Lipid levels in patients with lichen planus: a case–control study

Background Cardiovascular risk factors have been assessed with some skin diseases such as alopecia and psoriasis. Recently, a case–control study found that lichen planus (LP) was associated with dyslipidaemia in a large series of patients. However, no data were presented about lipid values in patients and controls. Objective The objective of this case–control study was to evaluate lipid levels in men and women with lichen planus and in healthy controls, excluding lichenoid drug eruption and treatment for LP such as systemic corticosteroids, retinoid acid or methotrexate. Patients and methods This case–control study included 160 patients, 80 with LP (40 men and 40 women) and 80 controls consecutively admitted to the outpatient clinic in Dermatology department of San Cecilio Hospital, Granada, Spain. Results Patients with LP presented higher significant triglycerides values (145.9 vs. 101.5 mg/dL P = 0.0007), total cholesterol values (197.7 vs. 178.4 mg/dL P = 0.001), LDL‐C values (120.8 vs. 100.9 mg/dL P < 0.0001) and lower HDL‐C values (55.3 vs. 61.9 mg/dL P = 0.004) vs. controls. Adjusted OR for dyslipidaemia in patients with LP was 3.03 (95% confidence interval: 1.49–6.17, P = 0.002). Conclusion The results obtained in this study indicate an association between LP and dyslipidaemia. Lipid levels screening in men or women with LP may be useful to detect individuals at risk and start preventive treatment against the development of cardiovascular disease.     

Comorbid autoimmune diseases in patients with sarcoidosis: A nationwide case–control study in Taiwan

The association between sarcoidosis and autoimmune comorbidities has been reported, however, it has seldom been confirmed by a large nationwide study. Our study aimed to clarify the association between sarcoidosis and autoimmune comorbidities in the Taiwanese. A total of 1237 patients with sarcoidosis and 4948 age‐ and sex‐matched control subjects were selected from the National Health Insurance Research Database of Taiwan from 1997 to 2010. Multiple logistic regressions were performed to calculate the odds of comorbidities between the two groups. The prevalence of sarcoidosis was 2.17/100 000 individuals in Taiwan. Sarcoidosis patients tended to run a higher risk of autoimmune comorbidities than the control group (17.6% vs 9.4%, P < 0.05). Autoimmune thyroid disease (adjusted odd ratio [aOR], 1.32; 95% confidence interval [CI], 1.05–1.64), Sjögren's syndrome (aOR, 11.6; 95% CI, 4.36–31.0) and ankylosing spondylitis (aOR, 3.80; 95% CI, 2.42–5.97) were significantly associated with sarcoidosis. The sex‐stratified analyses were carried out to demonstrate a significant association of sarcoidosis with ankylosing spondylitis in both sexes, but with autoimmune thyroid disease in male patients and with Sjögren's syndrome female patients, respectively. Besides, the diagnosis of the autoimmune comorbidities strongly associated with sarcoidosis tended to be established after that of sarcoidosis. This study demonstrated that patients with sarcoidosis tended to have autoimmune thyroid disease, Sjögren's syndrome and ankylosing spondylitis, and the diagnosis of sarcoidosis usually preceded that of associated comorbidities. Clinicians should be alert to autoimmune comorbidities in patients with sarcoidosis.     

Investigation of upper gastrointestinal tract involvement and H. pylori presence in lichen planus: a case–controlled study with endoscopic and histopathological findings

Background Lichen planus (LP) is a common disease of unknown etiology. Rare mucosal involvements like esophageal LP have been reported increasingly. Infectious agents including H. pylori and other autoantigens have been investigated in etiology and association with certain gastrointestinal pathologies have been well documented. Objectives The aim of this study is to investigate the upper gastrointestinal tract involvement in LP and to evaluate the possible etiologic role of H. pylori. Patients, Materials and Methods 49 LP patients and 35 volunteers (without LP) with gastrointestinal symptoms were included in the study as the control group. LP group was divided into subgroups regarding gastrointestinal symptoms. Upper videoendoscopy was performed in both groups and biopsies were taken from suspicious areas for LP, gastrointestinal diseases, H. pylori and examined histopathologically. SPSS 13 was used for the analysis. Groups/subgroups were compared via xi‐square test, Mann‐Whitney U test, and t‐test. Results Gastrointestinal symptoms were recorded in 71% of LP group; none of LP patients presented typical esophageal LP. Gastrointestinal diseases were more frequent in LP group than controls, endoscopically. Chronic gastritis (91.8%) was the leading diagnosis in LP patients. Superficial gastritis was significantly higher (13.3%) in LP patients than controls (p = 0.04). LP was not diagnosed in any of the esophageal mucosa biopsies whereas lymphoid follicles were observed significantly higher in control group (p < 0.01) histopathologically. H. pylori positivity was found higher in LP group (81.6%) though statistically insignificant. Conclusions We believe upper endoscopy should be performed to investigate esophageal LP and gastrointestinal pathologies especially when LP patient is symptomatic. Although we didn't detect esophageal LP, our study had the limitation of taking biopsies from pathological sites only. Since histopathological examination of normal appearing esophagus may help in diagnosing occult LP, and prevent eventual complications, it may be further evaluated in larger study groups. A new technique, magnification chromoendoscopy, may be useful in detecting esophageal involvement. We believe the possible role of H. pylori in LP is yet to be determined also.     

