Lichen planus autoimmune comorbidities: A retrospective case-control study

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.

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.

Skin disorders with different clinical features best express their differences on the glabrous skin: when these diseases affect particular locations like the mouth, scalp or nails, the differences between them become blurred because partially obscured by the characteristics of the affected site; it can happen so that diseases very different from each other, such as psoriasis and alopecia areata, express themselves at the nail level with similar characteristics, such as pitting or trachyonychia. You can ask yourself whether trachyonychia, which we observe in numerous diseases (2), especially autoimmune and particularly alopecia areata, psoriasis and lichen planus, has histological features that allow to go back to the skin disorder of which it is a manifestation. According to the literature when trachyonychia is associated with psoriasis, the histological findings - acanthosis, parakeratosis, accumulation of neutrophils - are also similar in the nail (4); however, there are cases of trachyonychia associated with psoriasis characterized by hypergranulosis (2), which is certainly not characteristic of psoriasis. The answer to this question becomes even more complicated when we examine the histology of trachyonychia associated with alopecia areata (4), usually characterized by eczema-like findings - spongiosis, exocytosis - but sometimes presenting findings typical of lichen planus (3), leading the Authors of this case to state that trachyonychia clinically associated with alopecia areata was not due to alopecia, but to lichen planus expressing itself only in the nail; moreover, there are the much more numerous cases of the so-called idiopathic trachyonychia whose histological findings usually consist of spongiosis and exocytosis (2).Regardless of the discrepancy between clinical and pathological findings, we must also think of the discrepancies between the clinical course of trachyonychia and that one of the associated disease. In children psoriasis and alopecia areata exceeding 10% of scalp involvement are chronic diseases recurring for decades; on the other hand, trachyonychia associated with these conditions is usually a unique episode that finally subsides after a few years.Our 3 cases are characterized by long monitoring – 20 years on average – and by the presence of 2 autoimmune conditions in addition to trachyonychia; in literature exists another case (1) of trachyonychia associated with psoriasis and alopecia areata. In our first case and in that one of Dogruk et Al. (1) it is difficult to say whether trachyonychia is to be considered associated with psoriasis or alopecia areata. Even more difficult it is to give one's opinion in our second and third case in which trachyonychia is associated with autoimmune disorders not affecting usually the nail plate such as celiac disease and lichen sclerosus in the third case or scleroderma in the second case; in this second case trachyonychia affecting the second, third and fourth finger of the right hand at the age of 4 can not be considered in relation with annular lichen planus affecting only the right breast at the age of 24.These clinical discrepancies and the inconstant correlation between the clinical disorder associated with trachyonychia and the histologic nail findings lead us to hypothesize that trachyonychia is an autoimmune condition in its own right: it may be associated with other autoimmune diseases as thyroiditis is associated with vitiligo, although in some cases trachyonychia may assume the same histological aspects of psoriasis or lichen planus associated with it.

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

Objectives: Primary objective was to compare between the serum cortisol levels in patients with lichen planus (LP) and normal subjects. The secondary objective was to compare between the serum cortisol levels of LP patients with and without oral lesions. Materials and Methods: This is a cross-sectional analytical study comparing the serum cortisol levels in patients with LP with that of age- and gender-matched normal subjects who attended a tertiary referral centre. Results: There were a total of 52 patients with LP in this study. The mean age was 48.1 ± 12.6 years. Male/female ratio was 1:1.9. Fifteen (28.8%) patients gave a history of recent stress in the 1 month before the onset of illness. Classical LP (34, 65.4%) was the most common type. Oral cavity was involved in 24 patients (46.2%). The mean serum cortisol level of patients with LP was higher than the same noted in age- and gender-matched normal subjects and this was statistically significant (P < 0.001). Statistically significant difference (P = 0.02) was noted between the serum cortisol levels of patients with different types of LP. No significant difference in the cortisol levels was observed between LP patients with and without oral lesions. Limitations: The main limitation of the study was the small sample size. Conclusion: This study showed a significant increase in serum cortisol levels in patients with LP when compared to normal subjects, while no significant difference was noted in cortisol levels between LP patients with and without oral lesions.

