Oral lichen planus in relation to transaminase levels and hepatitis C virus

BACKGROUND: Elevation of transaminase levels was reported earlier in patients with oral lichen planus. The association between hepatitis C virus (HCV) and lichen planus had given positive and negative results. The controversies and uncertainties regarding the association of HCV and the liver function status (transaminase levels) in oral lichen planus inspired us to conduct this study. PATIENTS AND METHODS: This study was performed on 40 patients with different types of oral lichen planus as a study group and 40 healthy cases as control group. All patients were subjected to routine blood test and urine analysis and the estimation of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) levels. The values of SGOT and SGPT levels < or =40 IU / l were considered within normal limits. Anti-HCV titer was estimated in all cases. RESULTS: Fourteen patients (35%) with oral lichen planus had diabetes mellitus, while six (15%) cases of the control group had diabetes mellitus (P = 0.04). Regarding SGOT and SGPT levels, it was elevated in 19 cases (47.5%) and in 4 cases (10%) of the study group and control group, respectively (P = 0.0002). In relation to the type of oral lichen planus, out of 15 erosive cases, 80% (12 cases) showed elevated SGOT/SGPT levels. Out of 25 non-erosive cases, 7 (28%) patients showed elevated SGOT/SGPT levels (P < 0.01). Anti-HCV titer was negative in all cases. CONCLUSION: We can conclude that diabetes mellitus and elevated transaminase levels might be related to the development of oral lichen planus lesions. There is a strong association between elevated SGOT/SGPT levels and detection of erosive type of such lesions. However, no correlation between oral lichen planus and HCV infection could be assessed in the present study.     

Oral lichen planus and hepatitis C virus infection

OBJECTIVE: This investigation was conducted to determine the possible association between oral lichen planus (OLP) and hepatitis C virus infection (HCV) in the population of São Paulo (Brazil). MATERIALS AND METHODS: Three groups of patients were studied: group 1 was composed of 68 patients with OLP lesions; group 2 had 126 patients with HCV infection; and the control group consisted of 898 individuals seeking dental treatment at our school, used to determine the prevalence of lichen planus in the general population. The prevalence of HCV in group 1 was determined and compared with that of the population of São Paulo ( 9 ) Brazilian J Infec Dis 2: 269), while the prevalence of OLP in group 2 was determined and compared with that of the control group. RESULTS: The results showed that the frequency of HCV in OLP patients was 8.8%, significantly higher than in the general population of São Paulo, which is 1.4% (P=0.002), and the frequency of OLP in HCV patients (4.7%) was also significantly higher (P=0.0003) than that of the control group (0.6%). CONCLUSION: These data suggest that, at least in São Paulo, there is an association between OLP and HCV infection.     

Lack of evidence of hepatitis in patients with oral lichen planus in China: A case control study

Background

China has been one of the countries with high prevalence of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) liver disease. And lichen planus is an extrahepatic manifestation of patients with chronic HCV infection. This case-control study was conducted to investigate the relationship between oral lichen planus (OLP) and HBV/HCV infection in China.

Material and Methods

A total of 776 patients, including 150 patients with OLP (Group OLP), 429 inpatients from the Trauma Ward of Oral and Maxillofacial Surgery Department (Group A), 110 patients with other oral mucosal diseases, but without a reported association with HCV infection (Group B) and 87 patients with oral lichenoid lesion (Group OLL), were compared with their seroprevalence of anti-HCV antibody (HCVAb), hepatitis B surface antigen (HBsAg) and the parameters of liver functions. Moreover, the clinical characteristics of OLP were also observed, such as gender, age, chief complaint, course of the disease, clinical type, sites involved and so on.

Results

The positive rates of HCVAb and HBsAg in OLP patients were 0.7% and 4%, respectively. Neither HCVAb nor HBsAg was associated with OLP as demonstrated by both the univariate and the multivariate analyses. The clinical features and liver functions of OLP patients with negative or positive HBsAg were nearly the same.

Conclusions

Our findings verify that there is no association between OLP and hepatitis and there is no need to run a screening test for HCV or HBV in OLP patients in China. Key words:Oral lichen planus, hepatitis C virus, hepatitis B virus.     

