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García-Pola M, Rodríguez-Fonseca L, Suárez-Fernández C, Sanjuán-Pardavila R, Seoane-Romero J, Rodríguez-López S. Bidirectional Association between Lichen Planus and Hepatitis C-An Update Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5777. [PMID: 37762719 PMCID: PMC10531646 DOI: 10.3390/jcm12185777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
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.
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Affiliation(s)
- María García-Pola
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, University of Oviedo, 33004 Oviedo, Spain; (L.R.-F.); (C.S.-F.); (R.S.-P.); (S.R.-L.)
| | - Lucia Rodríguez-Fonseca
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, University of Oviedo, 33004 Oviedo, Spain; (L.R.-F.); (C.S.-F.); (R.S.-P.); (S.R.-L.)
| | - Carlota Suárez-Fernández
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, University of Oviedo, 33004 Oviedo, Spain; (L.R.-F.); (C.S.-F.); (R.S.-P.); (S.R.-L.)
| | - Raquel Sanjuán-Pardavila
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, University of Oviedo, 33004 Oviedo, Spain; (L.R.-F.); (C.S.-F.); (R.S.-P.); (S.R.-L.)
| | - Juan Seoane-Romero
- Department of Surgery and Medical-Surgical Specialties, School of Medicine and Dentistry, University of Santiago de Compostela, 15780 Santiago de Compostela, Spain;
| | - Samuel Rodríguez-López
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, University of Oviedo, 33004 Oviedo, Spain; (L.R.-F.); (C.S.-F.); (R.S.-P.); (S.R.-L.)
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Strak SK, Al-Hamdi KI, Alabbood MH. A study of lichen planus and its association with hepatitis C infection. J Taibah Univ Med Sci 2015. [DOI: 10.1016/j.jtumed.2014.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gerayli S, Meshkat Z, Pasdar A, Mosannen Mozafari P, Banihashemi E, Khajavi MA, Rasekhi J. The association between oral lichen planus and hepatitis C virus infection; a report from northeast of iran. Jundishapur J Microbiol 2015; 8:e16741. [PMID: 26034540 PMCID: PMC4449850 DOI: 10.5812/jjm.8(4)2015.16741] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 05/06/2014] [Accepted: 06/24/2014] [Indexed: 12/13/2022] Open
Abstract
Background: The association between hepatitis C virus (HCV) infection and oral lichen planus (OLP)
has been the focus of many studies. Fifteen percent of HCV infections lead to sets of
extrahepatic manifestations including lichen planus (LP). The prevalence of HCV is
heavily influenced by geographical location. Objectives: This study aimed to evaluate the relationship between OLP and HCV infection in Mashhad,
northeast of Iran. Materials and Methods: Blood samples were taken from 134 OLP patients and 134 healthy controls (without OLP)
to screen for anti-HCV by ELISA (third generation) and reverse transcription polymerase
chain reaction (RT-PCR) for HCV-RNA. Results: Of the 134 OLP patients only three (2.23 %) had HCV infection where both anti-HCV and
HCV-RNA were positive. All controls were negative for both anti-HCV and HCV-RNA (P =
0.082). Conclusions: Our investigation illustrated that the prevalence of hepatitis C was higher among OLP
patients compared to the control group. These findings are in line with previous results
that reported a hepatitis C prevalence of 0.19% among the general population of
Mashhad.