Thyroid autoimmunity in patients with hidradenitis suppurativa: a case–control study

The aetiopathogenesis of hidradenitis suppurativa (HS) is not fully understood; however, increasing evidence suggests that it may be an immune‐mediated disorder. Autoimmune thyroid disease (AITD) has classically been considered as the ‘paradigm’ of autoimmunity, and it has been linked to a variety of skin disorders. To our knowledge, the prevalence of AITD has not been investigated in patients with HS. The aim of the present study was to assess and compare, for the first time, the prevalence of thyroid autoimmunity in 70 patients with HS and in 70 age‐ and sex‐matched controls. In all participants, thyroid autoantibodies and thyroid function tests were analysed. No statistically significant difference was detected between patients with HS and controls, either for the prevalence of thyroid antibodies or for thyroid function parameters. This lack of an association between HS and thyroid autoimmunity suggests that conventional autoimmune mechanisms may not be implicated in the pathogenesis of HS.     

Factors associated with emergence of pristinamycin‐resistant Staphylococcus aureus in a dermatology department: a case–control study

Background Pristinamycin is used for the treatment of Staphylococcus aureus skin infection. Staphylococcus aureus pristinamycin resistance is usually low. The frequency of pristinamycin‐resistant S. aureus (PRSA) increased in the Caen University Hospital dermatology department from 1% in 1998 to >11% in 1999–2002. Objectives This study aimed to identify the factors associated with PRSA acquisition. Methods Incidences of PRSA and pristinamycin consumption were calculated for the dermatology department and for the rest of the hospital from 1997 to 2007. Individual factors of PRSA acquisition in the dermatology department from 2000 to 2001 were analysed in a retrospective case–control study including 23 cases of PRSA skin colonization or infection and 46 controls with pristinamycin‐susceptible S. aureus. Clonal relatedness of isolates was analysed by pulsed‐field gel electrophoresis and pristinamycin resistance genes were detected by polymerase chain reaction. Conditional logistic regression was performed to analyse the relationship between pristinamycin resistance and epidemiological and microbiological data. Results PRSA frequency and pristinamycin consumption were significantly higher in the dermatology department than in other hospital departments. Two epidemic clones of two and six isolates were found for periods of 1 and 2 months, respectively. Thirteen of the 23 PRSA isolates (57%), including all isolates of the two epidemic clones, were found 48 h after the hospitalization or later. PRSA was associated with pristinamycin use during the previous year [odds ratio (OR) 5·60, 95% confidence interval (CI) 1·41–22·22], cumulative use of antibiotics exceeding 1 week during the previous year (OR 4·63, 95% CI 1·47–14·54) and methicillin resistance (OR 6·35, 95% CI 1·38–29·15). Conclusions Results suggest that antimicrobial selective pressure and microbial cross‐transmission are involved in PRSA acquisition.     

Hypertrophic lichen planus – successful treatment with acitretin

Lichen planus classifies into different subtypes according to morphology and location. Hypertrophic LP (HLP) manifests a great challenge due to persistent itching, the risk to develop into squamous cell carcinoma and therapeutic resistance. We report two clinical cases exemplary for the successful treatment of dramatic‐resistant HLP with acitretin.     

Atypical lichen planus associated with ulcerative colitis

A case is reported of a patient known to have ulcerative colitis who developed atypical lichen planus. This did not resolve when the patient discontinued sulphasalazine treatment but became more extensive within 48 h of an exacerbation of colitis. This case supports the view that there may be an association between ulcerative colitis and lichen planus.