Impairment of myocardial functions and arterial stiffness in patients with lichen planus

Giant cell myocarditis following COVID-19 successfully treated by immunosuppressive therapy

It has been shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), by coronavirus disease 2019 (COVID-19), can lead to multi-organ impairment including cardiac involvement and immunological problems. Acute myocarditis is one of serious and fatal complications of COVID-19. In this case report, we present a 46-year-old lady with a history of lichen planus dermatitis who has developed a rapidly progressive heart failure after an episode of COVID-19. The pathologic examination of her endomyocardial biopsy specimens was compatible with GCM, and she was successfully treated with a combined immunosuppressive therapy regimen.

Can Pioglitazone Safeguard Patients of Lichen Planus Against Homocysteine Induced Accelerated Cardiovascular Aging and Reduced Myocardial Performance: A Systematic Review

Lichen planus (L.P.) is a long-standing mucocutaneous inflammatory condition. A less familiar but essential illness association is increased arterial stiffness, endothelial dysfunction, and advanced atherosclerosis. Enhanced cardiac reconditioning and reduced performance of the heart have been suggested. Thiazolidinediones were commenced to manage hyperglycemia in diabetes mellitus. Recently, the class attained popularity after its action on vascular physiology was discovered. With this review, we attempted to explore whether an antidiabetic drug, pioglitazone (PIO), a peroxisome proliferator‑activated receptor γ (PPAR gamma) agonist, can defend patients of lichen planus against increased arterial stiffness and cardiac changes. We methodically screened numerous databases using focused words and phrases for relevant articles. After a comprehensive exploration, we applied the inclusion and exclusion criteria and performed a quality appraisal. Items retained were exhaustively studied. High homocysteine (HHcy) levels in lichen planus play a significant role in modifying the arteries and leading to their dysfunction. Not only does homocysteine affect the precursor cells, but it also increases the free radical damage. Arterial damage and upraised resistance encountered by the heart reduce its performance. After an exhaustive analysis, in our opinion, pioglitazone works in various miscellaneous ways to mitigate the homocysteine mediated changes. Early inclusion of the drug in managing patients with lichen planus seems promising in minimizing the harmful effects of high homocysteine. Evaluating the risk-benefit ratio, we believe that a trial of pioglitazone could be given to patients without underlying cardiac conditions.

Risk of metabolic syndrome in patients with lichen planus: A systematic review and meta-analysis

Background

Studies have investigated whether patients with lichen planus are at a high risk of metabolic syndrome; however, currently, no conclusive data are available in this regard.

Objective

This meta-analysis was performed to analyze the published literature investigating the association between metabolic syndrome and lichen planus.

Method

Two reviewers independently searched 4 databases (PubMed, Embase, the Cochrane Library and Web of Science) for observational studies assessing the prevalence of metabolic syndrome in patients with lichen planus. Review Manager 5.3 software was used to statistically analyze the data.

Results

200 relevant articles were searched. After a further reading, 12 studies with 1422 participants (715 with LP and 707 controls) fulfilled the eligibility criteria. Overall, the pooled odds ratio based on random effects analysis was 2.81 (95% confidence interval: 1.79–4.41, P<0.00001). This meta-analysis shows that compared with the general population, patients with lichen planus are more likely to develop metabolic syndrome. Subgroup analysis of prevalence of metabolic syndrome showed higher odds ratio in studies using International Diabetes Federation diagnostic criteria (odds ratio 4.65) and the Harmonized criteria (odds ratio 26.62) than studies using National Cholesterol Education Program Adult Treatment Panel III criteria (odds ratio 1.75), and thus might be more appropriate for diagnosing metabolic syndrome.

Conclusions

This meta-analysis shows that compared with the general population, patients with lichen planus are more likely to develop metabolic syndrome. Therefore, early diagnosis and prompt initiation of first-line therapy for metabolic disorders are important in patients with lichen planus.