Diabetes and hepatitis frequency in 140 lichen planus cases in Cukurova region

The aim of the present study was to determine the Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and diabetes mellitus (DM) frequencies in lichen planus (LP) cases in our region. We performed a retrospective review of records from all cases that were diagnosed with LP at the our department between 1997 and 2002. The results were compared with the control group (any type of dermatosis other than LP). The 260 LP cases included 108 (41.5%) males and 152 (58.5%) females aged between 5 and 78 years. The clinical distribution of the lesions were 127 (48.8%) with skin lesions and 133 (51.2%) with oral mucosal lesions. The duration of disease ranged from 1 to 240 months. In 140 of 260 LP cases, hepatitis serology and pre-prandial blood glucose were examined. We found HBV positivity in 24 (17.1%) cases, Anti-HCV positivity in 7 (5%) cases, and DM in 22 (15.7%) cases. The control group included 116 (41.4%) males and 164 (58.6%) females. Their ages ranged between 10 and 82 years. In this group, we found HBV positivity in 20 (7.1%), Anti-HCV positivity in 4 (1.4%), and DM in 20 (7.1%) cases. We believe that the co-association of LP with HCV is significant and this co-association ratio indicates variance depending on clinical attributes of the lesions and racial characteristics of the patients. Although we found co-associations between HBV and LP or DM and LP, we believe that further studies are necessary to determine if they are significant.     

Lichen ruber planus und Hepatitis‐Virus‐Infektionen: kausaler Zusammenhang?

Background: The causal association between hepatitis virus infections and lichen planus (LP) remains a matter of controversy. Reliable figures for German patients are still lacking. Patients and Methods: We analyzed the prevalence of serum antibodies against hepatitis B and C viruses (HBV, HCV) in 265 LP patients and compared the results to 257 patients with chronic urticaria (URT) and 222 patients with malignant melanoma (MM). Additionally, we analyzed age‐ and sex‐specific differences. Results: The prevalence of HBV (13.2 % or 14.7 %) antibodies was significantly higher in patients with LP and URT patients than in the MM control group (HBV: 5.4 %, p < 0.001). The prevalence of HCV antibodies among LP and URT patients (2.6 % or 0.8 %) was not significantly greater (p > 0.05) than in MM patients (0.4 %). The prevalences of HBV and HCV in the MM control group were comparable to those in the general German population (HBV: 5–8 %, HCV: 0.4–0.7 %). An analysis by sub‐groups showed that these differences resulted from sex‐ and age‐dependent prevalences. HBV antibodies were significantly more common only in male LP patients (16.1 %) and in male (20.0 %) and female URT patients (15.6 %) aged 31–60 years. The greater prevalence of HCV in female LP patients older than 60 years of age was not significant. Conclusions: LP is not specifically associated with hepatitis B or C antibodies in the Caucasian population of Germany. The higher prevalences of HBV antibodies found in LP and URT patients may be a reflection of age‐ and sex‐related factors rather than disease‐specific exposure to HBV infections. The increased prevalences seen in patients with LP or URT compared to MM patients may suggest that HBV infection serves as an unspecific trigger for a specific immune reaction of another origin.     

Lichen planus and other cutaneous manifestations in chronic hepatitis C: pre- and post-interferon-based treatment prevalence vary in a cohort of patients from low hepatitis C virus endemic area

