Association of oral lichen planus with thyroid disease in a Finnish population: a retrospective case-control study

Oral and non-oral lichen planus show genetic heterogeneity and differential risk for autoimmune disease and oral cancer

Lichen planus (LP) is a T-cell-mediated inflammatory disease affecting squamous epithelia in many parts of the body, most often the skin and oral mucosa. Cutaneous LP is usually transient and oral LP (OLP) is most often chronic, so we performed a large-scale genetic and epidemiological study of LP to address whether the oral and non-oral subgroups have shared or distinct underlying pathologies and their overlap with autoimmune disease. Using lifelong records covering diagnoses, procedures, and clinic identity from 473,580 individuals in the FinnGen study, genome-wide association analyses were conducted on carefully constructed subcategories of OLP (n = 3,323) and non-oral LP (n = 4,356) and on the combined group. We identified 15 genome-wide significant associations in FinnGen and an additional 12 when meta-analyzed with UKBB (27 independent associations at 25 distinct genomic locations), most of which are shared between oral and non-oral LP. Many associations coincide with known autoimmune disease loci, consistent with the epidemiologic enrichment of LP with hypothyroidism and other autoimmune diseases. Notably, a third of the FinnGen associations demonstrate significant differences between OLP and non-OLP. We also observed a 13.6-fold risk for tongue cancer and an elevated risk for other oral cancers in OLP, in agreement with earlier reports that connect LP with higher cancer incidence. In addition to a large-scale dissection of LP genetics and comorbidities, our study demonstrates the use of comprehensive, multidimensional health registry data to address outstanding clinical questions and reveal underlying biological mechanisms in common but understudied diseases.

The Correlation between Oral Lichen Planus and Thyroid Pathologies: A Retrospective Study in a Sample of Italian Population

OBJECTIVES

 The association between oral lichen planus and thyroid disorders, especially hypothyroidism and Hashimoto's thyroiditis, has been discussed in current literature with conflicting outcomes.

MATERIALS AND METHODS

 The study retrospectively evaluated the thyroid status in patients diagnosed with oral lichen planus and oral lichenoid lesions. A case-control approach was used to prove that thyroid disorders were statistically significant risk factors for oral lichen planus and oral lichenoid lesions.

STATISTICAL ANALYSIS

 To evaluate these associations, odds ratios (ORs) were used. ORs precision and statistical significance were estimated using a 95% confidence interval (CI) and p-value, respectively.

RESULTS

 A total of 307 patients were involved in the study: 158 females and 149 males. OR, 95% CIs, and p-values were analyzed. Patients with thyroid diseases showed an increased risk of developing oral lichen planus (OR: 4.29, 95% CI: 1.85-9.96, p-value: 0.0007) and oral lichenoid lesions (OR: 2.76, 95% CI: 1.24-6.13, p-value: 0.0129). This association was maintained in patients with oral lichen planus, while also considering hypothyroidism (OR: 3.74, 95% CI: 1.46-9.58, p-value: 0.0059) and Hashimoto's thyroiditis (OR: 4.57, 95% CI: 1.58-13.23, p-value: 0.005) alone. The correlation of hypertension, diabetes, dyslipidemia, and smoking status with oral lichen planus and oral lichenoid lesions was also evaluated but no statistical significance was found.

CONCLUSION

 Even if further investigations are needed, the association between oral lichen planus and oral lichenoid lesions with thyroid pathologies should be taken into consideration by endocrinologists due to the potential malignancy of these disorders.

Crossroads between Skin and Endocrine Glands: The Interplay of Lichen Planus with Thyroid Anomalies