Hepatitis C virus infection and lichen planus: a systematic review with meta‐analysis

Oral Diseases (2010) 16 , 601–612 Objective: Hepatitis C virus (HCV) is one of the major causes of chronic liver disease worldwide but its morbidity is also due to a variety of extra‐hepatic manifestations including mixed cryoglubulinemia, non–Hodgkin lymphoma, diabetes, porphyria cutanea tarda and lichen planus. The aims of this study were to conduct a systematic review and a meta‐analysis on the prevalence of HCV in lichen planus patients and on the prevalence of lichen planus in chronic HCV infection. Materials and Method: Bibliographic searches were conducted in several electronic databases. Pooled data were analysed by calculating odds ratios, using a random effects model. Results and Conclusions: Thirty‐three studies comparing the seroprevalence of HCV in lichen planus patients and six reporting the prevalence of lichen planus in patients with HCV infection were included in the meta‐analysis. The summary estimate showed that LP patients have significantly higher risk (odds ratio 4.85; 95% confidence interval 3.58–6.56) than controls of being HCV seropositive. A similar odds ratio of having lichen planus was found among HCV patients (4.47; 95% confidence interval 1.84–10.86). Sub‐analyses indicated that variability of HCV/lichen planus association seemed only partially depending on geographic effect.     

Oral lichen planus: a condition with more persistence and extra‐oral involvement than suspected?

Background: Lichen planus is a relatively common and often studied chronic mucocutaneous condition. Reports detailing certain aspects relevant to patients affected have been lacking or inconsistent. Methods: A questionnaire‐based survey was employed to assess the duration of oral lesions and the prevalence of self‐reported potential extra‐oral manifestations associated with oral lichen planus in 87 patients. All patients had recognized clinical features of oral lichen planus, and most had had histopathological confirmation following oral biopsy. Results: We report the findings of a preliminary survey which assessed the duration of oral lesions and the prevalence of extra‐oral lesions consistent with lichen planus in patients presenting with oral lesions. The study confirmed the chronic nature of oral lichen planus and the rarity of spontaneous resolution. Most subjects had experienced symptoms for one to ten years (66 patients; 75.8%). Approximately 40% (36 patients) of the sample reported clinical features suggestive of extra‐oral manifestations of lichen planus by the time that their oral lesions were apparent. The most commonly reported extra‐oral manifestations involved the nails (27.6%, 24 patients). 25.3% (22 patients) reported a persistently sore throat suggestive of oesophageal or pharyngeal involvement. Skin (17.2%, 11 patients), and genital (10.3%, 9 patients) involvement was relatively infrequently reported. Most patients reported extra‐oral lesions at only one site. Conclusions: The survey results suggest that in patients with oral lichen planus oral lesions persist for a prolonged period, and that extra‐oral lesions may be more common than suspected. However, further studies involving specialists to examine extra‐oral sites are required.     

Oral health of patients with hepatitis C virus infection: a pilot study

OBJECTIVES: This study examined the oral health of a cohort of hepatitis C virus (HCV) patients. In particular, the prevalence of lichen planus and xerostomia were determined. Experiences of discrimination against HCV-infected patients by their dentists were also recorded. METHODS: Forty patients infected with HCV, who were not undergoing anti-viral treatment, were examined. Patient information collected included demographic details together with patients' perception of their oral health and access to dental care since being diagnosed with hepatitis C. Both extra-oral and intra-oral examinations were conducted. Teeth present and visible caries were recorded, periodontal condition was measured using a Community Periodontal Index of Treatment Need (CPITN) probe and denture fit and hygiene were assessed where appropriate. The soft tissues were examined and lichen planus diagnosed clinically. Salivary flow rates were estimated by the Salivette system. RESULTS: The oral health of this cohort was poor. Eight patients had clinical evidence of oral lichen planus (OLP), although this was not confirmed histologically. The salivary flow rates were significantly lower (P < 0.001) than in previously reported healthy controls. Of the 15 (37.5%) regular dental attenders, two had encountered problems accessing dental care. CONCLUSIONS: Chronic hepatitis C patients have significant oral health needs. More effective oral health education is required for both HCV-infected patients and their carers, including dental practitioners.     