Background Several controversies exist regarding the relationship between hepatitis C virus (HCV) infection and some cutaneous manifestations, lichen planus (LP) in particular. Objectives To determine the prevalence of LP and other cutaneous manifestations in a cohort of patients infected with HCV from low HCV endemic area of Slovenia, to correlate findings with chosen biological variables and to assess the role of interferon (IFN)‐based treatment of HCV infection in cutaneous manifestations. Methods A total of 171 consecutive HCV‐seropositive patients and 171 HCV‐seronegative age‐ and gender‐matched controls were studied prospectively. Prevalence of cutaneous manifestations, comparison between study patients and controls and correlation of skin findings with demographic, biochemical, virological and liver histologic findings as well as IFN‐based therapy were assessed. Results Overall presence of LP in HCV‐seropositives was 2.3%; although LP was not found in controls, the difference was not statistically significant (P = 0.123). Significantly higher than in controls was the prevalence of pruritus (31.0%, P < 0.001), dry skin (16.4%, P < 0.001) and hair loss (9.9%, P < 0.001). In IFN‐based treatment naïves, skin findings were more frequent compared with controls, but not significantly, with no correlation to chosen biological variables. Current IFN‐based treatment was significantly connected to pruritus (P < 0.001) and dry skin (P < 0.001). Compared with treatment naïves, in post‐treated patients pruritus (odds ratio, 19.13; 95% confidence interval, 6.85–53.42; P < 0.001), dry skin (odds ratio, 4.21; 95% confidence interval, 1.44–12.31; P < 0.001) and hair loss (P < 0.001) were significantly more common. Conclusions LP was not significantly related to HCV infection. Prevalence of pruritus, dry skin and hair loss was significantly higher in post‐compared with pre‐treated patients. The role of IFN in post‐treatment persistence of skin manifestations needs to be assessed.     

Lichen planus and hepatitis C virus infection

BACKGROUND: The association of lichen planus (LP) with liver diseases is well established. The reported prevalence rates of hepatitis C virus (HCV) antibodies in patients with LP tend to appear quite variable. OBJECTIVE: The aim of this study was to assess the prevalence of HCV antibodies in a group of patients with LP and evaluate the clinical characteristics of the subgroup with LP associated with HCV. METHODS: We studied 101 patients, 57 (56.4%) women and 44 (43.5%) men with a mean age of 48 years, consecutively diagnosed with cutaneous and/or mucosal LP between January 1992 and December 2000. We used 99 age- and sex-matched controls. RESULTS: Anti-HCV antibodies were detected in nine cases (8.9%) of the LP group but only two (2.02%) of the controls. The odds ratio between the subjects with HCV positivity and those with negative HCV virus was 4.74, with a confidence interval at 95%, between 0.999 and 22.545. A statistically significant association was only demonstrated between erosive LP and infection by HCV. CONCLUSIONS: The possibility of liver disease caused by HCV should be ruled out in patients with LP, especially in the erosive form.     

No association between seropositivity for hepatitis C virus and lichen planus: a case control study

BACKGROUND: The epidemiological association of lichen planus (LP) with hepatitis C virus (HCV) infection has been recorded from some countries and HCV RNA3 has been isolated from lesional skin in patients with LP and chronic HCV infection. The observed geographical differences regarding HCV infection and LP could be immuno-genetically related. AIM: To determine whether HCV has a causal relationship with LP. METHODS: Histopathologically proved cases of LP were subjected to antibody to HCV test by the Third Generation Enzyme Immunoassay Kit for the detection of antibody to HCV (Anti-HCV) in human serum or plasma. They were routinely screened in the virology department by the reagent kit, HIVASE 1 + 2, adopting the "direct sandwich principle" for the assay to detect antibodies to HIV-1 and/or HIV-2. There were 150 age and sex matched controls (not suffering from LP) and HIV-I and II negative, and negative for HCV. RESULTS: Of the 104 patients studied only 2 patients (1.92%) of generalized LP with disease duration of more than 3 months were found to be positive for antibodies to HCV. This was not a significant finding and no statistical methods, e.g. Chi square test etc. could be applied. CONCLUSION: Hepatitis C virus is not significant to the causation of LP in India.     

Paucity of immune complexes in skin lesions of lichen planus

The significance of deposition of immunoglobulin and/or complements at the dermoepidermal junction (DEJ) and civatte bodies in skin lesions of 15 histopathologically confirmed cases of lichen planus (LP) was evaluated. Civatte boides were seen in 6 (40%) patients while in 9 (60%) these were absent. IgM, IgG, IgA and C3 were seen within civatte bodies in 6, 3, 2 and 3 specimens respectively in various combinations. LP lesions of a shorter duration (one year or less) had civatte bodies while these were absent in those with disease of a longer duration (more than 1 year). Immune complex deposition was seen in only 2 patients. It is concluded that civatte bodies are of diagnostic importance in lichen planus lesions of a short duration only and immune complexes do not seem to play a significant role in its pathogenesis.     

