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.     

Association between psoriasis and viral infections in the United States: focusing on hepatitis B,hepatitis C and human immunodeficiency virus

Background No published data in the U.S. population regarding an association between viral infections and psoriasis are currently available. Assessment of infection and immunosuppression risk is critical in managing psoriasis patients. Objectives To examine the association between psoriasis and viral infections including hepatitis B, hepatitis C and human immunodeficiency viral infections in the general U.S. population. Methods Population data representative of the U.S. cohort were analysed from the National Health and Nutrition Examination Survey (NHANES), 2003–2006. Hepatitis B, hepatitis C, and human immunodeficiency antibodies status were ascertained from laboratory evaluations. Univariate and multivariate analyses were performed to assess the associations between psoriasis and these viral infections. Results Among 6532 participants aged 20–59 years who provided responses to their psoriasis status, 162 patients reported having psoriasis. Based on multivariate regression analyses, psoriasis was not significantly associated with positive serology for hepatitis B core [odds ratio (OR), 0.83; 95% confidence interval (CI), 0.32–2.17; P = 0.7060], hepatitis B surface [OR, 7.89; CI, 0.52–119; P = 0.1355], hepatitis C [OR, 0.24; CI, 0.03–2.01; P = 0.1915], or human immunodeficiency virus [OR, 0.73; CI, 0.09–5.93; P = 0.7646] antibodies, after adjusting for age, gender, race and smoking status. Conclusions From the limited sample of the NHANES database on psoriasis and viral infections, psoriasis does not appear to be associated with an increased risk of hepatitis B, hepatitis C, or HIV infection in the U.S. population. Epidemiology of these viral infections in psoriasis needs to be continually studied and updated given their importance in management considerations.     

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.     

Hepatitis C virus infection prevalence in lichen planus: examination of lesional and normal skin of hepatitis C virus-infected patients with lichen planus for the presence of hepatitis C virus RNA

Hepatitis C virus (HCV) is the main cause of parenterally transmitted non-A, non-B viral hepatitis. In recent years, a significant association between lichen planus and chronic HCV infection has been reported. Anti-HCV antibody status was evaluated by ELISA in 54 patients with lichen planus and 54 patients with minor dermatological disorders. PCR was used to examine HCV RNA from serum and lesional and nonlesional cutaneous biopsy samples of HCV-infected patients. Seven patients with lichen planus (12.9%) and two patients in the control group (3.7%) were anti-HCV antibody positive. Five out of seven patients with anti-HCV antibodies had demonstrable HCV RNA in lesional skin biopsies. The viral RNA was absent in three out of four patients with lichen planus whose serum samples were positive for HCV RNA and agreed to biopsy of nonlesional skin. The prevalence of HCV infection is not increased in Turkish patients with lichen planus. However our findings suggest that the virus may play a potential pathogenic role by replicating in cutaneous tissue and triggering lichen planus in genetically susceptible HCV-infected patients.     

Detection of hepatitis C virus RNA and core protein in keratinocytes from patients with cutaneous lichen planus and chronic hepatitis C

Cutaneous lichen planus has been associated in patients with chronic hepatitis C virus infection. It is still unknown whether hepatitis C virus infects keratinocytes of lichen planus lesions. In this report we have analyzed the presence of genomic and anti-genomic hepatitis C virus RNA in skin biopsies from 26 patients with chronic hepatitis C and healthy skin and from 24 patients with cutaneous lichen planus (five with and 19 without hepatitis C virus infection) by in situ hybridization. Hepatitis C virus RNA was detected in the keratinocytes of 69% of the patients with healthy skin and chronic hepatitis C, in 100% of the patients with lichen planus and hepatitis C virus infection, and in none of lichen planus patients without hepatitis C virus infection. The percentage of keratinocytes showing genomic or anti-genomic hepatitis C virus RNA was statistically lower (p < 0.01 in all cases) in patients with healthy skin (mean +/- SD: 5.7 +/- 3.5% and 2.7 +/- 3.1% of keratinocytes with genomic or anti-genomic hepatitis C virus RNA, respectively) than in those with lichen planus lesions (31.7 +/- 7.9% and 18.8 +/- 7.4%, mean +/- SD) or the unaffected adjacent skin (24.8 +/- 6.9% and 14.3 +/- 3.8%, mean +/- SD). In conclusion, we have demonstrated that hepatitis C virus infects keratinocytes from patients with lichen planus and hepatitis C virus infection.     

