Comorbidities in Lichen Planus: A Case–control Study in Indian Patients

Lichen planus is considered a chronic inflammatory disease which affects different sites, such as the skin, mucous membranes, hair, and nails. Based on the evidence, a complex cytokine network plays a crucial role in lichen planus pathogenesis. The study was aimed at assessing the serum IL-23 levels in the patients with cutaneous and oral lichen planus compared to healthy controls. Method. The study included 30 cutaneous lichen planus patients, 20 oral lichen planus patients, and 33 control subjects. Five milliliters of peripheral blood was obtained from each patient, and the serum was separated. IL-23 levels were determined using the ELISA kit, and the data were analyzed using the Mann–Whitney test. Results. IL-23 levels in the patient serum with oral lichen planus (P value ≤ 0.001) were significantly higher than in controls. Furthermore, there were significant differences in IL-23 serum levels in the patients with cutaneous lichen planus compared to the healthy controls (P value ≤ 0.001). Moreover, IL-23 serum levels were statistically different between patients with cutaneous lichen planus and patients with oral lichen planus (P value ≤ 0.001). Based on the mean concentration of interleukin-23, IL-23 levels were higher in the patients with oral lichen planus than in the patients with cutaneous lichen planus. Conclusions. Elevated serum IL-23 levels in the patients with oral lichen planus may indicate that IL-23 plays a crucial role in the pathogenesis of oral lichen planus. However, more research is needed with a larger sample size.

BACKGROUND/AIMS:The objective was to assess uric acid (UA) levels in lichen planus (LP) patients and to investigate the impact of oxidative stress in LP etiopathogenesis. MATERIALS AND METHODS:Fiftieth participants with LP and 50 participants with tinea unguium, all aged 18 years and older, were included as the control group.Sociodemographic data including age, gender, and medical history were documented.In LP patients, disease duration, disease pattern, and severity, current, and past treatments were recorded.UA, total bilirubin, direct bilirubin, indirect bilirubin, were measured for both groups. RESULTS:This study included 50 LP patients (35 females, 15 males) and 50 patients with tinea unguium (28 females, 22 males) for the control group.The mean age was 52.9612.84years for the LP group, compared to 48.4415.14 for the control group.The difference in age and gender distribution between the LP group and the control group was not statistically significant.Among LP patients, 70% had the localized form, 26% had the oral form, and 4% had the generalized type.Topical corticosteroids were prescribed to 86% of the patients, while 14% received systemic corticosteroids.No significant difference was recorded between the LP group and the control group regarding total, direct, and indirect bilirubin levels, as well as UA levels. CONCLUSION:No significant difference was reported in total bilirubin, direct and indirect bilirubin, and UA between LP patients and the control group.

Antidepressant-Resistant Depression in Patients With Comorbid Subclinical Hypothyroidism or High-Normal TSH Levels.

Heart rate (HR) recovery after exercise is a function of vagal reactivation, and its impairment is a predictor of overall mortality and adverse cardiovascular events. While metabolic syndrome is associated with sympathetic overactivity, little is known about the relationship between metabolic syndrome and HR recovery. A symptom-limited exercise stress test in healthy subjects (n=1,434) was used to evaluate HR recovery. Metabolic syndrome was defined according to the National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP-III) criteria. Seventeen percent of subjects had ≥3 criteria for metabolic syndrome. HR recovery was lower in men than women and in smokers than nonsmokers. The subject with metabolic syndrome (vs. without) showed lower HR recovery (10.3±11.6 vs. 13.6±9.7 per minute) and higher resting HR (64.3±10.3 vs. 61.6±9.1 per minute). HR recovery correlated inversely to age (r=-0.25, p<0.0001), but not to resting HR or maximal oxygen uptake. Delayed HR recovery was associated with metabolic syndrome after an adjustment for age, sex, resting HR and smoking (p<0.01). Metabolic syndrome is associated with impaired vagal reactivation. Adverse cardiovascular outcomes associated with metabolic syndrome may be mediated by the failure of vagal reactivation in addition to sympathetic overactivity.