Recent controlled studies have confirmed that hepatitis C virus (HCV) is the main correlate of liver disease in patients with lichen planus (LP), mainly in southern Europe and Japan. However, a low prevalence of HCV infection has been found in LP patients in England and northern France, and significant differences in serum HCV RNA levels or HCV genotypes have not been found between LP patients and controls. Thus host rather than viral factors may be prevalent in the pathogenesis of HCV-related LP. The HLA-DR allele may influence both the outcome of HCV infection and the appearance of symptoms outside the liver. To assess whether major histocompatibility complex class II alleles play a part in the development of HCV-related LP. Intermediate-resolution DRB typing by hybridization with oligonucleotide probes was performed in 44 consecutive Italian oral LP (OLP) patients with HCV infection (anti-HCV and HCV RNA positive), in an age, sex and clinically comparable disease control group of 60 Italian OLP patients without HCV infection (anti-HCV and HCV RNA negative), and in 145 healthy unrelated Italian bone marrow donors without evidence of liver disease or history of LP and with negative tests for HCV. Patients with exclusive OLP and HCV infection possessed the HLA-DR6 allele more frequently than patients with exclusive OLP but without HCV infection (52% vs. 18%, respectively; Pc (Pcorrected) = 0.028, relative risk = 4.93). We did not find any relationship between mucocutaneous LP, HCV infection and HLA-DR alleles. HCV-related OLP therefore appears to be a distinctive subset particularly associated with the HLA class II allele HLA-DR6. This could partially explain the peculiar geographical heterogeneity of the association between HCV and LP.

Background: Lichen planus is an autoimmune chronic inflammatory condition of unknown etiology affecting stratified squamous epithelial. The cell-mediated immunity has a role in both developing oral lichen planus, and immune system regulation, that’s why have role in the pathogenesis of oral lichen planus. The roles of vitamin D in an immune system and its anti-inflammatory effects have been indicated in recent study. Objective: To determine the level of serum vitamin D in patients with oral lichen planus and in compression with healthy subjects, and study the relation of serum vitamin D level with clinical types of oral lichen planus, symptom, and demography of oral lichen planus. Patients and Methods: Two group were designed in this case –control study, the first consist of 40 patients with oral Lichen planus, while the second is control group which include 40 healthy people. A 5-ml blood sample was taken from patients and healthy subjects. The serum vitamin D levels were assessed with a vitamin D total (25-hydroxy vitamin D) kit by employing the electrochemiluminescence technique. Results: Oral lichen planus mostly affect middle age female, the most common type of oral lichen planus was reticular type (95%) followed by erosive (57.5%) and atrophic oral lichen planus (45%). Mostly oral lichen planus appears on buccal mucosa bilaterally (95%). Vitamin D deficiency was higher in patient with oral lichen planus (60%) and (22.5%) in control group. The control group has more insufficient vitamin D level (22.5%) as compared to oral lichen planus patient(OLP) (15%), which was statistically significant. The mean of vitamin D level in serum of patients with oral lichen planus were 18.84 ±12.69 ng/ml and in healthy subjects were 31.28 ± 13.58ng/ml, that was statistically significant (P< 0.001). Conclusion: The deficiency in serum vitamin D level was not only related to the development of oral lichen planus, but it was also related to the symptom, and types of oral lichen planus. DOI:https://doi.org/10.26505/DJM.17024991005