Clinical and Histopathologic Analysis of the Relationship between Lichen Planus and Chronic Hepatitis C

A prospective clinical investigation of 45 patients with lichen planus (LP) demonstrated a significant association between LP and chronic hepatitis C. Anti-hepatitis C virus (HCV) antibodies were found in 17 (37.8%) of the 45 LP patients. This was significantly higher than in the controls. This higher prevalence of anti-HCV antibodies was found equally in both male and female patients in the three types of LP; cutaneous only type, mucous only type, and both cutaneous and mucous type. Most of the patients with positive anti-HCV antibodies had abnormal values of transaminase enzymes and/or a past history of chronic hepatitis. Histological and immunohistological investigations of three cases with LP and chronic hepatitis C demonstrated some morphologic similarities between these two diseases. Histopathologic findings of both LP and chronic hepatitis C were based on a T lymphocytic infiltrate with keratinocyte or hepatocyte damage. The degrees of infiltrating cells positive to UCHL-1, MX-panB, Leu-7, and human leukocyte antigen (HLA)-DR antibodies in the chronic hepatitis C lesions seemed to be similar to those in the LP lesions. These results may support a possible relationship between LP and chronic hepatitis C and the hypothesis that LP may be associated with chronic liver diseases as a result of a cytotoxic attack on the hepatocytes.     

Clinical and laboratory presentation of lichen planus patients with chronic liver disease.

A recent case-control study on 577 lichen planus (LP) patients and 1008 controls confirmed that LP patients may significantly associate with a chronic liver disease (CLD) which is independent from drug or alcohol intake and has some connection with hepatitis B virus (HBV) infection. The study, however, failed to define the nature of CLD. This has been investigated through the clinical and laboratory features of 50 patients with LP and impaired liver function tests. Overall, the laboratory signs of cell necrosis prevailed over those of cholestasis and a good relationship with the HBV and HCV infections was found. Ninety percent of patients with LP and CLD had antibodies to one or another of the major viruses involved in infectious hepatitis. No patient had anti-liver kidney microsomal antibodies type 1. Liver biopsies were done in 12 cases and mostly revealed a chronic active hepatitis evolving into cirrhosis. No evident cases of primary biliary cirrhosis were found. It appears that LP associated CLD is post-viral in nature.     

The relationship between lichen planus and hepatitis C in dermatology outpatients in Kerman, Iran

BACKGROUND: Lichen planus (LP) is classified as a papulosquamous disease. It has been associated with liver disease, particularly hepatitis C virus (HCV) infection, in several studies. Most of these reports, especially the larger series, were conducted in Europe and Japan. OBJECTIVE: We conducted a case-control study in Kerman, Iran to explore the association between LP and HCV. METHODS: The study included 66 patients with LP (as cases; mean age = 39.7 +/- 15.8 years; 31 female, 35 male) and 140 volunteer blood donors (as controls; mean age = 29.5 +/- 8.4 years; 43 females, 97 males). An enzyme-linked immunosorbent assay (ELISA) was used to determine the presence of anti-HCV antibodies in all subjects in both groups. To confirm positive diagnoses, a second generation recombinant immunoblot assay (RIBA II) test was performed. RESULTS: Lichen planus lesions were most frequently located on the trunk and extremities, and the most common clinical type was generalized LP (48.5%). One of the patients with LP (1.5%) and three of the controls (2.1%) were HCV-Ab positive. No significant difference was observed in HCV-Ab positive between the two groups (OR = 0.7; 95% CI = 0.1-6.9). CONCLUSION: The findings indicate that an investigation for HCV infection should not necessarily be performed in all patients with LP. It is recommended that further studies should focus on larger groups in other regions of Iran to determine whether testing for HCV infection is necessary in patients with LP.     

