A study from Nepal showing no correlation between lichen planus and hepatitis B and C viruses

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.

Risk of Prediabetes and Diabetes in Oral Lichen Planus: A Case-Control Study according to Current Diagnostic Criteria

OBJECTIVE

To estimate the prevalence of prediabetes and diabetes in patients with oral lichen planus (OLP).

METHODS

Prospective cohort, including consecutive patients diagnosed clinically and histologically with OLP from 2018 to 2022. Patients and controls were matched by age and gender. Fasting plasma glucose value collection from all patients. Multivariate regression analysis evaluated the relationship between prediabetes and diabetes variables according to current diagnostic criteria.

RESULTS

The sample comprised 275 patients (207 women; 75.3%), mean age 59.60 ± 12.18 years for both groups. Prediabetes was diagnosed according to the American Diabetes Association (ADA, 100-125 mg/dL), in 21.45% of OLP patients (59/275) and 14.55% (40/275) of control patients (p = 0.035). Patients with the atrophic-erosive form exhibited stronger association with taking oral antidiabetics (p = 0.011). Multivariate analysis showed that being over >60 years and having a cutaneous location was associated with ≥3 sites (OR 1.81 and OR 2.43). ADA prediabetes and oral antidiabetics drugs increased the probability of OLP (OR 1.60 (1.04-2.51), p = 0.03 and OR 2.20 (1.18-4.69), p = 0.017) after adjustment for sex and age.

CONCLUSIONS

Because glycemia 100-125 mg/dL was associated with OLP, testing serum fasting plasma glucose seems reasonable in order to prevent development of diabetes and deal with possible complications until new studies are complete.

No evidence for association between cutaneous lichen planus and hepatitis B and C virus infection in south Poland - a case-control study

BACKGROUND

The incidence of hepatitis C virus (HCV) infection among patients with lichen planus (LP) varies considerably. Currently, there is more evidence for the association between hepatitic C and oral LP (OLP) than cutaneous LP (CLP). There is also lack of data on the Polish population. The study aimed at assessing the prevalence of HCV infection and liver test abnormalities among patients with CLP in south Poland.

METHODS

Eighty-four patients with CLP and 130 patients with other dermatoses (controls) were included in this retrospective case-control study. Medical records were reviewed for the presence of anti-HCV antibodies and hepatitis B surface antigen (HBsAg) and serum levels of liver function tests: aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glumatyltranspeptidase (GGT).

RESULTS

Anti-HCV antibodies were not found in any of the patients in the study or control group. HBsAg was detected in one (1.19%) patient with CLP and none of the controls. Considering the prevalence of abnormal liver function parameters, there were no statistically significant differences in the frequencies of AST (P = 0.87), ALT (P = 0.9), and GGT (P = 0.81) above the upper limit between patients with CLP and patients with other dermatoses.

CONCLUSIONS

Currently, there is no evidence confirming the relationship between HCV infection and CLP in southern Poland. There is also no increased incidence of liver function abnormalities compared to patients with other dermatoses. However, there is a need for further research on larger groups of patients.

Association between hepatitis C infection in Thai patients with oral lichen planus: A case-control study

AIM

The aim of the present study was to investigate the prevalence of hepatitis C virus (HCV) infection and evaluate liver enzyme levels in patients from upper northern Thailand with oral lichen planus (OLP).

METHODS

A case-control study of 101 patients with OLP and 101 patients without OLP was conducted. Peripheral blood was taken from each patient and screened for anti-HCV antibody using immunochromatography. Positive samples were further confirmed using chemiluminescent microparticle immunoassay (CMIA) and reverse transcription-polymerase chain reaction. In addition, liver enzyme levels, alanine transaminase, aspartate transaminase, and alkaline phosphatase were evaluated using spectrophotometry.

RESULTS

Immunochromatography and CMIA revealed that nine patients with OLP (8.9%) were positive for anti-HCV antibodies, whereas only one patient without OLP was HCV positive (odds ratio = 9.78). All patients who were HCV positive had significantly higher liver enzyme levels than patients who were HCV negative.

CONCLUSIONS

The results of the present study indicated that OLP in certain patients was significantly associated with HCV. This could warrant screening for HCV-infected patients with OLP in Thailand.

The association between oral lichen planus and hepatitis C virus infection; a report from northeast of iran

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.

