Cardiovascular risk factors in patients with lichen planus

Dyslipidemia in Dermatological Disorders

Dyslipidemias are one of the common metabolic disorders. A link between dermatological disorders like psoriasis and dyslipidemia has been established in the recent past. Many dermatological disorders could have a systemic inflammatory component which explains such association. Chronic inflammatory dermatological disorders could also have other metabolic imbalances that may contribute to dyslipidemia. Presence of such abnormal metabolism may justify routine screening of these disorders for associated dyslipidemia and other metabolic abnormalities and early treatment of such comorbidities to improve quality of life. Some of the drugs used by dermatologists such as retinoids are also likely to be a cause of dyslipidemia. Hence, it is imperative that the dermatologists obtain scientific knowledge on the underlying mechanisms involved in dyslipidemia and understand when to intervene with therapies. A systematic review of the English language literature was done by using Google Scholar and PubMed. In this review, attempts are made to list the dermatological disorders associated with dyslipidemia; to simplify the understanding of underlying mechanisms; and to give a brief idea about the interventions.

Alterations in Lipid Metabolism and Antioxidant Status in Lichen Planus

Background:

Lichen planus (LP), a T-cell-mediated inflammatory disorder, wherein inflammation produces lipid metabolism disturbances, is linked to increase in cardiovascular (CV) risk with dyslipidemia. Increased reactive oxygen species and lipid peroxides have also been implicated in its pathogenesis.

Aim and Objective:

The aim of the study was to evaluate the status on lipid disturbances, oxidative stress, and inflammation in LP patients.

Materials and Methods:

The study was initiated after obtaining Institutional Ethics Committee permission and written informed consent from participants. The study included 125 patients (74 LP patients and 51 age and sex-matched controls) visiting the outpatient clinic in the dermatology department of our hospital. Variables analyzed included lipid profile, C-reactive protein (CRP), malondialdehyde (MDA), and catalase (CAT) activity.

Results:

Analysis of lipid parameters revealed significantly higher levels of total cholesterol (TC), triglycerides, and low-density lipoprotein cholesterol (LDL-C) along with decreased levels of high-density lipoprotein cholesterol (HDL-C) in LP patients as compared to their respective controls. LP patients also presented with a significantly higher atherogenic index that is, (TC/HDL-C) and LDL-C/HDL-C ratios than the controls. A significant increase in CRP levels was observed among the LP patients. There was a statistically significant increase in the serum levels of the lipid peroxidation product, MDA and a statistically significant decrease in CAT activity in LP patients as compared to their respective controls. A statistically significant positive correlation (r = 0.96) was observed between serum MDA levels and duration of LP whereas a significantly negative correlation (r = −0.76) was seen between CAT activity and LP duration.

Conclusion:

Chronic inflammation in patients with LP may explain the association with dyslipidemia and CV risk. Our findings also suggest that an increase in oxidative stress and imbalance in the antioxidant defense mechanisms in LP may play a role in the pathogenesis of LP.

Prevalence of Metabolic Syndrome in Patients with Mucosal Lichen Planus: A Case-Control Study

BACKGROUND

Previous reports have demonstrated an association between chronic inflammation with metabolic syndrome (MS) and cardiovascular risk factors.

AIM

As lichen planus (LP) is a chronic inflammatory disease, the purpose of this study was to assess the prevalence of MS, dyslipidemia, insulin resistance and obesity in LP patients.

METHODS

A total of 79 patients with LP and 79 controls were examined in this case-control study. Both groups were evaluated for the presence of MS, dyslipidemia, obesity and insulin resistance, and other cardiovascular risk factors. Erythrocyte sedimentation rate, fibrinogen and C-reactive protein were measured as inflammation markers.

RESULTS

The prevalence of MS was significantly higher in the patients with LP than in controls (26.6 vs. 12.7%; P = 0.045). It was also significantly higher in LP patients with mucosal involvement than without (34.5 vs. 8.3%; P = 0.032). Among the MS criteria, mean fasting blood glucose and diastolic blood pressure were also significantly higher in LP patients than in controls (P = 0.012 and P = 0.021, respectively). No significant differences between LP patients and controls were observed with respect to prevalence of dyslipidemia and insulin resistance (P = 0.866 and P = 1.000, respectively). However, duration of disease was significantly longer in patients with insulin resistance than in those without (P = 0.034).