Lichen planus (LP) is an idiopathic, chronic, relapsing, inflammatory, autoimmune dermatological disease. The etiopathogenesis of LP is still unclear. Autophagy is a strictly regulated lysosomal degradation pathway that is crucial for maintaining intracellular homeostasis and normal development. The dysregulation of autophagy-associated genes was recognized to increase the susceptibility to multiple diseases, including inflammation, autoimmune disorders and cancer. Our study aimed to detect the expression of autophagy-related gene 9 b (ATG9B) in LP patients compared to normal control persons to investigate the possible role of autophagy in pathogenesis of this disease. This case-control study included 30 LP patients and 30 age-, gender-matched healthy controls. Four millimeters punch skin biopsies were obtained from LP lesions and from the controls and they were kept in lysis solution for the stability of the studied parameters and were kept frozen at -80°C till analysis of ATG9B using real-time polymerase chain reaction. The level of ATG9B in lesional skin of LP was significantly decreased compared to normal control persons (P < 0.01); also, there was a non-significant relation between ATG9B level and age, sex, duration and family history among LP patients. Limited number of patients included in our study (30 patients). Autophagy may play a role in the pathogenesis of cutaneous LP.

To study the role of serum Monoamine oxidase (MAO) in Lichen planus(LP). 82 cases of Lichen planus patients and 35 healthy controls were selected in the investigation. The total serum MAO levels were measured. The levels of serum MAO in Lichen planus patients were significantly higher than those in healthy controls (P<0.01). The severity of Lichen planus was not correlated with serum MAO levels (r =0.4873, t=0.73, p>0.05). According to the findings, there might be a coincidence of MAO and lichen planus. However, further studies are required to clarify the immunological mechanisms which are responsible for MAO synthesis during immunoreaction.

The number of patients with oral lichen planus (OLP) has increased due to the raise of aggressive forms of the disease (erosive, ulcerative and hyperkeratotic forms) with a possible risk of malignancy. There are isolated researches which indicate a genetic determinism to OLP, but more often these conclusions are based on insufficiently adequate and out of date methods, which make it impossible to correctly interpret the obtained data. The aim was to identify a genetical predisposition with a programmed risk to the oral lichen planus. The main group – 278 patients with the OLP (aged 26-65 years). The control group – 298 people (blood donors) who didn’t have dental diseases, as well as diseases of internal organs and systems. The groups were homogeneous by gender and age. In our research we used such methods: clinical, radiological, immunogenetic, statistical methods were used. The erosive form of OLP was associated with 0(I) group in 54.2±0.4% of cases, while the hyperkeratotic form was associated with group 0(I) only in 28.7±1.8% of cases. B(ІІІ) and AB(ІB) groups were less often associated with the erosive form of OLP and were observed in 17.3±0.1% and 2.0±0.1% of cases, respectively. The integration of A(ІІ) group in the erosive form of OLP was 30.5±0.1%, but the indicator was higher than in individuals with B(III) and AB(IV) groups. Hyperkeratotic form of OLP was more often observed in A(II) carriers than in 0(I) and was 44.1±0.1% versus 28.7±1.8%, respectively. With blood group B (ІІІ), the relationship with OLP is not traced. Correlative relationship with erythrocyte blood antigens of the ABO system in patients with oral lichen planus was established. Risk groups for the development of erosive and hyperkeratotic forms of lichen planus in patients with gastrointestinal tract pathology O(I)&gt;A(II)&gt;B(III) – with erosive form and A(II)&gt;O(I)&gt;B(III)) – with hyperkeratosis.

Background:Many previous studies have observed an association of lichen planus (LP) with one or two comorbidities such as diabetes mellitus and thyroid dysfunction. This study was undertaken to determine the association of LP with common comorbidities including diabetes mellitus, dyslipidemia, metabolic syndrome, thyroid dysfunction, and hepatitis C virus (HCV) infection.Materials and Methods:The study included 75 patients with clinical diagnosis of LP and 75 age- and sex-matched controls. After taking complete history, general examination and thorough dermatological examination were performed in all cases. Fasting serum samples were taken from all cases and controls and assayed for fasting plasma glucose, lipid profile, T3, T4, and thyroid-stimulating hormone levels, and anti-HCVantibodies. Metabolic syndrome was diagnosed according to 2005 revised National Cholesterol Education Programme's Adult Treatment Panel III. Two-sample Student's t-test was used for statistical analysis.Results:Increased triglyceride levels were seen in 26 cases (34.67%) compared with 14 controls (14%), which was significant (P = 0.024). Statistically significant increased prevalence of increasedlow-density lipoprotein levels (P = 0.027), low high-density lipoprotein levels (P = 0.0189), and diabetes mellitus (P = 0.0217) was also observed in LP. Metabolic syndrome (P = 0.656) and hypothyroidism (P = 0.117) were not significantly associated with LP. Strong association was observed between oral LP and hypothyroidism. All patients screened for anti-HCV antibodies were found to be negative.Conclusion:There is a clear associationof LP with dyslipidemia and diabetes mellitus. Screening for dyslipidemia and diabetes mellitus in all patients of LP will help in early detection, initiation of treatment, and prevent long-term morbidity.

