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The formation mechanism of OLP is very complicated, and its treatment has always been a difficult problem. This study was to explore the feasibility of pulsed Er: YAG laser in the treatment of erosive OLP by comparing its effect with that of Triamcinolone Acetonide ointment(TA) of OLP, in order to provide new ideas for the clinical treatment of erosive OLP. Forty patients who were clinically and histopathologically diagnosed as OLP at the Department of Periodontics and Oral Mucosa Disease of Dalian Stomatological Hospital were selected, all lesions accompanied by erosion. The included patients were randomly divided into two groups: Er: YAG group and TA group, with 20 cases in each group. The visual analogue scale (VAS), mean lesion area, clinical sign score, and function score in both groups were evaluated at baseline, 1 week, 2 weeks, 1 month and 3 months after treatment, and the recurrence rate of cured patients in both groups was evaluated at 3 months after treatment. Er: YAG laser was superior to TA in relieving pain at 1 week(1.50 ± 0.946 vs. 2.10 ± 0.912, P  < 0.05) and improving function at all stages( P  < 0.05). But TA was superior to the pulsed Er: YAG laser in promoting the healing of erosive lesions at 2 weeks(0.07 ± 0.223 vs. 0.31 ± 0.549, P  < 0.05). There was no significant difference in recurrence between the two groups( P  > 0.05). There is no significant difference between pulsed Er: YAG laser and TA in the treatment of erosive OLP. The use of pulsed Er: YAG laser represents a viable and effective therapeutic option for erosive OLP.

Introduction Erosive oral lichen planus (OLP) and periodontitis frequently coexist and may worsen each other. This study will evaluate the effectiveness and safety of combining periodontal initial therapy under local anesthesia with intralesional betamethasone sodium phosphate (BSP) injection in patients with erosive OLP, particularly in enhancing lesion healing. Methods and analysis This is a multicenter, randomized, split-mouth, self-controlled trial. We will recruit 29 adults from five tertiary centers in China. Eligible participants are adults (aged ≥ 18 years) diagnosed with erosive gingival OLP accompanied by generalized periodontitis (stage II–IV). Within each participant, sides will be randomly allocated to a test side (periodontal initial therapy under local anesthesia plus intralesional BSP) and a control side (intralesional BSP alone). Independent outcome assessors and statisticians will be strictly blinded to ensure objectivity of the assessments. The follow-up will last 6 months, with assessments at the 2nd, 4th, 8th, 12th, and 24th weeks. The primary outcome is the reduction in erosive lesion size at the 12th week. Secondary outcomes will include the complete healing rate, OLP clinical severity scores, visual analog score of pain, periodontal parameters, and complications. Discussion This protocol introduces an innovative method for managing erosive OLP accompanied by periodontitis by integrating periodontal initial therapy under local anesthesia with corticosteroid injections. It aims to offer a more effective and patient-centric multidisciplinary treatment strategy. The utilization of local anesthetics will enhance patient comfort and optimize adherence. Findings will guide clinical practice and motivate mechanistic studies. Trial registration The trial has been registered on the Chinese Clinical Trial Registry (No. ChiCTR2400083728; registered on April 30, 2024) and on the U.S. National Institutes of Health Clinical Trials website (No. NCT06498180; registered on July 12, 2024). Protocol version: 1.0 Version date: 01 September 2025.

Vulvar lichen sclerosus and lichen planus are T-cell–mediated chronic skin disorders. Although autoimmunity has been suggested, the exact pathogenesis of these disorders is still unknown. Therefore, the aim of the current study was to investigate the molecular and immunological mechanisms critical to the pathogenesis of vulvar lichen sclerosus and lichen planus. By using gene expression profiling and real-time RT-PCR experiments, we demonstrated a significantly increased expression of the pro-inflammatory cytokines (IFNγ, CXCR3, CXCL9, CXCL10, CXCL11, CCR5, CCL4, and CCL5) specific for a Th1 IFNγ-induced immune response. In addition, BIC/microRNA-155 (miR-155)—a microRNA involved in regulation of the immune response—was significantly upregulated in lichen sclerosus and lichen planus (9.5- and 17.7-fold change, respectively). Immunohistochemistry showed a significant T-cell response, with pronounced dermal infiltrates of CD4+, CD8+, and FOXP3+ cells. In conclusion, these data demonstrate an autoimmune phenotype in vulvar lichen sclerosus and lichen planus, characterized by increased levels of Th1-specific cytokines, a dense T-cell infiltrate, and enhanced BIC/miR-155 expression.

Oral lichen planus (OLP) is a chronic, T cell-mediated inflammatory disorder classified by the World Health Organization as an oral potentially malignant disorder (OPMD). Despite decades of research, its precise etiology remains incompletely understood and involves a complex interplay between genetic predisposition, environmental triggers, and autoimmune-like responses. This review provides a comprehensive update on OLP pathogenesis, emphasizing the role of CD8 positive cytotoxic T lymphocyte-driven basal keratinocyte apoptosis and the skewing of the T-cell receptor (TCR) repertoire. We highlight the significance of the epidermal growth factor receptor (EGFR) signaling pathway as a molecular bridge between chronic inflammation and epithelial proliferation. Furthermore, we discuss a stepwise therapeutic approach that prioritizes the management of the oral microenvironment—specifically Candida colonization and periodontal health—before escalating to immunosuppressive agents. Finally, we explore emerging precision medicine frontiers, including IL-17/IL-23 inhibitors and JAK inhibitors, alongside traditional Japanese Kampo medicine (Hange-shashin-to) and systemic adjuncts like Cepharanthine, offering a contemporary perspective on modern OLP management. This integrative framework redefines OLP not merely as a chronic inflammatory disorder, but as an immunologically sustained, microenvironment-driven, potentially malignant condition.