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Affiliation(s)
- Sina Gerayli
- Department of Biology, Faculty of Sciences, Ferdowsi
University of Mashhad, Mashhad, IR Iran
| | - Zahra Meshkat
- Antimicrobial Resistance Research Center, Mashhad
University of Medical Sciences, Mashhad, IR Iran
| | - Alireza Pasdar
- Department of Modern Sciences and Technologies, Faculty of
Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Division of Applied Medicine, Medical School, University of
Aberdeen, Foresterhill, Aberdeen, UK
| | - Pegah Mosannen Mozafari
- Oral and Maxillofacial Diseases Research Center, School of
Dentistry, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Pegah Mosannen Mozafari, Oral
and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of
Medical Sciences, Mashhad, IR Iran. Tel: +98-5138829501, Fax: +98-5138829500, E-mail:
| | - Elham Banihashemi
- Oral and Maxillofacial Diseases Research Center, School of
Dentistry, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohammad Amin Khajavi
- Oral and Maxillofacial Diseases Research Center, School of
Dentistry, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Javid Rasekhi
- Oral and Maxillofacial Diseases Research Center, School of
Dentistry, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Denli YG, Durdu M, Karakas M. Diabetes and Hepatitis Frequency in 140 Lichen Planus Cases in Çukurova Region. J Dermatol 2014; 31:293-8. [PMID: 15187324 DOI: 10.1111/j.1346-8138.2004.tb00675.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2003] [Accepted: 12/09/2003] [Indexed: 12/18/2022]
Abstract
The aim of the present study was to determine the Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and diabetes mellitus (DM) frequencies in lichen planus (LP) cases in our region. We performed a retrospective review of records from all cases that were diagnosed with LP at the our department between 1997 and 2002. The results were compared with the control group (any type of dermatosis other than LP). The 260 LP cases included 108 (41.5%) males and 152 (58.5%) females aged between 5 and 78 years. The clinical distribution of the lesions were 127 (48.8%) with skin lesions and 133 (51.2%) with oral mucosal lesions. The duration of disease ranged from 1 to 240 months. In 140 of 260 LP cases, hepatitis serology and pre-prandial blood glucose were examined. We found HBV positivity in 24 (17.1%) cases, Anti-HCV positivity in 7 (5%) cases, and DM in 22 (15.7%) cases. The control group included 116 (41.4%) males and 164 (58.6%) females. Their ages ranged between 10 and 82 years. In this group, we found HBV positivity in 20 (7.1%), Anti-HCV positivity in 4 (1.4%), and DM in 20 (7.1%) cases. We believe that the co-association of LP with HCV is significant and this co-association ratio indicates variance depending on clinical attributes of the lesions and racial characteristics of the patients. Although we found co-associations between HBV and LP or DM and LP, we believe that further studies are necessary to determine if they are significant.
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Affiliation(s)
- Y Gül Denli
- Cukurova University, Faculty of Medicine, Department of Dermatology, Adana, Turkey
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Payeras MR, Cherubini K, Figueiredo MA, Salum FG. Oral lichen planus: focus on etiopathogenesis. Arch Oral Biol 2013; 58:1057-69. [PMID: 23660124 DOI: 10.1016/j.archoralbio.2013.04.004] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 03/09/2013] [Accepted: 04/11/2013] [Indexed: 02/07/2023]
Abstract
Lichen planus is a chronic mucocutaneous inflammatory disease, which frequently affects the oral mucosa of white females over 40 years old. Its aetiology remains uncertain and the pathogenesis is still the object of much speculation. The present paper presents the most well known antigens, and describes the action of different cells and proteins associated with the development of that disease, as well as the possible agents involved with its malignant transformation. Different external agents, especially virus, and internal agents, like stress, and the heat shock protein antigen expression, associated or not, can alter the basal keratinocytes of the oral mucosa making them susceptible to apoptosis by CD8(+) cytotoxic T cell as well as activate matrix metalloproteinase and mast cell degranulation, which produce a great range of inflammatory mediators and cytokines determining the clinical onset of the disease. Regarding carcinogenesis, since it is a complex process and presents multifactorial origin, it is believed that there may be a synergism between intrinsic, such as inflammation mediators, and extrinsic agents (tobacco, alcohol, viral infections) for the OLP malignant transformation to occur. However, further studies are needed to better understand the origin, pathogenesis and process of malignant transformation of OLP.
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Affiliation(s)
- Márcia Rodrigues Payeras
- Oral Medicine Division, Pontifical Catholic University of Rio Grande do Sol, Av. Ipiranga 6690, Porto Alegre, RS, Brazil.
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Ukonu AB, Augustine U. The prevalence of hepatitis C Virus (HCV) among lichen planus patients and its clinical pattern at the University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria. Glob J Health Sci 2012; 4:113-9. [PMID: 22980383 PMCID: PMC4776808 DOI: 10.5539/gjhs.v4n5p113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 08/05/2012] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The relationship between hepatitis C virus and Lichen Planus have been widely reported in the literature; although there are wide geographical variations in the reported prevalence of hepatitis C virus infection in patients with lichen planus. This study seeks to determine the prevalence of hepatitis C virus among lichen planus patients and its clinical morphological type in the University of Abuja Teaching Hospital, Gwagwalada Abuja, Nigeria. MATERIALS/METHODS This study was conducted between January 2010 and December, 2011 at the out patients Dermatological unit of the department of medicine at the University of Abuja Teaching Hospital Gwagwalada Abuja, Nigeria. Consecutive patients who had body eruptions suspected to be lichen planus were recruited and histology done for confirmation. The control group included patients' relations and some dermatology patients known to have low risk of hepatitis C virus infection and liver function tests done for both subjects and control after obtaining oral consent from them to participate in the study. RESULT Anti- HCV antibodies were detected in nine cases (21.4%) and one case (3.3%) in the control group. This was statistically significant difference between the HCV antibody among the subject and control group (P<0.038). Hypertrophic lichen planus was the most frequent clinical type. Liver function test was not statistically significant among the subject and control group. CONCLUSION Lichen planus and Hepatitis C virus appear to have a relationship and the prevalence rate was higher among the subject as compared to the control group in our environment.