The possible increased risk of oral lichen planus (OLP) in patients with chronic liver diseases is a controversial issue. We investigated a total of 156 outpatients with known liver diseases for occurrence of OLP. Hepatitis C virus (HCV) infection was proven for 117 patients (75%) and hepatitis B virus (HBV) infection for 16 patients (10.3%). Four patients were coinfected with HCV and HBV. An alcohol-derived hepatic cirrhosis was found in 23 patients (14.7%). Three patients had a biliary cirrhosis and one had a primary sclerosing cholangitis. Patients suspected of having OLP were transferred to the Department of Oral and Maxillofacial Surgery where excisional biopsies were taken. Eight patients had a white alteration of the oral mucosa. OLP was suspected in five of them and was confirmed histologically in four. The alteration of the fifth patient disappeared during continued interferon therapy. Our results show that there is no increased prevalence of OLP manifestation in patients suffering from HCV infection.

An association between viral infection and lichen planus (LP) was postulated long ago, but only recently has evidence been presented that incriminated the hepatitis B (HBV) and C (HCV) viruses. The importance of HBV has been documented by the Italian Group for Epidemiologic Studies in Derma- tology.¹In a study of 577 newly diagnosed LP patients and 1008 control subjects, HBsAg-positive patients of any age and sex had at least double the risk of developing LP compared with HBsAg-negative patients.¹Anecdotal reports of anti-HBV antibodies in LP patients, of LP eruption following HBV vaccination, and of the association of LP with hepatocarcinoma, an HBV/HCV-linked cancer, are additional evidence for such an association.2 In a series of 87 LP patients, 27 (31%) were found to be anti— HBV-positive.² Infection with HCV has been investigated more recently.³In a series of 79 LP patients,⁴21 (26%) were

High-sensitivity C-reactive protein predicts target organ damage in Chinese patients with metabolic syndrome

Previous researches demonstrate uncertainty about the effect of metabolic syndrome (MS) on bone. We performed a meta-analysis to investigate the association of MS with bone mineral density (BMD) of spine and femoral neck (FN). In this meta-analysis, searches of Medline, Embase, Cochrane Library, Chinese biological medical database and China national knowledge infrastructure were undertaken to identify studies in humans of the association between MS and BMD. Random effects model was used for this meta-analysis. The results of our research were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 11 studies (including an outlier study) with 13,122 subjects were included in our research. We detected a significant overall association of MS with increased BMD of spine (weighted mean difference, WMD = 0.027, 95 % confidence interval, CI [0.011, 0.042]) and no significant overall association of MS with BMD of FN (WMD = 0.008, CI [-0.011, 0.026]). Subgroup analyses indicated significant association between MS and increased BMD of spine in subjects whose BMD was measured by dual-energy X-ray absorptiometry (DXA) scanner manufactured by Hologic Inc., subjects diagnosed by International Diabetes Federation criteria and subjects diagnosed by National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) criteria. And significant association between MS and increased BMD of FN in Caucasian subjects, subjects whose BMD was measured by DXA scanner manufactured by Hologic Inc. and subjects diagnosed by NCEP-ATP III criteria was also found. Our meta-analysis suggests that MS has no clear influence on BMD, or its influence maybe beneficial.

Lichen planus (LP) is an idiopathic, chronic inflammatory disease. Chronic inflammatory diseases can cause metabolic complications. In the literature, data related to the relationship between lichen planus and metabolic syndrome (MS) are limited. We aimed to evaluate the relationship between MS and lichen planus with disease activity. The patients diagnosed with lichen planus at the dermatology outpatient clinic between January 2018 and January 2020 were retrospectively analyzed. 98 lichen planus cases, age- and sex-matched 99 controls, 197 cases in total were included in the study. Of the 98 lichen planus cases included in the study, 60 (61%) were women. The mean age of the patients was 49.3±14.4, and the average disease duration was 33.5±31.4months. 55 (55%) of the patients in the control group were female, and the mean age of the control group was 50±13.2. The body mass index of LP cases was 29.5±5.8, in the control group was 25.8±3.7. Metabolic syndrome was found in 47 (48%) of 98 cases with lichen planus and 32.3% in the control group. MS in the lichen planus group was significantly higher than the control group (P=.025). Metabolic syndrome was detected in the oral lichen planus at the rate of 60% (12 cases). Although the incidence of MS was more common in the oral lichen planus, it was not statistically significant (P=.29). While no significant relationship was found between oral disease severity and metabolic syndrome (P=.19), a significant correlation was found between cutaneous disease severity and metabolic syndrome (P=.023). The risk of mucosal malignancy that can occur when following LP cases has been known for a long time. According to our results, caution should be taken in terms of metabolic complications in the follow-up of LP cases, especially oral LP cases.