Hepatitis C virus infection and oral lichen planus: a report from the Netherlands

The reported frequency of anti-hepatitis C virus (HCV) antibodies in groups of cutaneous lichen planus (CLP) and/or oral lichen planus (OLP) patients varies from about 4% to 65%. Most of these studies have been performed in countries with a high overall prevalence of HCV infection in the general population, such as the southern European countries and Japan. Limited data are available from areas with a low prevalence of HCV infection. Therefore, we investigated the prevalence of HCV infection in a series of 55 patients with OLP in the Netherlands, which apparently has a low prevalence of HCV infection. None of the 55 patients revealed serological evidence of antibodies to HCV. The present data suggest that HCV infection in OLP patients in the Netherlands is probably not very common. A larger study group with a sex- and age-matched control group is required to advise against routine serological examination for HCV infection in Dutch OLP patients.     

Oral lichen planus and hepatitis C virus (HCV) infection: is there a relationship? A report of 10 cases

Ten patients are reported suffering from oral lichen planus (OLP) associated with chronic liver diseases linked to HCV. All patients were affected by varieties of erosive oral lichen planus. In six of these 10 patients the diagnosis of HCV was made as a result of the OLP diagnosis and four of them had unknown, but severe, chronic liver disease. These preliminary data support the possible existence of a relationship between oral erosive lichen planus and HCV infection.     

Oral conditions in hepatitis C virus-infected Iranian patients: a case-control study

Abstract Aim: Hepatitis C virus is now found worldwide, giving rise to concern that general populations might become infected. Extrahepatic manifestations might indicate latent disease. The aim of this study was to evaluate the association between oral lichen planus and xerostomia with hepatitis C virus infection in an Iranian population. Methods: The study (case) group consisted of 73 individuals with hepatitis C virus infection. The control group consisted of 139 age- and sex-matched individuals. All patients were examined for oral conditions, and their hepatitis C virus infection was confirmed by an antihepatitis C virus antibody and hepatitis C virus-RNA polymerase chain reaction. Results: The prevalence of oral lichen planus was 1.4% and 4.1% of individuals complained of a dry mouth. There were no statistically-significant differences between the case and control groups. Conclusion: Our findings reinforce other regional studies that there is no association between hepatitis C virus infection and oral conditions in the north of Iran, an area with a low prevalence of this infection.     

黑龙江地区口腔扁平苔藓患者丙型肝炎病毒感染的检测

目的 检测黑龙江地区口腔扁平苔藓(OLP)患者丙型肝炎病毒(HCV)的感染率,并讨论两者之间的关系。方法 采用双抗夹心酶联免疫吸附试验(ELISA)对本地区62例OLP患者和61例非OLP黏膜病患者及22例健康志愿者进行血清丙型肝炎病毒抗体(HCV-Ab)的检测。结果 口腔扁平苔藓组HCV感染率(9.7%)明显高于非OLP黏膜病组(1.6%)和健康组(0%)HCV感染率(P<0.05)。结论 黑龙江地区OLP的发病与HCV感染存在一定的关系。     

Hepatitis C virus infection in Italian patients with oral lichen planus: a prospective case-control study

To assess the aetiology of liver disease associated with lichen planus, we prospectively studied 70 consecutive newly diagnosed patients with oral lichen planus (OLP) living in northwest Italy (Piemonte) and 70 controls matched for age and sex with other oral keratoses coming from the same district. Twenty-two patients with OLP (3.4%) and 9 controls (12.9%) were found to be affected by chronic liver disease (CLD) ( P =0.014). In sixteen of the 22 OLP patients with CLD the liver disease was hepatitis C virus (HCV)-related. whereas 2 of the 9 controls had a HCV-related CLD ( P =0.016). In another OLP case, liver damage was related to a combination of HCV and alcohol abuse. The prevalence of HCV antibodies in the whole OLP group (27.1%) was significantly higher than in controls (4.3%) ( P =0.014). whereas no difference was found between the OLP and control groups regarding hepatitis B virus markers and other common causes of CLD. HCV infection was more frequently found in patients with erosive OLP (58.8%) than in patients with non-erosive OLP (13.2%) ( P =0.004). Serum HCV-RNA was detected by polymerase chain reaction (RT-PCR) in the majority (93.7%) of OLP patients who had HCV antibodies. Excluding OLP and control patients with HCV markers, there was no difference between the two groups regarding frequency of CLD. Our data show that HCV is probably the main pathogenic factor in liver disease of Italian patients with OLP. and suggests that HCV could be involved in the pathogenesis of OLP.     