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Affiliation(s)
- Agwu Bob Ukonu
- University of Abuja Teaching Hospital Gwagwalada Abuja, Nigeria.
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Hassan M, Selimovic D, El-Khattouti A, Ghozlan H, Haikel Y, Abdelkader O. Hepatitis C virus-host interactions: Etiopathogenesis and therapeutic strategies. World J Exp Med 2012; 2:7-25. [PMID: 24520529 PMCID: PMC3905577 DOI: 10.5493/wjem.v2.i2.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 04/16/2012] [Accepted: 04/18/2012] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) is a significant health problem facing the world. This virus infects more than 170 million people worldwide and is considered the major cause of both acute and chronic hepatitis. Persons become infected mainly through parenteral exposure to infected material by blood transfusions or injections with nonsterile needles. Although the sexual behavior is considered as a high risk factor for HCV infection, the transmission of HCV infection through sexual means, is less frequently. Currently, the available treatment for patients with chronic HCV infection is interferon based therapies alone or in combination with ribavirin and protease inhibitors. Although a sustained virological response of patients to the applied therapy, a great portion of patients did not show any response. HCV infection is mostly associated with progressive liver diseases including fibrosis, cirrhosis and hepatocellular carcinoma. Although the focus of many patients and clinicians is sometimes limited to that problem, the natural history of HCV infection (HCV) is also associated with the development of several extrahepatic manifestations including dermatologic, rheumatologic, neurologic, and nephrologic complications, diabetes, arterial hypertension, autoantibodies and cryglobulins. Despite the notion that HCV-mediated extrahepatic manifestations are credible, the mechanism of their modulation is not fully described in detail. Therefore, the understanding of the molecular mechanisms of HCV-induced alteration of intracellular signal transduction pathways, during the course of HCV infection, may offer novel therapeutic targets for HCV-associated both hepatic and extrahepatic manifestations. This review will elaborate the etiopathogenesis of HCV-host interactions and summarize the current knowledge of HCV-associated diseases and their possible therapeutic strategies.
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Affiliation(s)
- Mohamed Hassan
- Mohamed Hassan, Denis Selimovic, Youssef Haikel, National Institute of Health and Medical Research, U 977, Faculty of Medicine, and Dental Faculty, 11 Rue Humann, 67085 Strasbourg Cedex, France
| | - Denis Selimovic
- Mohamed Hassan, Denis Selimovic, Youssef Haikel, National Institute of Health and Medical Research, U 977, Faculty of Medicine, and Dental Faculty, 11 Rue Humann, 67085 Strasbourg Cedex, France
| | - Abdelouahid El-Khattouti
- Mohamed Hassan, Denis Selimovic, Youssef Haikel, National Institute of Health and Medical Research, U 977, Faculty of Medicine, and Dental Faculty, 11 Rue Humann, 67085 Strasbourg Cedex, France
| | - Hanan Ghozlan
- Mohamed Hassan, Denis Selimovic, Youssef Haikel, National Institute of Health and Medical Research, U 977, Faculty of Medicine, and Dental Faculty, 11 Rue Humann, 67085 Strasbourg Cedex, France
| | - Youssef Haikel
- Mohamed Hassan, Denis Selimovic, Youssef Haikel, National Institute of Health and Medical Research, U 977, Faculty of Medicine, and Dental Faculty, 11 Rue Humann, 67085 Strasbourg Cedex, France
| | - Ola Abdelkader
- Mohamed Hassan, Denis Selimovic, Youssef Haikel, National Institute of Health and Medical Research, U 977, Faculty of Medicine, and Dental Faculty, 11 Rue Humann, 67085 Strasbourg Cedex, France
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Petti S, Rabiei M, De Luca M, Scully C. The magnitude of the association between hepatitis C virus infection and oral lichen planus: meta-analysis and case control study. Odontology 2011; 99:168-78. [PMID: 21505737 DOI: 10.1007/s10266-011-0008-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 10/31/2010] [Indexed: 12/12/2022]