In this narrative review, we aimed to overview the interplay between lichen planus (LP) and thyroid conditions (TCs) from a dual perspective (dermatologic and endocrine), since a current gap in understanding LP-TC connections is found so far and the topic is still a matter of debate. We searched PubMed from Inception to October 2023 by using the key terms "lichen planus" and "thyroid", (alternatively, "endocrine" or "hormone"). We included original clinical studies in humans according to three sections: LP and TC in terms of dysfunction, autoimmunity, and neoplasia. Six studies confirmed an association between the thyroid dysfunction (exclusively hypothyroidism) and LP/OL (oral LP); of note, only one study addressed cutaneous LP. The sample size of LP/OLP groups varied from 12-14 to 1500 individuals. Hypothyroidism prevalence in OLP was of 30-50%. A higher rate of levothyroxine replacement was identified among OLP patients, at 10% versus 2.5% in controls. The highest OR (odd ratio) of treated hypothyroidism amid OLP was of 2.99 (p < 0.005). Hypothyroidism was confirmed to be associated with a milder OLP phenotype in two studies. A single cohort revealed a similar prevalence of hypothyroidism in LP versus non-LP. Non-confirmatory studies (only on OLP, not cutaneous LP) included five cohorts: a similar prevalence of hypothyroidism among OLP versus controls, and a single cohort showed that the subjects with OLP actually had a lower prevalence of hypothyroidism versus controls (1% versus 4%). Positive autoimmunity in LP/OLP was confirmed in eight studies; the size of the cohorts varied, for instance, with 619 persons with LP and with 76, 92, 105, 108, 192, 247, and 585 patients (a total of 1405) with OLP, respectively; notably, the largest control group was of 10,441 individuals. Four clusters of approaches with respect to the autoimmunity in LP/OLP were found: an analysis of HT/ATD (Hashimoto's thyroiditis/autoimmune thyroid diseases) prevalence; considerations over the specific antibody levels; sex-related features since females are more prone to autoimmunity; and associations (if any) with the clinical aspects of LP/OLP. HT prevalence in OLP versus controls was statistically significantly higher, as follows: 19% versus 5%; 12% versus 6%; and 20% versus 9.8%. A single study addressing LP found a 12% rate of ATDs. One study did not confirm a correlation between OLP-associated clinical elements (and OLP severity) and antibody values against the thyroid, and another showed that positive TPOAb (anti-thyroperoxidase antibodies) was more often found in erosive than non-erosive OLP (68% versus 33%). Just the reverse, one cohort found that OLP subjects had a statistically significantly lower rate of positive TPOAb versus controls (9% versus 15%). Five case-control studies addressed the issue of levothyroxine replacement for prior hypothyroidism in patients that were diagnosed with OLP (no study on LP was identified); three of them confirmed a higher rate of this treatment in OLP (at 8.9%, 9.7%, and 10.6%) versus controls. In conclusion, with regard to LP/OLP-TC, we note several main aspects as practical points for multidisciplinary practitioners: OLP rather than LP requires thyroid awareness; when it comes to the type of thyroid dysfunction, mostly, hypothyroidism should be expected; female patients are more prone to be associated with ATDs; a potential higher ratio of OLP subjects taking levothyroxine was found, thus a good collaboration with an endocrinology team is mandatory; and so far, OLP individuals have not been confirmed to be associated with a higher risk of thyroid nodules/cancer.

Bidirectional Association between Lichen Planus and Hepatitis C-An Update Systematic Review and Meta-Analysis

Lichen planus (LP) is a chronic, inflammatory mucocutaneous disorder associated with systemic diseases such as hepatitis C (HCV). The objective of this study is to evaluate the association between LP and HCV bidirectionally through a systematic review and meta-analysis. A comprehensive search of studies published was performed in the databases of PubMed, Embase, and Web of Science. Out of 18,491 articles, 192 studies were included. The global prevalence of HCV positive (HCV+) in LP patients registered from 143 studies was 9.42% [95% confidence interval (CI), 7.27-11.58%], and from these, 84 studies showed HCV+ 4-fold more frequent in LP than a control group (OR, 4.48; 95% CI, 3.48-5.77). The global prevalence of LP in patients HCV+ recorded from 49 studies was 7.05% (95% CI, 4.85-9.26%), and from these, 15 registered a 3-fold more LP in HCV (OR, 3.65; 95% CI, 2.14-6.24). HCV+ in LP patients showed great geographic variability (OR, 2.7 to 8.57), and the predominantly cutaneous location was higher (OR, 5.95) than the oral location (OR, 3.49). LP in HCV+ patients was more frequent in the Eastern Mediterranean (OR, 5.51; 95% CI, 1.40-15.57). There is a higher prevalence of HCV+ in LP and vice versa than in the control group, especially in certain geographical areas that should be taken into consideration when doing screening in countries with an upper prevalence of HCV among the general population.

