making timely and costly decisions to replace or cover existing dental restorations. This study aimed to assess the role of epicutaneous patch testing with a battery of dental allergens in patients with undifferentiated oral LP.
A retrospective review of the medical records of patients with biopsy-proven oral LP referred by an oral medicine specialist and who presented for dental epicutaneous patch testing at a dermatology clinic in Perth, Western Australia between 2009 and 2016 was performed.
In total, 68 patients were included, of whom 54 (79%) had positive patch tests. Gold 26 (48%), mercury 24 (44%), nickel 22 (41%), copper 19 (35%), potassium dichromate 14 (26%) and methylhydroquinone 13 (24%) were the most common allergens for which patients tested positive. Hypothyroidism and non-steroidal anti-inflammatory drugs were associated with negative patch tests (P = 0.01 and 0.04, respectively). Smoking history, other medications and comorbidities, the location of the dental restorations and unilateral or bilateral disease were not significantly associated with the patch test results. Restorations were removed in 23 patients: 21 of these (91%) had positive epicutaneous patch tests. Of the 20 patients followed up, 19 (95%) experienced some improvement, among whom 11 (58%) had complete remission.
Epicutaneous patch testing disclosed a high proportion of relevant positives. This guided the clinical decision to change dental restorations, with high rate of clinical improvement.
背景/目的：基于临床和组织病理学依据，可能无法区分口腔扁平苔藓（LP）和对牙科修复体的苔藓样反应。皮肤斑贴试验是一项有助于患者和医生及时做出更换或覆盖现有牙科修复体这一昂贵决策的检查。本研究旨在评估使用一组牙科变应原进行皮肤斑贴试验在未分化口腔LP患者中的作用。
对2009年至2016年期间由口腔医学专家转诊至西澳大利亚珀斯一家皮肤科诊所进行牙科皮肤斑贴试验的经活检证实为口腔LP的患者的病历进行回顾性研究。
共纳入68例患者，其中54例（79%）斑贴试验呈阳性。金（26例，48%）、汞（24例，44%）、镍（22例，41%）、铜（19例，35%）、重铬酸钾（14例，26%）和甲基对苯二酚（13例，24%）是患者试验呈阳性的最常见变应原。甲状腺功能减退和非甾体抗炎药与斑贴试验阴性相关（P分别为0.01和0.04）。吸烟史、其他药物和合并症、牙科修复体的位置以及单侧或双侧疾病与斑贴试验结果无显著相关性。23例患者的修复体被移除：其中21例（91%）皮肤斑贴试验呈阳性。在随访的20例患者中，19例（95%）病情有所改善，其中11例（58%）完全缓解。
皮肤斑贴试验显示出高比例的相关阳性结果。这为改变牙科修复体的临床决策提供了指导，临床改善率较高。