Abstract
Although hepatitis C virus (HCV) infection is associated with oral lichen planus (OLP), a case-control study and a meta-analysis were designed to investigate the magnitude of such an association. A total of 413 presumptive OLP patients (18-75 years) who referred to a dental clinic in Rasht (Iran) were consecutively selected. OLP was diagnosed clinically (typical forms) and histologically (atypical forms) by a calibrated examiner. A total of 487 adults (20-77 years) attending the same dental clinic were the controls. The two groups were homogeneous in terms of age, gender and occupation. Subjects were tested for anti-HCV antibodies. The odds ratio (OR) for OLP attributable to HCV infection was non-significant [OR 1.2, 95% confidence interval (95CI) 0.3-4.8], suggesting that the association between HCV and OLP was weak in the Iranian context. Meta-analysis of observational studies characteristics of primary studies were that cases were diagnosed clinically (only typical forms) and histologically and exposure was assessed through anti-HCV antibodies. Exposed/unexposed cases/controls were extracted and zero values were appropriately transformed. As much as 44 studies, including the present, were located. Publication bias could not be totally excluded. The pooled OR, estimated using the random-effect model, was 2.8 (95CI 2.4-3.2). Sensitivity analysis confirmed the robustness of results. Subgroup analysis showed non-significant differences between American/European and Asian/African studies. The fraction of global OLP cases associated with HCV (population attributable fraction) was 2.1% (95CI 1.9-2.2%). Although HCV and OLP were significantly associated, the majority of OLP patients were not affected by HCV.
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Affiliation(s)
- Stefano Petti
- Department of Public Health and Infectious Diseases, Sanarelli Building, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
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Lodi G, Pellicano R, Carrozzo M. Hepatitis C virus infection and lichen planus: a systematic review with meta-analysis. Oral Dis 2010; 16:601-12. [DOI: 10.1111/j.1601-0825.2010.01670.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies. Clin Dermatol 2010; 28:100-8. [PMID: 20082959 DOI: 10.1016/j.clindermatol.2009.03.004] [Citation(s) in RCA: 197] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lichen planus (LP) is an inflammatory disease of the stratified squamous epithelia of unknown etiology. LP affects most frequently the oral mucosa, but it may also involve other mucosa and the skin. Oral LP (OLP) most frequently affects woman aged between 30 and 60 years. Histopathologic examination typically shows orthokeratotic hyperkeratosis, basal cell degeneration, and a dense well-defined infiltrate of lymphocytes in the superficial dermis. OLP lesions may result from the induction of keratinocytes apoptosis by cytotoxic CD8+ T cells stimulated by a yet unidentified self-antigen on a genetically predisposed patient. The association of OLP with hepatitis C virus (HCV) has been more consistently demonstrated in the Mediterranean area. Although HCV RNA and HCV-specific CD4+ and CD8+ T cells have been retrieved in the mucosal lesions of patients with chronic HCV infection and OLP, the eventual pathophysiology of HCV in OLP lesions remains unclear. Available treatments of OLP are not curative, and many have potentially prominent side effects. The objectives of OLP management should be to prevent and screen for malignant transformation and alleviate symptoms on the long-term. Avoidance of potential precipitating drugs, tobacco, alcohol, and local trauma, as well as strict oral hygiene, is essential. The first-line pharmacologic treatment relies on topical steroids. Systemic steroids should be limited to the short-term cure of severe refractory OLP. Life-long clinical follow-up, at least annually, is fundamental.
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Affiliation(s)
- David Farhi
- Department of Dermatology and Venereology, Hôpital Cochin, APHP, Université Descartes - Paris 5, Pavillon Tarnier, 75006 Paris, France.