CONCLUSIONS

The patients with LP, particularly those with mucosal involvement, have a higher prevalence of MS, which is associated with a risk for cardiovascular diseases and diabetes mellitus.

Lipid profile and metabolic syndrome status in patients with oral lichen planus, oral lichenoid reaction and healthy individuals attending a dental college in northern India - a descriptive study

BACKGROUND

Chronic inflammation causes disturbances in the lipid metabolism. When this dyslipidemia becomes prolonged it increases the risk of cardiovascular disease. Recent literature reveals similar dyslipidemia in patients with lichen planus. However, the results were not compared with lichenoid reactions.

OBJECTIVE

The aim of this study was to profile the lipid levels and metabolic syndrome status in patients with oral lichen planus (OLP), oral lichenoid reactions (OLR) and healthy individuals in order to evaluate their respective cardiovascular risk.

MATERIALS AND METHODS

This case-control descriptive study included 32 adults from the OPD visiting the Department of Oral Medicine, 18 with either oral lichen planus or oral lichenoid reactions and 14 age and sex matched healthy controls. Ethical clearance and informed consent were obtained. Their lipid levels, body mass index and metabolic syndrome status were evaluated. Statistical analyses were performed with the SPSS version 16.0 software.P≥0.05 was considered significant.

RESULTS

The key findings of this study were a) increased levels of S.cholesterol and LDL-C in OLP and OLR patients when compared to normal healthy individuals b) significantly higher S.triglyceride and VLDL in OLP when compared to OLR and c) lower HDL-C levels in OLP when compared to OLR. 2(18%) patients with OLP and 3(50%) with OLR were found to have high BMI suggestive of obesity whereas none of the normal individuals were obese.

CONCLUSION

There may be an association between chronic inflammation and dyslipidemia that increases the risk for cardiovascular disease. OLP and OLR patients have increased serum cholesterol and LDL-C when compared to normal adults. Further research on lipid levels in OLR are required to establish the findings of this study.

Homocysteine and other cardiovascular risk factors in patients with lichen planus

BACKGROUND

Chronic inflammation was found to play an important role in the development of cardiovascular risk factors. Homocysteine (Hcy) and fibrinogen have been identified as a major independent risk factor for cardiovascular disease. Lichen planus is assumed to be closely related to dyslipidaemia. Several cytokines involved in lichen planus pathogenesis, could explain its association with dyslipidaemia. Also chronic inflammation with lichen planus has been suggested as a component of the metabolic syndrome.

OBJECTIVE

The aim of this study was to detect a panel of cardiovascular risk factors in patients of lichen planus.

PATIENTS AND METHODS

This study was done on 40 patients of lichen planus and 40 healthy controls. All patients and controls were subjected to clinical examination. Serum levels of homocysteine, fibrinogen and high-sensitive C-reactive protein (hs-CRP) were measured by enzyme-linked immunosorbent assay technique (ELISA). Metabolic syndrome parameters including anthropometric measures, lipid profiles, blood sugar and blood pressure were studied.

RESULTS

Patients with lichen planus showed significant association with metabolic syndrome parameters than controls (P < 0.001). Serum homocysteine, fibrinogen and hs-CRP were significantly higher in lichen planus patients than controls (P < 0.001). Serum homocysteine correlated with both serum hs-CRP and serum fibrinogen. However, there was no correlation between serum levels of homocysteine and fibrinogen with any metabolic syndrome criteria and related disorders except for a negative correlation of fibrinogen with high-density lipoprotein (HDL).

CONCLUSION

In the present work, patients with lichen planus were found to have higher makers of both metabolic and cardiovascular risk factors in relation to controls most probably due to long standing inflammation.