Lichen planus and hepatitis C virus: a multicentre study of patients with oral lesions and a systematic review

BACKGROUND: An association between hepatitis C virus (HCV) infection and lichen planus (LP) has been investigated, but results have been inconsistent. OBJECTIVES: To investigate the relationship between LP and HCV seropositivity. Methods In a cross-sectional study we tested the sera of 303 consecutive newly diagnosed patients with histologically proven LP referred to three Italian centres for the presence of anti-HCV IgG. A comparable control group was also tested. Next, in a systematic review, studies were identified by searching different databases in April 2004. Inclusion criteria were: (i) analytical study design; (ii) clinical and histological diagnosis of LP; and (iii) serological test for anti-HCV antibodies as main outcome. The risk of bias was assessed on the basis of characteristics of the study group, appropriateness of the control group and study design. Pooled data were analysed by calculating odds ratios (ORs), using a random effects model. RESULTS: In the cross-sectional study, nearly one in five (19.1%) of the LP group was HCV positive, while a much lower prevalence of infection was found in the control group (3.2%) [OR 7.08; 95% confidence interval (CI) 3.43-14.58]. The systematic review yielded 25 relevant studies, six of which had a low risk of bias. There was a statistically significant difference in the proportion of HCV-seropositive subjects among patients with LP, compared with controls (OR 4.80; 95% CI 3.25-7.09). Following subgroup analyses, the variability of HCV prevalence in patients with LP seemed to depend on geographical area, but not on age. CONCLUSIONS: Anti-HCV circulating antibodies are more common in patients with LP than in controls, although such an association may not be significant in some geographical areas.     

Nail changes in patients with liver disease

Background Liver cirrhosis, hepatitis C virus (HCV) and hepatitis B (HBV) virus infections are known to be associated with different skin disorders. Nail changes are additional important criteria, which would help in identification of these systemic diseases. Objective To record the nail abnormalities in patients with liver disease which were not reported before, especially those with HCV and HBV infection. Patients and methods The study comprised 100 patients with HCV, HBV and liver cell failure, and 100 normal healthy controls. Both groups underwent full history taking and thorough general examination, complete blood picture, hepatitis B antigen, hepatitis C antibody, liver function tests, abdominal ultrasonography and PCR were performed in patients with liver disease. Full nail examination was performed. Results Nail changes were more prevalent in patient group (68%) than in the control group (35%). The nail infection, onychomycosis, was the most common finding in 18% of patients and that in controls was 10% followed by in a descending order, longitudinal striations, brittle nails, onychorrhexis, clubbing of fingers, dystrophic nails, leukonychia and longitudinal melanonychia. Conclusion Nail changes are observed with not only liver cirrhosis but also with HCV and HBV infection, and this will add additional clinical criteria for general practitioners and dermatologists to help them with diagnosis of these common systemic infections.     

Downregulation of TLR-7 receptor in hepatic and non-hepatic patients with lichen planus

Background Lichen planus (LP) is an inflammatory disease of the skin and oral mucosa. The association of LP and chronic hepatitis C virus (HCV) is well established, with variable prevalence rates among different populations. Toll‐like receptors (TLRs) are key regulators of both the innate response and the adaptive response. However, TLRs also interact with endogenous ligands released by necrotic cells, and this process can intensify autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus. Objective To investigate the role of Toll‐like receptor‐7 (TLR‐7) in LP through the detection of TLR‐7 protein, and to compare between the expression of TLR‐7 protein in HCV‐positive and HCV‐negative patients with LP. Materials and methods The study included 20 skin biopsies from patients with LP and 10 control biopsies. TLR‐7 protein was detected by Western blot analysis. Detection of HCV‐specific antibodies in the patient serum was done using ELISA technique. Results Our analysis revealed a significantly lower level of TLR‐7 protein in all the LP skin biopsies compared with controls. The expression showed no difference between HCV‐positive and HCV‐negative patients. Conclusion We concluded that TLR‐7 abnormal expression in LP may have an impact on the pathogenesis of the disease. TLR‐7 receptor and HCV relationship in patients with LP could not be confirmed by this study.     