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Stojanovič L, Lunder T, Poljak M, Marš T, Mlakar B, Matičič M. Lack of evidence for hepatitis C virus infection in association with lichen planus. Int J Dermatol 2008; 47:1250-6. [DOI: 10.1111/j.1365-4632.2008.03832.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Carrozzo M. Oral diseases associated with hepatitis C virus infection. Part 2: lichen planus and other diseases. Oral Dis 2008; 14:217-28. [PMID: 18221456 DOI: 10.1111/j.1601-0825.2007.01432.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Some of the most frequent extrahepatic manifestations of hepatitis C virus (HCV) infection involve the oral region predominantly or exclusively. Part 2 of this review discusses the current evidences regarding the association of lichen planus (LP) and other diseases frequently involving the oral cavity with HCV. Epidemiological data suggest that LP may be significantly associated with HCV infections especially in southern Europe and Japan but not in northern Europe. These geographical differences are possibly influenced by immunogenetic factors, the duration of the HCV infection and the design of the published studies. Because of the fact that most of the studies published are retrospective, it is impossible to establish whether the HCV exposure occurred earlier to or after the onset of disease and more prospective studies are clearly warranted. As the virus may replicate in the skin and oral mucosa and HCV-specific T lymphocytes can be found in the oral mucosa of patients with chronic hepatitis C and LP, HCV may be implicated in the pathogenesis of LP. However, little attention has been paid to the variable effect of therapy with interferon-alpha (IFN-alpha), with or without ribavirin for LP. Conversely, it is unlikely that other oral diseases such as oral carcinoma, pemphigus and Behcet disease are triggered by HCV.
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Affiliation(s)
- M Carrozzo
- Department of Oral Medicine, School of Dental Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
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Lodi G, Scully C, Carrozzo M, Griffiths M, Sugerman PB, Thongprasom K. Current controversies in oral lichen planus: Report of an international consensus meeting. Part 1. Viral infections and etiopathogenesis. ACTA ACUST UNITED AC 2005; 100:40-51. [PMID: 15953916 DOI: 10.1016/j.tripleo.2004.06.077] [Citation(s) in RCA: 261] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite recent advances in understanding the immunopathogenesis of oral lichen planus (LP), the initial triggers of lesion formation and the essential pathogenic pathways are unknown. It is therefore not surprising that the clinical management of oral LP poses considerable difficulties to the dermatologist and the oral physician. A consensus meeting was held in France in March 2003 to discuss the most controversial aspects of oral LP. Part 1 of the meeting report focuses on (1) the relationship between oral LP and viral infection with special emphasis on hepatitis C virus (HCV), and (2) oral LP pathogenesis, in particular the immune mechanisms resulting in lymphocyte infiltration and keratinocyte apoptosis. Part 2 focuses on patient management and therapeutic approaches and includes discussion on malignant transformation of oral LP.
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Affiliation(s)
- Giovanni Lodi
- Department of Medicine, Surgery, and Dentistry, University of Milan, Italy.
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Lodi G, Giuliani M, Majorana A, Sardella A, Bez C, Demarosi F, Carrassi A. Lichen planus and hepatitis C virus: a multicentre study of patients with oral lesions and a systematic review. Br J Dermatol 2005; 151:1172-81. [PMID: 15606512 DOI: 10.1111/j.1365-2133.2004.06257.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- G Lodi
- Unit of Oral Medicine and Pathology, Department of Medicine, University of Milan, via Beldiletto 1/3, Milan 20142, Italy.
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Harman M, Akdeniz S, Dursun M, Akpolat N, Atmaca S. Lichen planus and hepatitis C virus infection: an epidemiologic study. Int J Clin Pract 2004; 58:1118-9. [PMID: 15646408 DOI: 10.1111/j.1742-1241.2004.00214.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The reported prevalence of hepatitis C virus (HCV) infection in patients with lichen planus (LP) shows variations from different regions. The aim of this study was to investigate the prevalence of HCV infection in patients with LP, in Diyarbakir region of Turkey. A total of 128 patients with LP and 128 healthy controls were detected for HCV infection, using a third generation enzyme-linked immunosorbent assay. Eight of 128 patients (6.25%) with LP were found to have anti-HCV antibodies, whereas only one patient (0.78%) in control group was found to have anti-HCV antibodies. A statistically significant difference was found between LP and control group (p < 0.001). In conclusion, the coexistence of HCV infection and lichen planus is more than coincidental, and it is appropriate to screen all patients with lichen planus for HCV infection.
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Affiliation(s)
- M Harman
- Department of Dermatology and Venerology, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey.