Association between oral lichen planus and systemic conditions and medications: Case-control study

OBJECTIVE

The aim of this study is to investigate the association between oral lichen planus (OLP) and a variety of systemic conditions, medication, and supplement usage.

MATERIALS AND METHOD

A total of 156 patients diagnosed with OLP and 156 controls at Columbia University Irving Medical Center from 2000 to 2013 were selected as part of the matched (1:1) case-control study. Demographics, systemic conditions, prescription medications and supplements were extracted from the patients' medical records. A univariable conditional logistic regression (CLR) analysis was performed to calculate unadjusted odds ratio, to identify significant variables associated with OLP (p < .10). Significant variables were further tested using multivariable CLR analysis with both forward and backward selection to calculate adjusted odds ratio (aOR) and further distinguish variables associated with OLP (p < .05).

RESULTS

This analysis identified six significant variables: thyroid disorder (aOR:5.1,95%CI:2.3-11.2), any form of cancer (aOR:3.4,95%CI:1.4-8.4), type 2 diabetes (aOR:2.8,95%CI:1.2-6.3), hyperlipidemia (aOR:2.3,95%CI:1.3-4.1), oral sedative usage (aOR:6.3,95%CI:1.8-22.5), and vitamin D supplementation (aOR:2.7,95%Cl:1.3-6.0).

CONCLUSION

Thyroid disorders, cancer, type 2 diabetes, hyperlipidemia, sedatives, and vitamin D supplementation were found to be associated with OLP. Additional investigation is required to explore these associations, which could shed light on the potential mechanism of OLP and reinforce the idea that oral lesions could be predicative of previously undetected systemic conditions.

Does autoimmune thyroid disorder act as a predisposing factor in the development of oral lichen planus?

Considering previous data from our clinic, as had consistently demonstrated a significant number of OLP patients also reporting thyroid disease (Hashimoto's thyroiditis, in particular), the present study investigated the prevalence of OLP in patients with autoimmune thyroid disease, including Hashimoto's thyroiditis and Graves' disease.

Potential Co-Factors of an Intraoral Contact Allergy-A Cross-Sectional Study

The aim of this cross-sectional study was to evaluate the frequency of dental allergens and potential co-factors, especially hypothyroidism, for patients with an intraoral contact allergy. From 2015 to 2016, patients with confirmed symptoms of an intraoral contact allergy (study group SG n = 50) were recruited in the dental clinic of the University of Leipzig. The participants of the control group (CG n = 103) were patients without oral diseases or intraoral symptoms of a contact allergy. For the data collection, a new "Allergy questionnaire" was developed. Information on allergies and general diseases were collected. The statistical analysis was carried out with SPSS 23.0. Sensitizations/allergies to metals and composites were higher in SG compared to CG. Of all study participants (n = 148), 14.2% (n = 21) had a nickel allergy. In 18% (n = 8) of the SG a cobalt allergy based on all metal allergens could be seen. In addition, an association between a nickel and cobalt allergy was found. Hypothyroidism occurred significantly more frequently (p = 0.049) in SG than in CG. Sensitizations and allergies can occur to metals in dental alloys. Hypothyroidism increased the risk of having an allergy threefold.

No detection of TSH or TSHR in oral lichen planus lesions in patients with or without hypothyroidism

Objective: An association between hypothyroidism (HT) and oral lichen planus (OLP) has been reported. However, the mechanisms that could explain this association remain unresolved. This study aimed to evaluate the expression of thyroid-stimulating hormone (TSH) and thyroid-stimulating hormone receptor (TSHR) in healthy oral mucosa and in OLP lesions of individuals with and without HT.Material and methods: Immunohistochemical expression of TSH and TSHR was studied in oral mucosal biopsies obtained from 14 OLP patients with HT, 14 OLP patients without HT and 10 healthy controls without oral mucosal lesions. Gene expression of TSHR was investigated by using three different PCR techniques in oral mucosal samples from 7 OLP patients with HT, 3 OLP patients without HT, 9 healthy controls and in cultured human oral epithelial cells. Gene expression of TSH was examined by employing 2 PCR techniques in oral mucosal samples from 2 OLP patients with HT, 2 OLP patients without HT and 4 healthy controls.Results: TSH and TSHR stainings were negative in the studied oral mucosal specimens. Gene quantification assays demonstrated negative gene expression of TSH and TSHR in clinical and in vitro samples.Conclusions: These results suggest that TSH and TSHR may not be commonly involved in the pathogenetic mechanism that could explain the association between OLP and hypothyroidism.