Dermatological manifestations in hepatitis B surface antigen carriers in east region of Turkey

BACKGROUND AND DESIGN: Various cutaneous disorders associated with hepatitis B virus infection have been reported so far. Almost all of them were some peculiar eruptions or some disorders mainly based on immune complex reaction. OBJECTIVE: The aim of this study was to compare the frequency of all dermatological disorders other than genetic ones in hepatitis B surface antigen (HBsAg) carrier patients and controls in our geographical area. METHODS: Examinations were made on 88 hepatitis B carriers and 84 control patients, including entire skin surface, and oral and anogenital mucosa, and all the manifestations that could be seen were noted down. RESULTS: While the number of HBsAg carrier patients with dermatological disorders was 62 (70.75%), it was only 24 (28.57%) in control patients. This seems statistically important: Yates' corrected chi-square test = 28.5; P = 0.0000001; odds ratio = 6.0 (2.94 < odds ratio < 12.2). The prevalence of oral lichen planus and pitted keratolysis in HBsAg carrier group was significantly higher than that of controls. We found the duration of positivity was not important statistically in the development of the dermatological disorders. CONCLUSIONS: HBsAg positivity may induce or cause proneness to oral lichen planus and pitted keratolysis with some mechanism that needs to be elucidated.     

Lichen planus is not associated with hepatitis C virus infection in patients from north west England.

It has been suggested that infection with hepatitis C virus may be associated with the development of lichen planus and that geographical area may be an important factor affecting the relative risk. The present 2-centre, prospective, epidemiological study investigates this possible association in north west England. A total of 45 patients with classical and/or erosive mucous membrane lichen planus and 32 controls were tested for seropositivity to hepatitis C virus. None of the patients with lichen planus and only 1 of the control patients had serological evidence of infection with hepatitis C. Whilst there may be an important association between these 2 diseases in other countries, this study suggests that this does not appear to be the case in north west England and, furthermore, provides no evidence to advise routine investigation to exclude hepatitis C in patients with lichen planus in this region.     

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 dyslipidaemia: a case–control study

Background  Previous reports have demonstrated an association between psoriasis and dyslipidaemia.
Objectives  As lichen planus (LP) is also a chronic inflammatory disorder, we investigated the association between LP and dyslipidaemia in Israel.
Methods  A case–control study was performed utilizing the database of Clalit Health Services, a large healthcare provider organization in Israel. Patients aged 20–79 years who were diagnosed as having LP were compared with a sample of enrollees without LP regarding the prevalence of dyslipidaemia. Data on other health-related lifestyle factors and comorbidities were collected.
Results  The study included 1477 patients with LP and 2856 controls without LP. The prevalence of dyslipidaemia was significantly higher in patients with LP (42·5% vs. 37·8%, P  =   0·003; odds ratio, OR 1·21, 95% confidence interval, [CI]: 1·06–1·38). A multivariate logistic regression model demonstrated that LP was significantly associated with dyslipidaemia even after controlling for confounders, including age, sex, smoking, hypothyroidism, diabetes, hypertension, socioeconomic status and obesity (multivariate OR 1·34, 95% CI: 1·14–1·57, P  <   0·001).
Conclusions  In the present study, LP was found to be associated with dyslipidaemia.     