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Petruzzi M, De Benedittis M, Loria MP, Dambra P, D'Oronzio L, Capuzzimati C, Tursi A, Lo Muzio L, Serpico R. Immune response in patients with oral lichen planus and HCV infection. Int J Immunopathol Pharmacol 2004; 17:93-8. [PMID: 15000872 DOI: 10.1177/039463200401700113] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In recent years an association between oral lichen planus (OLP) and HCV infection has been reported, but the frequency of this association seems to differ in the various geographic areas. It is clear, instead, that some abnormalities occur in the immune-regulation mechanisms of patients with OLP and it is thought to be due to the chronic antigenic stimulus of HCV that causes functional disorders of the immune system in infected patients. Possible immunologic difference between 17 patients with OLP and HCV+ and 17 patients with OLP and HCV- were investigated using standard immunofluorescence and flow cytometry techniques. The distribution of T and B cells was normal in all patients examined, while NK CD56+ cells were increased, above all in HCV- patients. About 65% of T CD4+ lymphocytes coexpressed the CD45RO isoform (p=0.002), while approximately 32% expressed CD45RA, without significant differences in comparison to HCV+ subjects (p>0.05). Moreover, almost all the CD4+CD45RO+ subpopulation coexpressed CD29 in all patients examined. No significant differences between the two groups of patients were detected as to the increase of cytotoxic T CD8+CD57+ lymphocytes. The B cells CD19+CD5+ responsible for the production of "natural" antibodies were detectable in both the examined groups, even if not in all HCV+ subjects (30% +/- 10.1 in HCV- and 27% +/- 19.4 in HCV+ patients; p=0.47). These findings suggest the existence of differences in lymphocyte subpopulations between OLP-HCV+ subjects and OLP-HCV- patients.
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Affiliation(s)
- M Petruzzi
- Department of Dentistry and Surgery, University of Bari, Bari, Italy
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Abstract
Hepatitis C virus (HCV) is an important factor in the development of chronic liver disease and hepatocellular carcinoma. In recent years it has become known that HCV induces various extrahepatic manifestations including mixed cryoglobulinemia, membranoproliferative glomerulonephritis, Sjögren's syndrome, autoimmune thyroiditis, malignant lymphoma, porphyria cutanea tarda and lichen planus. Although the mechanisms of extrahepatic manifestations remain unclear, it is known that interferon (IFN) therapy and coadministration of IFN with ribavirin are effective in promoting the disappearance or alleviation of such extrahepatic lesions, which have tended to be overlooked. The present review focuses on lichen planus, one of the major extrahepatic manifestations.
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Affiliation(s)
- Yumiko Nagao
- Research Center for Innovative Cancer Therapy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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Abstract
INTRODUCTION The relationship between hepatitis C virus (HCV) infection and oral lichen planus (OLP) remains a matter of controversy. It is important to determine whether there is an association between OLP and HCV infection so that guidelines regarding the routine HCV testing of patients with OLP can be developed for clinicians. OBJECTIVES The objective of this article was to review and summarize the published literature on the association between OLP and HCV and to describe future directions. METHODS A search of the computerized database MEDLINE (1966-June 2003) was conducted. The bibliographies of articles identified by means of MEDLINE were also searched. Any studies reporting the prevalence of HCV in a group of patients with LP either with or without a control group were included in this review. Also included were studies comparing the clinical and histologic features of LP among patients with and without HCV infection, studies on the presence of HCV within LP lesions, and studies of HCV genotypes among patients with LP. RESULTS Thirty-two studies conducted in various parts of the world were identified. Study types included prevalence studies on HCV exposure among patients with OLP (0%-62%), prevalence of OLP among patients with HCV infection (1.6%-20%), and case-control studies of this association. In addition, the results from 3 studies on the replication of HCV in the oral mucosa, 3 studies on the genotype of HCV in OLP patients, and 4 studies comparing the clinical and histologic features of OLP in HCV-infected and uninfected individuals have been summarized. CONCLUSION At present, studies on the association of OLP and HCV provide enough information to raise a number of interesting questions about this association. Important biases-including selection bias; investigator bias due to lack of blinding and the possible resultant nondifferential misclassification of disease; and possible confounding by age in the studies published-make it difficult to draw firm conclusions. However, the need for future studies that take into consideration all these factors in the study methodology is highlighted by this review.
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Affiliation(s)
- Nita Chainani-Wu
- Department of Stomatology, Division of Oral Medicine, Oral Pathology, and Oral Radiology, University of California, San Francisco, CA 94143-0658, USA.