Oral lichen planus and associated comorbidities: An approach to holistic health

Lichen planus (LP) is a chronic inflammatory disorder with involvement of skin, oral and genital mucosa, scalp, and nail appendages. Oral lichen planus (OLP) lesions demonstrate a number of morphologic presentations, persist for a long time with rare self-resolution, and undergo malignant changes. OLP has been associated with numerous systemic connotations such as metabolic syndrome, diabetes mellitus, hypertension, thyroid diseases, psychosomatic ailments, chronic liver disease, gastrointestinal diseases, and genetic susceptibility to cancer. The oral health physician should be aware of these systemic associations and should work in close connect with the primary healthcare physicians to rule out the predisposing factors for the associated comorbidities. This article aims to highlight the various systemic associations of OLP and warrants the screening of these ailments in OLP for prevention and effective management.

Oral lichen planus and thyroid gland diseases: possible associations

Background

Lichen planus (LP) is a chronic inflammatory mucocutaneous disease that commonly affects the oral cavity. Previous reports have suggested a possible association between LP and thyroid gland diseases (TGDs). The purpose of this study was to investigate possible associations between oral lichen planus (OLP) and TGDs.

Methods

Patients diagnosed with OLP, both clinically and histopathologically (N = 102), were classified according to clinical course (symptomatic/asymptomatic), type (reticular/plaque, atrophic and erosive) and location of lesions. Data on TGDs was compared to age- and gender-matched controls (N = 102) without OLP. Diagnosis of any type of TGD and related medication for study and control groups was recorded from the medical files provided by patients’ physicians. Statistical analysis used Student’s t-test and Fisher’s exact test; significance was set at p < 0.05.

Results

TGDs (all), hypothyroidism and related medications were found in 16.6, 12.7 and 12.7% of patients with OLP, respectively. These findings were similar to the control group: TGDs (all) -15.7%, hypothyroidism - 9.8% and thyroid gland disease-related medication - 9.8% (p > 0.05). No significant associations were found between different characteristics of OLP and hypothyroidism or other TGD (p > 0.05).

Conclusions

We found no significant associations between the co-existence of OLP and TGD or related-medications. Our findings are in agreement with some of the previously published similar studies but in controversy with others. Further well-designed, multicenter studies with large groups of patients and controls may help to establish the nature of the associations between OLP and TGDs.

Comorbid conditions in lichen planopilaris: A retrospective data analysis of 334 patients

Background

Lichen planopilaris (LPP) is a rare, cicatricial, lymphocyte-mediated alopecia that is thought to have an autoimmune pathogenesis and possibly related to other autoimmune diseases. However, data are limited and studies that examine comorbid conditions are lacking.

Objectives

We sought to determine the prevalence of systemic comorbid conditions, nutritional deficiencies, psychological problems, and skin cancers in patients with LPP.

Methods

We identified 334 patients with LPP who were seen in the Department of Dermatology at the Cleveland Clinic Foundation between 2000 and 2016. Patients with LPP were compared with 78 control patients with a diagnosis of seborrheic dermatitis.

Results

There were more female patients with LPP compared with the controls (93.1% vs. 79.5%; p < .001) but the average age did not differ (54.77 ± 12.83 vs. 52.19 ± 15.37; p = .12). Conditions positively associated with LPP were Hashimoto’s thyroiditis (6.3% vs. 0%; p = .023), hypothyroidism (24.3% vs. 12.8%; p = .028), and hirsutism (11.4% vs. 1.3%; p = .006). Negatively associated conditions were allergic rhinitis (15% vs. 24.4%; p = .046), diabetes mellitus type II (11.7% vs. 21.8%; p = .019), hyperlipidemia (38.6% vs. 52.6%; p = .024), vitamin D deficiency (50% vs. 65.4%; p = .014), depression (15.6% vs. 28.9%; p = .018), and sleep problems (7.5% vs. 29.5%; p < .001).