Lichen planus and hepatitis C virus: prevalence and clinical presentation of patients with lichen planus and hepatitis C virus infection

Summary Although cases of lichen planus (LP) associated with hepatitis C virus (HCV) infection have been described, the association between the two diseases has not been established because the geographic origin of patients could be an important factor in HCV prevalence in patients with LP. The serum samples of 78 consecutive patients with cutaneous and/or mucous LP and 82 control patients were analysed for the presence of antibodies to HCV by enzyme-immunoassay and for the presence of antigens of HCV by two-stage polymerase chain reaction (PCR). The clinical features of patients with LP associated with HCV infection were compared with patients with LP without HCV infection. Sixteen of the 78 (20%) patients had anti-HCV antibodies. In 13 of these 16 cases (81%), HCV-RNA was detected by PCR in serum samples. In the 82 control patients, anti-HCV antibodies was observed in two (2·4%) patients. We have found a statistically significant association (P < 0·05) between erosive LP and HCV infection. We conclude that the high prevalence of HCV-RNA in patients with LP provides some evidence for the role of HCV in the pathogenesis of LP. Our results suggest an association between erosive LP and HCV infection.     

Prevalence of oral, skin, and oral and skin lesions of lichen planus in patients visiting a dental school in southern India

Background:

Lichen planus (LP) is a mucocutaneous disease that is relatively common among adult population. LP can present as skin and oral lesions. This study highlights the prevalence of oral, skin, and oral and skin lesions of LP.

Aims:

The aim of this study was to evaluate the prevalence of oral, skin, and oral and skin lesions of LP from a population of patients attending the Department of Oral Medicine and Radiodiagnosis, Pushpagiri College of Dental Sciences, Tiruvalla, Kerala, India.

Materials and Methods:

A cross-sectional study was designed to evaluate the prevalence of oral, skin, and oral and skin lesions of LP. This is a ongoing prospective study with results of 2 years being reported. LP was diagnosed on the basis of clinical presentation and histopathological analysis of mucosal and skin biopsy done for all patients suspected of having LP. Statistical analysis was carried out using SPSS (Statistical package for social sciences) software version 14. To test the statistical significance, chi-square test was used.

Results:

Out of 18,306 patients screened, 8,040 were males and 10,266 females. LP was seen in 118 cases (0.64%). Increased prevalence of LP was observed in middle age adults (40–60 years age group) with lowest age of 12 years and highest age of 65 years. No statistically significant differences were observed between the genders in skin LP group (P=0.12) and in oral and skin LP groups (P=0.06); however, a strong female predilection was seen in oral LP group (P=0.000036). The prevalence of cutaneous LP in oral LP patients was 0.06%.

Conclusion:

This study showed an increased prevalence of oral LP than skin LP, and oral and skin LP with a female predominance.     

Heat shock proteins 60 and 70 expression of cutaneous lichen planus: comparison with normal skin and psoriasis vulgaris

BACKGROUND: Heat shock proteins (HSPs) are expressed by most living cells and play fundamental roles in many biological processes. Their synthesis increases by a variety of stresses in order to enable cellular survival. Although it is known that they play an important role in immune and inflammatory responses of the skin, the role of HSPs in the pathogenesis of skin diseases has been studied in only limited skin diseases. Lichen planus (LP) is a relatively common papulosquamous dermatosis, and cell-mediated immunity plays an important role in its pathogenesis. Although an altered expression of certain HSPs was reported in oral LP lesions, the expression of HSPs in cutaneous lesions of LP has not been investigated. In this immunohistochemical study, we aimed at investigating the role of HSPs in the pathogenesis of LP by studying whether there is any difference in HSP expression in cutaneous lesions of LP when compared to normal skin and psoriasis vulgaris (PV). METHODS: Formalin-fixed paraffin-embedded skin biopsy specimen blocks from LP patients (n = 39), patients with psoriasis (n = 20), and normal skin controls (n = 20) were used in the study. Antibodies to HSPs 60 and 70 were applied immunohistochemically by using streptavidin-biotin-horseradish peroxidase complex. An immunoreactivity intensity distribution index (IRIDI) was calculated to express the proportion of the immunoreactive cells as well as the staining intensity in different layers of the epidermis. RESULTS: The mean IRIDI scores for HSP60 expression in the basal, suprabasal, and superficial epidermal layers of cutaneous LP were moderately higher than those of normal skin, but not different from those of PV skin. These scores for HSP70 in lesions of LP were moderately lower than those for normal skin in the basal layer, but not significantly different from normal in the other two layers. Scores for HSP70 in PV lesions were markedly lower in all three layers. In the cells of the inflammatory infiltrates (mostly lymphocytes), HSP60 scores for LP were moderately higher, compared to those for PV, whereas scores for HSP70 were much lower for LP and very much lower for PV. CONCLUSIONS: Significantly altered levels of HSP proteins were found in cutaneous LP lesions in comparison with normal skin and psoriasis, suggesting the role of HSPs in the pathogenesis of LP.     