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Ghodsi SZ, Daneshpazhooh M, Shahi M, Nikfarjam A. Lichen planus and Hepatitis C: a case-control study. BMC DERMATOLOGY 2004; 4:6. [PMID: 15153247 PMCID: PMC434515 DOI: 10.1186/1471-5945-4-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2004] [Accepted: 05/20/2004] [Indexed: 12/20/2022]
Abstract
BACKGROUND The association of lichen planus with hepatitis C (HCV) has been widely reported in the literature. However, there are wide geographical variations in the reported prevalence of HCV infection in patients with lichen planus. This study was conducted to determine the frequency of hepatitis C in Iranian patients with lichen planus at Razi hospital, Tehran. METHODS During the years 1997 and 1998, 146 cases of lichen planus, 78 (53.1%) women and 69 (46.9%) men were diagnosed. They were diagnosed on the basis of the usual clinical features and, if necessary, typical histological findings. The patients were screened for the presence of anti-HCV antibodies by third generation ELISA and liver function tests. We used the results from screening of blood donors for anti HCV (carried out by Iranian Blood Transfusion Organization) for comparison as the control group. RESULTS Anti-HCV antibodies were detected in seven cases (4.8%). This was significantly higher than that of the blood donors' antibodies (p < 0.001). The odds ratio was 50.37(21.45-112.24). A statistically significant association was demonstrated between erosive lichen planus and HCV infection. Liver function tests were not significantly different between HCV infected and non-infected patients. CONCLUSION HCV appears to have an etiologic role for lichen planus in Iranian patients. On the other hand, liver function tests are not good screening means for HCV infection.
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Affiliation(s)
- S Zahra Ghodsi
- Department of Dermatology Tehran University of Medical Sciences Razi Hospital Vahdat Islami Square 11996 Tehran Iran
| | - Maryam Daneshpazhooh
- Department of Dermatology Tehran University of Medical Sciences Razi Hospital Vahdat Islami Square 11996 Tehran Iran
| | - Mohammad Shahi
- Private dermatologist Razi Hospital Vahdat Islami Square 11996 Tehran Iran
| | - Ali Nikfarjam
- District Health Center Prevention and Disease Control Sector Tehran University of Medical Sciences Nasr Ave. 24 Str. No 35 14488 43117 Tehran Iran
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Abstract
Part of periodontology involves the diagnosis and treatment of a variety of non-plaque-related diseases of the periodontium. The International Workshop for a Classification of Periodontal Diseases and Conditions noted that the periodontist may be called upon to manage non-plaque-related mucocutaneous disorders either alone, or as part of a treatment team consisting of physicians, dentists or other allied health care professionals. This informational paper will review the etiology, clinical manifestations, diagnosis, and treatment of the most common chronic mucocutaneous diseases, including those that may present as desquamative gingivitis or intraoral vesiculobullous lesions. This paper is intended for the use of periodontists and other members of the dental profession.
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Carrozzo M, Gandolfo S. Oral diseases possibly associated with hepatitis C virus. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 2003; 14:115-27. [PMID: 12764074 DOI: 10.1177/154411130301400205] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Morbidity associated with hepatitis C virus (HCV) infection can involve a variety of extrahepatic conditions, including lichen planus (LP) and sialadenitis, predominantly or exclusively involving the oral region, conditions which have been largely neglected in reviews. The literature suggests that HCV-infected patients may frequently have Sjögren-like sialadenitis with mild clinical symptoms, whereas oral LP may be significantly associated with HCV infections in Southern Europe and Japan but not in Northern Europe. These geographical differences could be related to immunogenetic factors such as the HLA-DR6 allele, significantly expressed in Italian patients with OLP and HCV. Analysis of experimental data suggests that HCV could be involved in the pathogenesis of both these diseases. Moreover, parotid lymphoma may arise in patients with sialadenitis, mainly with type II cryoglobulinemia. Little attention has been paid to oral health needs in HCV-infected patients and the variable effect of interferon-alpha therapy on oral tissues. Further research is needed, because of the potentially great influence of oral diseases possibly linked to HCV on the quality of life of millions of patients.
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Affiliation(s)
- M Carrozzo
- Department of Biomedical Sciences and Human Oncology, Oral Medicine Section, C. so Dogliotti 14, University of Turin, I-10126 Torino, Italy.
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