Conclusions

Our study further emphasizes that dermatologists should screen patients with LPP for autoimmune disorders that are associated with LPP and complete a full metabolic workup to avoid missing other abnormalities. The importance of atopy, autoimmune disorders, endocrine disorders, nutritional deficiencies, psychological problems, and skin cancers in patients with scarring alopecia should be better understood.

Correlation Between Oral Lichen Planus and Thyroid Disease in China: A Case-Control Study

BACKGROUND

A possible relationship between oral lichen planus (OLP) and thyroid disease has received attention in recent years.

OBJECTIVE

This study aimed to evaluate the correlation between OLP and thyroid diseases in Chinese ethnic patients.

METHODS

192 OLP patients, 123 patients with oral lichenoid lesions (OLLs), and 162 controls were recruited in this case-control study. All participants received screening for thyroid function and underwent ultrasound. Sex and age of the patients in the three groups were matched. The prevalence of thyroid diseases in the subjects was analyzed. Using logistic regression, the odds ratio (OR) with 95% confidence intervals was appraised for associations between OLP, OLL, and different types of thyroid diseases [Hashimoto's thyroiditis (HT), hypothyroidism, and thyroid nodule].

RESULTS

The prevalence of thyroid diseases in the OLP group (72.4%) and OLL group (68.3%) was higher than the control group (49.4%) with statistical significance. The OR of HT was 3.16 (1.87-5.33) for OLP, 2.09 (1.18-3.70) for OLL, while the OR of thyroid nodule was 2.31 (1.30-4.09) for OLP.

CONCLUSION

Our study suggested a close relationship between OLP/OLL and HT and thyroid nodule in a Chinese population. The possible mechanism behind this association warrants further investigation.

Evidence of earlier thyroid dysfunction in newly diagnosed oral lichen planus patients: a hint for endocrinologists

The association between oral lichen planus (OLP) and hypothyroidism has been debated with conflicting results: some authors detected a statistically significant association between these two, while others did not confirm it. The aim of this study was to evaluate the thyroid status in patients with newly diagnosed OLP to test the null hypothesis that thyroid disease is not associated with an increased incidence of oral lesions, with a prospective case-control approach. A total of 549 patients have been evaluated, of whom 355 were female. Odds ratio (OR) and 95% confidence intervals (CIs) were obtained. Patients suffering from thyroid diseases were associated with an almost 3-fold increased odds of having OLP (OR 2.85, 95% CI: 1.65-4.94), after adjusting this analysis for age, gender, body mass index, smoking status, diabetes, hypertension and hepatitis C infection. It would be appropriate to further investigate the possible concomitance of OLP among patients with thyroid disorder; endocrinologists should be aware of this association, especially because OLP is considered a potentially malignant oral disorder.

High percentage of oral lichen planus and lichenoid lesion in oral squamous cell carcinomas

OBJECTIVE

Oral lichen planus (OLP) and lichenoid lesions (OLL) are regarded as precursor lesions of oral squamous cell carcinoma (OSCC) with potential for malignant transformation. This potential is not clear due to difficulties in diagnosis of OLP and OLL. Our aim was therefore to evaluate previously identified OLP and OLL as precursor lesions in OSCC and to identify cancer related etiological factors such as smoking and alcohol consumption.

MATERIAL AND METHODS

We retrospectively reviewed all cases (total 323, comprising 164 females and 159 males) with OSCC treated at the Department of Oral and Maxillofacial Diseases and Surgery, Helsinki University Hospital during 2015. Confirmed by histopathological biopsy, 58 (17.9%) had OLP and 13 had OLL (4.0%) as precursor lesion.

RESULTS

Patients with OLP were slightly older than those without it. OLP was more common in females than in males (p < .0001). TN class 1 tumors were more prevalent among patients with OLP or OLL (p = .006) and cancer relapses less common (p = .005). Smoking was less frequent in patients with OLP and OLL (p < .0001). Also alcohol abuse was less frequent among these patients (p < .001).