A clinico-aetiological profile of 375 cases of lichen planus

The study of clinical, histopathological and aetiological pattern, of lichen planus (LP) in 375 patients was done in this part of Western Rajasthan. The incidence of LP was 0.8%. 58.7% cases were male and maximum number of cases (46.93%) were in age group of 20-39 years. In 70.66% of patients only skin was involved while in 10.18% of cases only mucous membrane was involved. In 61.6% patients the lower extremities were involved. Familial LP was seen in 8 families. Association of LP was found with hypertension (2.4%), polymorphic light eruption (2.1%), vitiligo (1.9%) and diabetes mellitus (1.6%). 48.5% of cases showed lymphocytosis with raised ESR. Actinic LP was seen in 14.1% of cases. 13.1% of patients showed combination of typical LP or its variants to which term lichen planus variata was given.     

Hepatitis C virus genotypes among patients with lichen planus in the Kingdom of Saudi Arabia

Objectives This study aimed to determine the prevalence of anti‐hepatitis C virus (HCV) antibodies and HCV genotypes/subtypes among patients with lichen planus (LP) in Saudi Arabia. Methods Fifty patients with LP and 50 healthy blood donors were recruited from dermatology outpatient clinics, and blood samples along with demographic and clinical data were collected. Sera were analyzed for aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, bilirubin, hepatitis B virus surface antigen, anti‐HCV antibodies, and HCV‐RNA. Patients with anti‐HCV‐positive LP were genotyped and subtyped. Results Clinical examination revealed that 26 (55.3%) of our patients had cutaneous LP, and 10 (21.30%) presented with oral LP. Eleven (23.4%) patients with LP had cutaneous as well as oral infection. Twenty‐eight (59.6%) of our patients with LP were exposed to a variety of HCV risk factors, including history of intramuscular injections (nine of 47; 19%), blood transfusion (seven of 47; 15%), and exposure to family member with HCV infection (five of 47; 10.6%). Of the 47 patients with LP, six (12.76%) tested positive for anti‐HCV antibodies, with two of six (33.33%) being HCV‐RNA positive showing HCV genotypes 1b and 4a, respectively. Mean ± SD serum levels of ALT and AST among patients with anti‐HCV‐positive LP (n = 6) were slightly higher as compared with patients with anti‐HCV‐negative LP. None of the 50 healthy blood donors tested positive for anti‐HCV antibodies, and their liver function test profiles were within normal reference range. Conclusion Our findings are in agreement with earlier reports that HCV infection is associated with LP and recommend the screening of patients with LP for ALT, AST, and anti‐HCV antibodies for early diagnosis of HCV infection.     

Lack of evidence for hepatitis C virus infection in association with lichen planus

Background The association between hepatitis C virus (HCV) infection and lichen planus (LP) is a subject of controversy. Prevalence studies of HCV infection in LP patients in various countries reveal diverse results. The Slovenian population is rather homogenous with specific geographic and epidemiological characteristics. Lack of data or contradictory results from neighboring countries urged the need for a case‐controlled study in our LP patients. Methods The retrospective study was performed on 173 LP patients. Control group included 218 patients with dermatological diseases other than LP. Results Anti‐HCV antibodies were found in 2/173 patients (1.2%) with LP and in 0/218 controls. No statistically significant difference was found between the study and control group regarding anti‐HCV antibody prevalence (P = 0.195; estimated OR 6.4, 95% CI 0.3–134.0) and risk factors for HCV infection. Conclusions Based on our results, anti‐HCV antibody testing is not necessarily required in LP patients with no risk factors for HCV infection in this geographic region.