Lichen planus (LP) is a rare, chronic inflammatory disorder affecting both skin and mucous membranes. LP has been associated with autoimmune conditions, glucose intolerance, dyslipidemia, and cardiovascular disorders; however, comprehensive data on these associations is limited. This study utilized data from the TrinetX Linked Network, comprising over 112 million patients, to assess the risk of comorbidities in LP patients from July 1, 2016, to December 9, 2024. LP patients were identified using International Classification of Diseases, 10th Revision, Clinical Modification codes, and propensity score matching was applied to compare comorbidity risks with a control cohort. The analysis revealed a significant association between LP and autoimmune dermatologic and rheumatologic conditions, including localized scleroderma, alopecia areata, vitiligo, psoriasis, lupus erythematous, Sjögren syndrome, autoimmune hepatitis, and autoimmune thyroiditis. Additionally, a lower risk was observed for hepatitis C and B infections in LP patients. The study highlights the stronger association between LP and autoimmune comorbidities, which could be linked to the higher prevalence of autoimmune diseases in women, explaining LP’s female predilection. These findings emphasize the need for heightened awareness of LP’s autoimmune nature. Limitations include diagnostic misclassification and potential geographic biases in the dataset.

Focus on lifestyle change and the metabolic syndrome

Metabolic Syndrome is a public health problem in the world with high and increasing prevalence. The prevalence of metabolic syndrome and associated factors in health professionals working in high complexity services was verified. This is a cross-sectional and analytical study between January 2017 and December 2018 with 490 health professionals. The criteria of the National Cholesterol Education Program's Adult Treatment Panel III were used. The variables were reported by numbers, percentages, in addition to the odds ratio with their respective 95% Confidence Intervals. The prevalence of Metabolic Syndrome in the total sample was 22.7%, 26.9% in men and 20.4% in women. The low hdl-c level was the most prevalent component of the syndrome in this group of professionals, regardless of gender. Age over 35 years, income, lifestyle and body mass index were the adjusted variables that had an influence on metabolic syndrome. However, overweight was the one that favored a greater chance of association with metabolic syndrome in professionals working in high complexity services, in both sexes. This study can provide support for preventive programs for the promotion of workers' health in hospital services.

Patients with psoriatic arthritis followed in tertiary centers in Southern Brazil have a high prevalence of metabolic syndrome

Toward the end of the last century a better knowledge of cardiovascular (CV) risk factors and their associations led investigators to propose the existence of a unique pathophysiological condition called "metabolic" or "insulin resistance syndrome". Among all, insulin-resistance and compensatory hyperinsulinemia are considered its most important treatment targets. Different definitions have been provided by World Health Organization (WHO) and by The Third Report of The National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP III). In particular, abdominal obesity, hypertension, low HDL cholesterol and hyperglicemia are the most common items used for its definition. The presence of MetS is effective in predicting the future risk of diabetes and coronaropathies. The evidence of a higher CV risk rate among different rheumatic inflammatory diseases has recently been associated with high prevalence of MetS in some cases. Rheumatoid or psoriatic arthritis have the large series among arthritis, whereas systemic lupus erythematosus among connective tissue disorders. This review analyses all most important studies about the evidence of MetS in rheumatic patients and the main clinical and prognostic significance of this relation.

Oral lichen planus (OLP) is a chronic inflammatory and immune-mediated disease that presents as bilateral, symmetrical oral lesions with three main clinical presentations: reticular, atrophic, and erosive. It is clinically characterized by pain, burning sensation, and discomfort for sufferers. Currently OLP is classified as a potentially malignant oral disorder. It has been associated with numerous systemic connotations such as diabetes mellitus, hypertension, metabolic syndrome, thyroid diseases, psychosomatic ailments, chronic liver disease, and gastrointestinal diseases. Diagnosis is made by clinical and histological examinations. It is a non-curable disease, the treatments are applied seeking the reduction or disappearance of the associated pain, as well as improving the clinical appearance of erosive-ulcerative lesions. The objective of this work was to present through a clinical case the difficulties in the treatment of OLP in a systemically compromised patient, highlighting the comprehensive assessment of the same, failed pharmacological therapies, until the symptomatology diminished and the patient's quality of life improved.