Lichen planus is an autoimmune disorder that primarily affects the body's skin and multiple mucous membranes. In multicellular species, protein 53 and syndecan-1protein play an significant role since they control the cell cycle and thus play a major role in tumor suppression and cancer prevention. The p53 gene was therefore identified as a "genome protector," referring to its role in preserving the integrity of genetic information by preventing gene mutations. The purpose of this analysis was to study the association between certain immune markers in lichen planus patients. The aim of this study: Study correlation between some immune markers in patients with lichen planus.&#x0D; Methods: 'Thirty formalin-fixed, paraffin-embedded tissue pieces, diagnosed as Oral Lichen planus (OLP), were included in the sample of this report.&#x0D; Results: Evaluation of P53 Immunohistochemistry and Evaluation of syndecan-1protein Immunohistochemistry&#x0D; Conclusion: The marker p53 expression is high in the patient with Lichen Planus while the second studed markersyndecan-1 protein is less than marker p53.

Lichen planus (LP) is an autoimmune chronic inflammatory disease. Interleukin 10 (IL-10) can inhibit the synthesis of pre-inflammatory cytokines. Regarding the role of inflammatory cytokines in lichen planus patients, evaluating the serums level of IL-10 in such patients can declare the potential role of this cytokine. In this study, 44 serum samples from patients with lichen planus and 44 serum samples from healthy participants were collected during 2015–2016. The patients with clinical or histopathological confirmation for oral lichen planus (OLP) were included in the case group, and the healthy patients were recruited in the control group. The serum level of IL-10 was measured by ELISA kits. In this cross-sectional study between 2015 and 2016, the serum level of IL-10 was measured in 53 females (60.22%) and 35 males (39.77%). In the lichen planus group, 44 subjects and in the control group, 44 healthy participants were enrolled. The mean serum level of IL-10 in oral lichen planus patients was reported as 3.68 ± 3.44 pg/ml and this was 0 ± 0 pg/ml in the healthy control group. The mean serum level of IL-10 in oral lichen planus patients was significantly more than the mean serum level of IL-10 in the control participants (P = 0.042).There was no relation between serum level of IL-10 in OLP patients and age (P = 0.771) and sex (P = 0.547) of participants. The findings indicated significant difference between the serum level of IL-10 and types of oral lichen planus lesions (P < 0.001). This study indicated that significant elevation of IL-10 in OLP patients might be important in immunomodulating of this disease, although the exact mechanism is not clear.

The purpose of the present investigation was to demonstrate in vitro cellular hypersensitivity to oral lichen planus lesions. Twenty oral lichen planus patients and 20 control persons matched by and sex were examined by the leukocyte migration agarose technique with tissue extracts from oral lichen planus lesions, normal oral mucosa and normal human kidney, the two latter extracts serving as control antigens. The female lichen planus patients showed statistically significant (P=0.004) migration inhibition with extracts from oral lichen planus lesions, which supports the hypothesis of cellular hypersensitivity to oral lichen planus lesions. However, the male lichen planus patients did not show any significant reaction. No significant reaction was found with the control antigens. The findings do not exclude the hypothesis of cellular hypersensitivity to oral lichen planus lesions. Furthermore, they do not support the hypothesis of oral lichen planus being an autoimmune disease.