PDF(Pubmed)
Abstract：
Discoid lupus erythematosus and oral lichen planus are chronic systemic immune system-mediated diseases with unclear etiology and pathogenesis. The oral mucosa is the common primary site of pathogenesis in both, whereby innate and adaptive immunity and inflammation play crucial roles. The clinical manifestations of discoid lupus erythematosus on the oral mucosa are very similar to those of oral lichen planus; therefore, its oral lesion is classified under oral lichenoid lesions. In practice, the differential diagnosis of discoid lupus erythematosus and oral lichen planus has always relied on the clinical manifestations, with histopathological examination as an auxiliary diagnostic tool. However, the close resemblance of the clinical manifestations and histopathology proves challenging for accurate differential diagnosis and further treatment. In most cases, dentists and pathologists fail to distinguish between the conditions during the early stages of the lesions. It should be noted that both are considered to be precancerous conditions, highlighting the significance of early diagnosis and treatment. In the context of unknown etiology and pathogenesis, we suggest a serological and genetic diagnostic method based on TNF-α and IL-10. These are the two most common cytokines produced by the innate and adaptive immune systems and they play a fundamental role in maintaining immune homeostasis and modulating inflammation. The prominent variability in their expression levels and gene polymorphism typing in different lesions compensates for the low specificity of current conventional diagnostic protocols. This new diagnostic scheme, starting from the immunity and inflammation of the oral mucosa, enables simultaneous comparison of discoid lupus erythematosus and oral lichen planus. With relevant supportive evidence, this information can enhance physicians\' understanding of the two diseases, contribute to precision medicine, and aid in prevention of precancerous conditions.
摘要：
盘状红斑狼疮和口腔扁平苔藓是由免疫系统介导的慢性疾病，病因和发病机制尚不清楚。口腔粘膜是两者发病的共同原发部位,因此，先天和适应性免疫和炎症起着至关重要的作用。盘状红斑狼疮在口腔粘膜上的临床表现与口腔扁平苔藓非常相似；因此，其口腔病变分类为口腔苔藓样病变。在实践中,盘状红斑狼疮与口腔扁平苔藓的鉴别诊断一直依靠临床表现,组织病理学检查作为辅助诊断工具。然而,临床表现和组织病理学非常相似，这对于准确的鉴别诊断和进一步的治疗具有挑战性。在大多数情况下,牙医和病理学家无法区分病变早期的状况。应该注意的是，两者都被认为是癌前病变，强调早期诊断和治疗的意义。在病因和发病机制不明的情况下，我们建议一种基于TNF-α和IL-10的血清学和遗传学诊断方法。这些是由先天和适应性免疫系统产生的两种最常见的细胞因子，它们在维持免疫稳态和调节炎症中起着重要作用。不同病变中它们的表达水平和基因多态性分型的显着变异性弥补了当前常规诊断方案的低特异性。这个新的诊断方案,从口腔粘膜的免疫和炎症开始，能够同时比较盘状红斑狼疮和口腔扁平苔藓。有了相关的支持证据，这些信息可以增强医生对这两种疾病的理解，为精准医学做出贡献，并帮助预防癌前病变。