Low prevalence of hepatitis B markers among Mexican female sex workers

OBJECTIVES: To estimate the prevalence and associated risk factors of hepatitis B virus (HBV) serological markers in female sex workers (FSW) in Mexico City. METHODS: The study population consisted of 1498 FSW who attended a detection centre for human immunodeficiency virus (HIV) in Mexico City, between January and October 1992. Study participants responded to a standardised questionnaire and provided a blood sample for serology of syphilis, HIV, and HBV. RESULTS: A total of 0.2% (95% CI 0.1-0.3) of the population were hepatitis B surface antigen (HBsAg) carriers. The general prevalence of antibodies to hepatitis B core antigen (anti-HBc) was 6.3% (95% CI 5.5-7.1). This marker of previous exposition to HBV, was independently associated by logistic regression multivariate analysis with age, working in the street, and history of blood transfusion (BT) before 1987 (OR 4.8, 95% CI 2.1-11.3). Syphilis prevalence was 7.6% (95% CI 6.2-8.9) and HIV prevalence was 0.1% (95% CI 0-0.3). CONCLUSIONS: The prevalence of HBV infection in this group of Mexican FSW is lower than previously reported in other countries. In addition, the frequency of HBsAg carriers is similar to that in the general Mexican population. The absence of two major risk factors for HBV transmission in this group of FSW--that is, injecting drug use and anal intercourse, could help to explain this finding. However, the positive association between anti-HBc and history of blood transfusion demonstrated here, highlights the need to reinforce strict control of blood supplies in Mexico.     

Scleromyxedema and lichen myxedematosus: Is it associated with viral hepatitis?

Scleromyxedema (SM) was previously known to be associated with monoclonal gammopathy. The association of SM and its counterpart lichen myxedematosus (LM) with chronic hepatitis has rarely been reported. We retrospectively reviewed medical records and histopathological reports of consecutive patients who presented at our department with the diagnosis of SM or LM from January 2001 to September 2017. The patients’ demographic details, cutaneous presentation, associated underlying diseases and hepatitic profile were studied and compared with previous published cases. In all, 28 patients were enrolled, including one SM, 19 LM and eight atypical LM. Of the patients, 50% (n = 14/28) had hepatitis. Of these, 21.4% (n = 6/28) had hepatitis C, 10.7% (n = 3/28) hepatitis B, 7.1% (n = 2/28) concurrent hepatitis B and C, whereas 10.7% (n = 3/28) had alcoholic liver disease. The prevalence of hepatitis C in our patients was 6.5‐times higher than that of the general population (28.6% vs 4.4%) and the prevalence of hepatitis B was similar (17.9% vs 17.3%). Polyclonal gammopathy was found in 28.6% (n = 8/28) of the patients and monoclonal gammopathy was found in 7.1% (n = 2/28). The extent of clonality did not correlate with disease severity. Our study did not notice a significant association with monoclonal gammopathy but the prevalence of hepatitis C was found to increase 6.5‐times in these patients compared with the general population. We recommend dermatologists to be aware of hepatitis investigations in such patients and future studies are warranted to understand the mechanism behind such association.     

扁平苔藓和丙型肝炎病毒

扁平苔藓是一种原因不明的炎症性皮肤病,其患病率为0.5%～2%.目前认为,扁平苔藓可能是一种自身免疫性疾病.丙型肝炎病毒被证明其伴随着一系列肝外表现,包括扁平苔藓,为此,综述扁平苔藓和丙型肝炎病毒的关系,以及病毒感染如何导致扁平苔藓的发生,从而为扁平苔藓合并丙型肝炎病毒感染的临床治疗及早期诊断提供一种思路.     

扁平苔藓和丙型肝炎病毒

扁平苔藓是一种原因不明的炎症性皮肤病,其患病率为0.5%～2%.目前认为,扁平苔藓可能是一种自身免疫性疾病.丙型肝炎病毒被证明其伴随着一系列肝外表现,包括扁平苔藓,为此,综述扁平苔藓和丙型肝炎病毒的关系,以及病毒感染如何导致扁平苔藓的发生,从而为扁平苔藓合并丙型肝炎病毒感染的临床治疗及早期诊断提供一种思路.     