CONCLUSION

Our findings confirm the importance of active follow-up of all patients with OLP and OLL even in patients who do not fit a traditional high-risk category for OSCC.

The Association of Thyroid Disease and Oral Lichen Planus: A Literature Review and Meta-analysis

BACKGROUND

The objective of this study was to systemically evaluate the association between oral lichen planus (OLP) and thyroid disease.

METHOD

Eleven electronic databases were searched for any clinical study published up until August 2016 that explored an association between OLP and thyroid disease, complemented with manual searching. The titles and abstracts of all studies identified from the electronic searches were then assessed independently to determine inclusion of the study. The population of interest was patients with OLP, and the exposure was the presence of thyroid disease in OLP patients. Statistical analyses were conducted using Review Manager 5.2. The odds ratios (OR) and 95% confidence intervals (CIs) were calculated to evaluate the association between OLP and thyroid disease.

RESULTS

Eight studies were included for review, and of these, four case-control studies were included in the final meta-analysis. The mean Newcastle-Ottawa Scale score evaluating the methodological quality of the four studies was 6.5. The OR was 2.10 (95% CI: 1.47-3.01), indicating a statistically significant difference in the prevalence of thyroid disease between the OLP and control groups. Heterogeneity was satisfactory (I² = 0%, <25%). An approximately symmetrical funnel plot suggested no obvious publication bias. Two articles showed a higher correlation between OLP and hypothyroidism (OR 1.83, 95% CI: 1.16-2.89), with satisfactory heterogeneity (I² = 0%, <25%).

CONCLUSION

This meta-analysis indicated a significantly high prevalence of thyroid disease among OLP patients compared with controls, suggesting that routine screening for thyroid disease could be beneficial to OLP patients. However, due to the small number of studies included, further studies are needed to confirm the results.

Oral lichen planus: a literature review and update

Lichen planus (LP) is a common chronic inflammatory condition that can affect skin and mucous membranes, including the oral mucosa. Because of the anatomic, physiologic and functional peculiarities of the oral cavity, the oral variant of LP (OLP) requires specific evaluations in terms of diagnosis and management. In this comprehensive review, we discuss the current developments in the understanding of the etiopathogenesis, clinical-pathologic presentation, and treatment of OLP, and provide follow-up recommendations informed by recent data on the malignant potential of the disease as well as health economics evaluations.

Etiology and pathogenesis of oral lichen planus: an overview

Oral lichen planus is a noninfectious, chronic inflammatory condition that involves the oral mucosal stratified squamous epithelium and the underlying lamina propria and may be accompanied by skin lesions. This overview describes the current understanding of the immunopathologic mechanisms implicated in oral lichen planus.

Thyroid Disease and Oral Lichen Planus as Comorbidity: A Prospective Case-Control Study

BACKGROUND

Thyroid disease has been mentioned to have a possible relation to the development of oral lichen planus (OLP).

OBJECTIVE

Because goiter is considered endemic in many countries, we proposed to determine whether thyroid disease constitutes a comorbidity of OLP.

METHODS

Two hundred and fifteen patients diagnosed as having OLP were evaluated concerning their serum thyroid-stimulating hormone and thyroxine (T4) levels. The results were contrasted with those obtained in control series of the same number of subjects matched for age and sex.

RESULTS

Diagnosis of thyroid disease was present in 15.3% of OLP patients (33/215) and in 5.2% (12/215) of the control group. In relation to OLP patients, the odds ratio of presence of thyroid disorders was 3.06 and that of using levothyroxine medication 3.21.

CONCLUSIONS

In the present study, OLP patients were associated with thyroid disease, specifically with hypothyroidism. Because most thyroid patients need T4 treatment, our findings confirmed that OLP and thyroid disease could be comorbidities.

Clinical characteristics of patients with concomitant oral lichen planus and thyroid disease

OBJECTIVE

To study the prevalence and profile of thyroid disease in a cohort of referred patients with oral lichen planus (OLP) in comparison with a random population sample and to examine the clinical characteristics of OLP patients with and without thyroid disease.

