title: Is chronic ulcerative stomatitis a variant of lichen planus, or a distinct disease?
abstract: Chronic ulcerative stomatitis is an immune-mediated mucocutaneous disorder characterized clinically by erosions or ulcers. Most cases are limited to the mouth. The histopathological features are non-specific or mimic those of oral lichen planus, and studies by immunofluorescent microscopy are essential for definitive diagnosis. The defining immunopathogenic mechanism is the binding of IgG to the nuclear protein deltaNp63alpha of keratinocytes in the basal and parabasal cell layers of the oral stratified epithelium. DeltaNp63alpha functions as a regulator of epithelial stem cell activity and as an antiapoptotic agent and regulates the expression of cell-to-cell and cell-to-basement membrane adhesion molecules. The autoimmune IgG-deltaNp63alpha interaction is thought to result in damage to the structural attachment of keratinocytes to one another and to the epithelial basement membrane zone and in dysregulation of the cell cycle and apoptosis of basal keratinocytes with the development of erosions or ulcers. The aims of treatment are to suppress the pathogenic immunoinflammatory responses, to prevent local infection and to promote healing. The purpose of this article is to provide a succinct review of the diagnostic, clinical and etiopathogenic features of, and treatment guidelines for chronic ulcerative stomatitis, and to argue that this disease should be regarded as a variant of oral lichen planus, rather than as a distinct entity.
authors.affiliation: Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
authors.forename: Liviu
authors.identifier: http://orcid.org/0000-0002-6135-6807
authors.initials: L
authors.lastname: Feller
authors.affiliation: Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
authors.forename: Razia A G
authors.initials: RAG
authors.lastname: Khammissa
authors.affiliation: Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
authors.forename: Johan
authors.initials: J
authors.lastname: Lemmer
mesh_terms: D002908:Chronic Disease; D003937:Diagnosis, Differential; D006801:Humans; D017676:Lichen Planus, Oral / Q000175:diagnosis*; D019226:Oral Ulcer / Q000150:complications / Q000175:diagnosis*; D013280:Stomatitis / Q000150:complications / Q000175:diagnosis*
keywords: antimalarial agents; deltaNp63alpha; glucocorticosteroids; immune-mediated mucocutaneous disorder; p63