扁平苔藓和丙型肝炎病毒

扁平苔藓是一种原因不明的炎症性皮肤病,其患病率为0.5%～2%.目前认为,扁平苔藓可能是一种自身免疫性疾病.丙型肝炎病毒被证明其伴随着一系列肝外表现,包括扁平苔藓,为此,综述扁平苔藓和丙型肝炎病毒的关系,以及病毒感染如何导致扁平苔藓的发生,从而为扁平苔藓合并丙型肝炎病毒感染的临床治疗及早期诊断提供一种思路.     

扁平苔藓和丙型肝炎病毒

扁平苔藓是一种原因不明的炎症性皮肤病,其患病率为0.5%～2%.目前认为,扁平苔藓可能是一种自身免疫性疾病.丙型肝炎病毒被证明其伴随着一系列肝外表现,包括扁平苔藓,为此,综述扁平苔藓和丙型肝炎病毒的关系,以及病毒感染如何导致扁平苔藓的发生,从而为扁平苔藓合并丙型肝炎病毒感染的临床治疗及早期诊断提供一种思路.     

扁平苔藓和丙型肝炎病毒

扁平苔藓是一种原因不明的炎症性皮肤病,其患病率为0.5%～2%.目前认为,扁平苔藓可能是一种自身免疫性疾病.丙型肝炎病毒被证明其伴随着一系列肝外表现,包括扁平苔藓,为此,综述扁平苔藓和丙型肝炎病毒的关系,以及病毒感染如何导致扁平苔藓的发生,从而为扁平苔藓合并丙型肝炎病毒感染的临床治疗及早期诊断提供一种思路.     

扁平苔藓和丙型肝炎病毒

扁平苔藓是一种原因不明的炎症性皮肤病,其患病率为0.5%～2%.目前认为,扁平苔藓可能是一种自身免疫性疾病.丙型肝炎病毒被证明其伴随着一系列肝外表现,包括扁平苔藓,为此,综述扁平苔藓和丙型肝炎病毒的关系,以及病毒感染如何导致扁平苔藓的发生,从而为扁平苔藓合并丙型肝炎病毒感染的临床治疗及早期诊断提供一种思路.     

扁平苔藓和丙型肝炎病毒

扁平苔藓是一种原因不明的炎症性皮肤病,其患病率为0.5%～2%.目前认为,扁平苔藓可能是一种自身免疫性疾病.丙型肝炎病毒被证明其伴随着一系列肝外表现,包括扁平苔藓,为此,综述扁平苔藓和丙型肝炎病毒的关系,以及病毒感染如何导致扁平苔藓的发生,从而为扁平苔藓合并丙型肝炎病毒感染的临床治疗及早期诊断提供一种思路.     

扁平苔藓和丙型肝炎病毒

扁平苔藓是一种原因不明的炎症性皮肤病,其患病率为0.5%～2%.目前认为,扁平苔藓可能是一种自身免疫性疾病.丙型肝炎病毒被证明其伴随着一系列肝外表现,包括扁平苔藓,为此,综述扁平苔藓和丙型肝炎病毒的关系,以及病毒感染如何导致扁平苔藓的发生,从而为扁平苔藓合并丙型肝炎病毒感染的临床治疗及早期诊断提供一种思路.     

扁平苔藓和丙型肝炎病毒

扁平苔藓是一种原因不明的炎症性皮肤病,其患病率为0.5%～2%.目前认为,扁平苔藓可能是一种自身免疫性疾病.丙型肝炎病毒被证明其伴随着一系列肝外表现,包括扁平苔藓,为此,综述扁平苔藓和丙型肝炎病毒的关系,以及病毒感染如何导致扁平苔藓的发生,从而为扁平苔藓合并丙型肝炎病毒感染的临床治疗及早期诊断提供一种思路.