STUDY DESIGN

Data from 1611 patients with OLP and 1615 patients from the general population were collected by using a standardized registration method. Patients with OLP using levothyroxine (OLP/levothyroxine+) were re-examined to collect information about existing OLP lesions and to confirm the thyroid disease diagnosis. The clinical characteristics of OLP lesions in this group were compared with those in an age- and gender-matched population of patients with OLP without a history of thyroid disease or levothyroxine medication (OLP/levothyroxine-).

RESULTS

Nearly 11% (n=170) of the patients with OLP were taking levothyroxine compared with 2.5% (n=40) of the controls (multivariate odds ratio 2.99, 95% confidence interval 2.03-4.44; P<.0001). No difference was found in the thyroid disease profile between the groups. At the time of re-examination, patients with OLP/levothyroxine- displayed more erythematous OLP lesions and complained of more severe symptoms compared with the OLP/levothyroxine+ group (P<.001).

CONCLUSIONS

The prevalence of thyroid disease in patients with OLP was significantly higher than in the general population. The OLP lesions of patients with concomitant thyroid disease have a different presentation over time, which indicates a specific subgroup of OLP.

Adverse drug events in the oral cavity

Adverse reactions to medications are common and may have a variety of clinical presentations in the oral cavity. Targeted therapies and the new biologic agents have revolutionized the treatment of cancers, autoimmune diseases, and inflammatory and rheumatologic diseases but have also been associated with adverse events in the oral cavity. Some examples include osteonecrosis, seen with not only bisphosphonates but also antiangiogenic agents, and the distinctive ulcers caused by mammalian target of rapamycin inhibitors. As newer therapeutic agents are approved, it is likely that more adverse drug events will be encountered. This review describes the most common clinical presentations of oral mucosal reactions to medications, namely, xerostomia, lichenoid reactions, ulcers, bullous disorders, pigmentation, fibrovascular hyperplasia, white lesions, dysesthesia, osteonecrosis, infection, angioedema, and malignancy. Oral health care providers should be familiar with such events, as they will encounter them in their practice.

Association of autoimmune diseases with oral lichen planus: a cross-sectional, clinical study

BACKGROUND

The aim of this study was to investigate the association between autoimmune disease and oral lichen planus (OLP), comparing OLP patients with a control population.

METHODS

This cross-sectional clinical study evaluated the prevalence of autoimmune diseases in male and female patients with OLP. The variables analysed were age, sex, tobacco and alcohol consumption, the clinical form of OLP, time of evolution and the presence of autoimmune diseases.

RESULTS

Autoimmune diseases were present in 7% of OLP patients (10/130) and 4% of the control group (6/130) without statistically significant difference (P = 0.67). The estimated odds ratios (with 95% confidence intervals) of the presence of autoimmune disease in OLP sufferers was 1.033 (0.97-1.10). A logistic regression model for presence/absence of the risk autoimmune disease found statistically significant differences in relation to age.

CONCLUSIONS

At present, there is no definitive hypothesis that explains the coexistence of OLP and autoimmune disease; further research is required into the mechanisms whereby this coexistence occurs.

A retrospective clinicopathological study on oral lichen planus and malignant transformation: analysis of 518 cases

Objective: To investigate the epidemiological and clinical characteristics of a relatively large cohort of patients with oral lichen planus (OLP) from eastern China. Study design: A total of 518 patients with histologically confirmed OLP in a long-term follow-up period (6 months-21.5 years) were retrospectively reviewed in our clinic. Results: Of the 518 patients, 353 females and 165 males were identified. The average age at diagnosis was 46.3 years (range 9-81 years) with the buccal mucosa being the most common site (87.8%). At initial presentation, white lichen and red lichen was seen in 52.3% and 47.7% patients, respectively. Of these, 5 (0.96%) patients previously diagnosed clinically and histopathologically as OLP developed oral cancer. All of them were the females with no a history of smoking or alcohol use. Conclusions: Clinical features of eastern Chinese OLP patients were elucidated. Notably, approximately 1% of OLP developed into cancer, which provides further evidence of potentially malignant nature of OLP.

Key words:Oral lichen planus, clinical features, malignant transformation, oral cancer.

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.