Lichen sclerosus (LS) is a chronic, inflammatory, mucocutaneous disorder of genital and extragenital skin. LS is a debilitating disease, causing itch, pain, dysuria and restriction of micturition, dyspareunia, and significant sexual dysfunction in women and men. Many findings obtained in recent years point more and more towards an autoimmune-induced disease in genetically predisposed patients and further away from an important impact of hormonal factors. Preceding infections may play a provocative part. The role for Borrelia is still controversial. Trauma and an occlusive moist environment may act as precipitating factors. Potent and ultrapotent topical corticosteroids still head the therapeutic armamentarium. Topical calcineurin inhibitors are discussed as alternatives in the treatment of LS in patients who have failed therapy with ultrapotent corticosteroids, or who have a contraindication for the use of corticosteroids. Topical and systemic retinoids may be useful in selected cases. Phototherapy for extragenital LS and photodynamic therapy for genital LS may be therapeutic options in rare cases refractory to the already mentioned treatment. Surgery is restricted to scarring processes leading to functional impairment. In men, circumcision is effective in the majority of cases, but recurrences are well described. Anogenital LS is associated with an increased risk for squamous cell carcinoma of the vulva or penis. This review updates the epidemiology, clinical presentation, histopathology, pathogenesis, and management of LS of the female and male genitals and extragenital LS in adults and children.

Isousnic acid (isoUA) has been detected in a few usnic acid (UA)-producing lichens with chemotaxonomic values. IsoUA was first isolated from a specimen belonging to Cladonia arbuscula s.l. (referred to as C. mitis in the publication). However, the isolation and detection of isoUA in this Cladonia species have not been reproduced and confirmed with clear evidence. This study focused on C. arbuscula s.l. collected in Iceland and aimed to (1) identify the lichen specimen using DNA barcoding and (2) investigate whether isoUA is produced using a series of chromatographic methods. The fungal nuclear ribosomal internal transcribed spacer (nrITS) barcode was sequenced, and the specimen was identified as C. arbuscula, following recent circumscription recommendations. Routine metabolite profiling did not detect isoUA, and it could only be identified after vigorous chromatographic purification and concentration steps using flash chromatography and preparative high-performance liquid chromatography. IsoUA was found in trace quantities (~24 µg/g dry weight), which likely explains its absence in routine metabolite profiling. A rapid ultra-high-performance liquid chromatography (UHPLC) method using a pentafluorophenyl column was developed to separate UA and isoUA. Our study highlights the importance of an integrative approach combining DNA barcoding and detailed chromatographic analyses for lichen chemistry research.

Lichens play significant roles in ecosystem function and comprise about 20% of all known fungi. Polyketide-derived natural products accumulate in the cortical and medullary layers of lichen thalli, some of which play key roles in protection from biotic and abiotic stresses (e.g., herbivore attacks and UV irradiation). The depside and depsidone series compounds of polyketide origin accumulate in the cortical or medullary layers of lichen thalli. Despite the taxonomic and ecological significance of lichen chemistry and its pharmaceutical potentials, there has been no single piece of genetic evidence linking biosynthetic genes to lichen substances. Thus, we systematically analyzed lichen polyketide synthases (PKSs) for categorization and identification of the biosynthetic gene cluster (BGC) involved in depside/depsidone production. Our in-depth analysis of the interspecies PKS diversity in the genus Cladonia and a related Antarctic lichen, Stereocaulon alpinum , identified 45 BGC families, linking lichen PKSs to 15 previously characterized PKSs in nonlichenized fungi. Among these, we identified highly syntenic BGCs found exclusively in lichens producing atranorin (a depside). Heterologous expression of the putative atranorin PKS gene (coined atr1 ) yielded 4- O -demethylbarbatic acid, found in many lichens as a precursor compound, indicating an intermolecular cross-linking activity of Atr1 for depside formation. Subsequent introductions of tailoring enzymes into the heterologous host yielded atranorin, one of the most common cortical substances of macrolichens. Phylogenetic analysis of fungal PKS revealed that the Atr1 is in a novel PKS clade that included two conserved lichen-specific PKS families likely involved in biosynthesis of depsides and depsidones. Here, we provide a comprehensive catalog of PKS families of the genus Cladonia and functionally characterize a biosynthetic gene cluster from lichens, establishing a cornerstone for studying the genetics and chemical evolution of diverse lichen substances. IMPORTANCE Lichens play significant roles in ecosystem function and comprise about 20% of all known fungi. Polyketide-derived natural products accumulate in the cortical and medullary layers of lichen thalli, some of which play key roles in protection from biotic and abiotic stresses (e.g., herbivore attacks and UV irradiation). To date, however, no single lichen product has been linked to respective biosynthetic genes with genetic evidence. Here, we identified a gene cluster family responsible for biosynthesis of atranorin, a cortical substance found in diverse lichen species, by categorizing lichen polyketide synthase and reconstructing the atranorin biosynthetic pathway in a heterologous host. This study will help elucidate lichen secondary metabolism, harnessing the lichen’s chemical diversity, hitherto obscured due to limited genetic information on lichens.