Metabolic syndrome and skin: psoriasis and beyond

Metabolic syndrome (Met S) is a clustering of risk factors comprising of abdominal obesity, dyslipidemia, elevated blood pressure, and abnormal glucose tolerance. The prevalence of Met S has been increasing in the last few years throughout the world. Psoriasis has consistently been associated with Met S as well as its various components. However, the association is no longer limited to psoriasis alone. Various dermatological conditions such as lichen planus, androgenetic alopecia, systemic lupus erythematosus, skin tags, acanthosis nigricans, and even cutaneous malignancies have also been found to be associated with this syndrome. Though chronic inflammation is thought to be the bridging link, the role of oxidative stress and endocrine abnormalities has recently been proposed in bringing them together.

Increased P-wave dispersion in patients with newly diagnosed lichen planus

OBJECTIVE

Lichen planus is a chronic inflammatory autoimmune mucocutaneous disease. Recent research has emphasized the strong association between inflammation and both P-wave dispersion and dyslipidemia. The difference between the maximum and minimum P-wave durations on an electrocardiogram is defined as P-wave dispersion. The prolongation of P-wave dispersion has been demonstrated to be an independent risk factor for developing atrial fibrillation. The aim of this study was to investigate P-wave dispersion in patients with lichen planus.

METHODS

Fifty-eight patients with lichen planus and 37 age- and gender-matched healthy controls were included in this study. We obtained electrocardiographic recordings from all participants and used them to calculate the P-wave variables. We also assessed the levels of highly sensitive C-reactive protein, which is an inflammatory marker, and the lipid levels for each group. The results were reported as the means ± standard deviations and percentages.

RESULTS

The P-wave dispersion was significantly higher in lichen planus patients than in the control group. Additionally, highly sensitive C-reactive protein, LDL cholesterol, and triglyceride levels were significantly higher in lichen planus patients compared to the controls. There was a significant positive correlation between highly sensitive C-reactive protein and P-wave dispersion (r=0.549, p<0.001) in lichen planus patients.

CONCLUSIONS

P-wave dispersion increased on the surface electrocardiographic measurements of lichen planus patients. This result may be important in the early detection of subclinical cardiac involvement. Increased P-wave dispersion, in terms of the tendency for atrial fibrillation, should be considered in these patients.

Alterations in serum lipid profile patterns in oral lichen planus: a cross-sectional study

BACKGROUND

Oral lichen planus (OLP) is a chronic inflammatory disorder. Recently, a case-control study found that lichen planus was associated with dyslipidemia in a large series of patients. However, no data were presented about lipid values in patients and controls.

OBJECTIVES

The aim of this study was to investigate the hypothetical association between OLP and dyslipidemia.

MATERIALS AND METHODS

The study included a total of 400 patients (200 with OLP and 200 controls with other oral diseases) and investigated the prevalence of dyslipidemia. The variables analyzed were age, sex, tobacco and alcohol consumption, clinical form of OLP and lipid profiles.

RESULTS

A 54% prevalence of dyslipidemia was found (58% among the OLP group and 50% in the control group). Statistically significant differences in high-density lipoprotein were found between OLP patients and the control group (p = 0.003). A logistic regression model for presence/absence of cardiovascular risk (Castelli's atherogenic index of ≥ 5.1 for men and ≥ 4.5 for women) found statistically significant differences for sex and tobacco consumption.

CONCLUSIONS

The study found a higher atherogenic index amongst OLP patients.

Transient liver hypoxia after liver hilus dearterialization

Lichen planus (LP) is a chronic inflammatory disorder that most often affects middle-aged adults. LP can involve the skin or mucous membranes including the oral, vulvovaginal, esophageal, laryngeal, and conjunctival mucosa. It has different variants based on the morphology of the lesions and the site of involvement. The literature suggests that certain presentations of the disease such as esophageal or ophthalmological involvement are underdiagnosed. The burden of the disease is higher in some variants including hypertrophic LP and erosive oral LP, which may have a more chronic pattern. LP can significantly affect the quality of life of patients as well. Drugs or contact allergens can cause lichenoid reactions as the main differential diagnosis of LP. LP is a T-cell mediated immunologic disease but the responsible antigen remains unidentified. In this paper, we review the history, epidemiology, and clinical subtypes of LP. We also review the histopathologic aspects of the disease, differential diagnoses, immunopathogenesis, and the clinical and genetic correlations.