A multicenter study of oral lichen planus in Thai patients

Abstract Aim: Oral lichen planus is an oral mucosal disease that affects middle‐aged patients. The characteristics of oral lichen planus in Thai patients from a multicenter were studied. Methods: Data of 533 patients from the oral medicine clinics at Chulalongkorn and Mahidol (central Thailand), Chiang Mai (northern Thailand), and Khon Kaen (northeastern Thailand) universities during 2002–2007 were analyzed. The diagnosis of patients with oral lichen planus was clinically and/or histopathologically confirmed. Results: There was a greater number of female patients than males (4:1). There were significant differences in age, sex, and some systemic diseases among the oral lichen planus patients from the three centers. Burning sensation was the most common symptom (72.9%), followed by pain (26.5%), roughness (6.4%), and then no other symptoms (7.9%). The most common site of lesions was found at the buccal mucosa (87.1%). Atrophic oral lichen planus was common in Thai patients. There were significant differences in the types of oral lichen planus, including reticular, atrophic, and ulcerative oral lichen planus among these patients from the three centers (P = 0.000). Nine cases (1.7%) showed dysplasia, but one case (0.2%) developed squamous cell carcinoma. Conclusion: Patients with oral lichen planus from the central, northern, and northeastern parts of Thailand presented with distinct characteristics. The malignant transformation of oral lichen planus was low in Thai patients.     

Lack of association between hepatitis C virus and oral epithelial dysplasia in British patients

Oral lichen planus may be a premalignant condition. An association between hepatitis C virus (HCV) infection and oral lichen planus has been described in Southern European and Japanese patients, and recently an association between HCV and oral squamous cell carcinoma was suggested from a study of Japanese patients. The present study investigated the frequency of chronic liver disease and HCV infection in UK patients with oral epithelial dysplasia (OED), a known premalignant disorder. Subjects included 75 patients with histologically proven OED and 110 healthy controls. Liver function and IgG antibodies to HCV were examined serologically. No patient with OED or control subject had serological evidence of hepatic disease, and anti-HCV antibodies were detected in only two (2.6%) of the 75 patients with OED, none of the controls being HCV seropositive. It is concluded that in the UK there is no association between HCV infection and OED.     

口腔扁平苔藓患者幽门螺杆菌感染状况分析

目的 分析口腔扁平苔藓患者幽门螺杆菌感染状况,探索口腔扁平苔藓与幽门螺杆菌感染的相关性.方法 收集口腔扁平苔藓患者(扁平苔藓组)69例和口腔黏膜慢性炎症患者(慢性炎症组)28例,在初诊时进行14C-尿素呼气试验,其中32例患者(扁平苔藓组23例,慢性炎症组9例)同时检测血清抗幽门螺杆菌(Helicobacter pylori,Hp)抗体.结果 扁平苔藓组14C-尿素呼气试验阳性率为68.12%,慢性炎症组14C-尿素呼气试验阳性率为46.43%,扁平苔藓组高于慢性炎症组,差异有统计学意义(x2=3.970,P=0.046).23例口腔扁平苔藓患者中抗Hp抗体阳性检出率为52.17%,9例口腔黏膜慢性炎症患者Hp抗体阳性检出率为22.22%,差异无统计学意义(x2=2.358,P=0.125).结论 口腔扁平苔藓患者幽门螺杆菌感染率较高,口腔扁平苔藓与幽门螺杆菌感染可能有关.     

Prevalence of hepatitis C virus in patients with lichen planus of the oral cavity and chronic liver disease

Lichen planus (LP) may represent a mucosal reaction to a variety of factors including hepatitis C virus (HCV) infection. We compared the prevalence of HCV infection in patients with LP of the oral mucosa and chronic liver disease (LP-CLD) with those suffering exclusively from LP or from chronic liver disease (CLD). A total of 267 outpatients participated in a prospective study. There were 41 patients in the LP-CLD group, 128 in the LP group, and 98 in the CLD group. The diagnosis of LP was based on typical macroscopic and histopathologic features and the diagnosis of liver disease on liver histology. Serum samples were screened for anti-HCV antibodies. In 89 patients, serum HCV RNA was also measured. The overall prevalence of anti-HCV antibodies was 29.2% (78/267 patients). Serum HCV RNA levels were positive in 96.2% of anti-HCV-positive patients and in none of anti-HCV-negative subjects. Anti-HCV-positivity was more frequent in the groups of LP-CLD (78%) and CLD (42.8%) than in the LP group (3.1%). It is concluded that HCV infection plays an etiopathogenetic role in CLD associated with oral LP, whereas according to the present findings, the majority of patients suffering exclusively from oral LP are not infected by the HCV.     

丙型肝炎病毒在口腔扁平苔藓发病中的意义

目的：探索丙型肝炎病毒在口腔扁平苔藓发病中的意义。方法：应用ＰＣＲ技术对６０例口腔扁平苔藓患者进行了丙型肝炎病毒ＲＮＡ的检测。结果：在６０例口腔扁平苔藓患者中，其中７例丙型肝炎病毒ＲＮＡ阳性，与对照组相比具有显著性差异（Ｐ＜０．０５）；且丙型肝炎病毒ＲＮＡ阳性患者的损害均表现为白纹伴糜烂。结论：在口腔扁平苔藓中，尤其是在糜烂伴白纹的口腔扁平苔鲜患者中，应用敏感的ＰＣＲ技术检测血液中的丙型肝炎病毒ＲＮＡ，不仅对于防治慢性肝炎，而且对于探索口腔扁平苔藓的病因与治疗均具有重要意义。     

Antibodies to epithelial components in oral lichen planus (OLP) associated with hepatitis C virus (HCV) infection

Oral lichen planus (OLP) is a common chronic inflammatory disorder sometimes associated with hepatitis C virus (HCV) infection. An increased prevalence of autoimmune markers has been reported in patients with HCV infection. The aim of the present study was to determine, by conventional indirect immunofluorescence, the nature and frequency of circulating antibodies to epithelial antigens in the sera of HCV-positive patients who also have OLP. The study comprised four groups: 14 patients with OLP and HCV infection. 14 HCV-seronegative patients with OLP, 21 HCV-seropositive patients without OLP and 18 healthy controls. We found a significant association between the concomitance of OLP and HCV infection and the presence of such antibodies. It is concluded that some patients with HCV-associated OLP may have circulating antibodies to epithelial antigens, although their precise aetiological role in the development of this disease in HCV infection remains unknown.     

口腔黏膜病患者牙周健康状况调查分析

目的通过流行病学调查方法了解口腔黏膜病患者牙周健康状况,为口腔黏膜病患者牙周病的预防与治疗提供依据。方法对中国医科大学附属盛京医院口腔科门诊的黏膜病患者766人进行牙周专科检查,填写调查问卷,检查结果采用SPSS 13.0软件进行统计学分析。结果口腔黏膜病患者牙周健康者只有10.70%。不同性别、年龄、学历、口腔护理情况显著影响口腔卫生及口腔健康情况;口腔黏膜病中,患者就诊率最高的是口腔溃疡(34.20%),其次为扁平苔癣(32.64%);口腔溃疡及扁平苔藓的牙周炎患病率均较高,分别是95.42%和92.80%。结论口腔黏膜病的发病与发展与牙周健康水平有着密切的相关性,应从多角度分析口腔黏膜病患者牙周健康不良原因,及牙周健康不良是否会影响口腔黏膜病变,并采取积极预防及治疗措施。