A potential peptide pathway from viruses to oral lichen planus

Oral lichen planus is an idiopathic inflammatory disease of oral mucous membranes, characterized by an autoimmune epidermis attack by T cells. It remains unknown, however, how such aggressive T cells are activated in vivo to cause epidermal damage. This study analyzes the relationship at the peptide level between viruses and oral lichen planus disease. Four potentially immunogenic peptides (SSSSSSS, QEQLEKA, LLLLLLA, and MLSGNAG) are found to be shared between HCV, EBV, HHV-7, HSV-1, and CMV and three human proteins (namely pinin, desmoglein-3, and plectin). The described peptide sharing might be of help in deciphering the still unexplained immunopathogenic pathway that leads to oral lichen planus.

Diabetes and Hepatitis Frequency in 140 Lichen Planus Cases in Çukurova Region

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.

Oral lichen planus: focus on etiopathogenesis

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.

The magnitude of the association between hepatitis C virus infection and oral lichen planus: meta-analysis and case control study

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.

Oral diseases associated with hepatitis C virus infection. Part 2: lichen planus and other diseases

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.

Current controversies in oral lichen planus: Report of an international consensus meeting. Part 1. Viral infections and etiopathogenesis

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.

Lichen planus and hepatitis C virus: a multicentre study of patients with oral lesions and a systematic review

BACKGROUND

An association between hepatitis C virus (HCV) infection and lichen planus (LP) has been investigated, but results have been inconsistent.

OBJECTIVES

To investigate the relationship between LP and HCV seropositivity. Methods In a cross-sectional study we tested the sera of 303 consecutive newly diagnosed patients with histologically proven LP referred to three Italian centres for the presence of anti-HCV IgG. A comparable control group was also tested. Next, in a systematic review, studies were identified by searching different databases in April 2004. Inclusion criteria were: (i) analytical study design; (ii) clinical and histological diagnosis of LP; and (iii) serological test for anti-HCV antibodies as main outcome. The risk of bias was assessed on the basis of characteristics of the study group, appropriateness of the control group and study design. Pooled data were analysed by calculating odds ratios (ORs), using a random effects model.

RESULTS

In the cross-sectional study, nearly one in five (19.1%) of the LP group was HCV positive, while a much lower prevalence of infection was found in the control group (3.2%) [OR 7.08; 95% confidence interval (CI) 3.43-14.58]. The systematic review yielded 25 relevant studies, six of which had a low risk of bias. There was a statistically significant difference in the proportion of HCV-seropositive subjects among patients with LP, compared with controls (OR 4.80; 95% CI 3.25-7.09). Following subgroup analyses, the variability of HCV prevalence in patients with LP seemed to depend on geographical area, but not on age.

CONCLUSIONS

Anti-HCV circulating antibodies are more common in patients with LP than in controls, although such an association may not be significant in some geographical areas.

Hepatitis C virus and lichen planus

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.

HCV infection and oral lichen planus: a weak association when HCV is endemic

Oral lichen planus (OLP), an immune-mediated disorder, has been reported as an extra-hepatic manifestation of Hepatitis C virus (HCV) infection, especially in HCV hyperendemic areas such as southern Europe and Japan. The aim of this study was to investigate from an epidemiological standpoint whether HCV infection is an important factor affecting the relative risk of OLP in a Mediterranean population or whether this relates to the degree of HCV endemicity. Two cohorts of OLP patients resident in two different regions of southern Italy (Campania and Sicily; n = 859) were evaluated for HCV infection status and categorized into five age classes to respective region-matched controls. No significant difference was found between OLP patients and the general population in this area, when data were corrected by the age-stratified prevalence of HCV. Therefore, the age-specific prevalence of HCV infection in OLP patients shows a close trend of direct association with increasing age, without significant differences with the general population of each geographical area. An aetiological link between OLP and HCV cannot be inferred solely by epidemiological data.

Lack of evidence of hepatic disease in patients with oral lichen planus in Serbia

OBJECTIVE

The reported frequency of chronic liver disease, and particularly, Hepatitis C virus (HCV) infection in patients with oral lichen planus (OLP) shows geographical variation. The aim of this study was to determine the prevalence of chronic hepatic disease, Hepatitis B virus and HCV infection in patients with OLP and control subjects resident in Serbia.

PATIENTS AND METHODS

In this prospective study 48 patients with OLP (33 women and 15 men, with a mean age of 49.7 years) and 60 control subjects (38 women and 22 men, with a mean age of 46.7 years) were examined for the presence of serological evidence of chronic hepatic disease, Hepatitis B surface antigen (HBsAg) and anti-HCV seropositivity.

RESULTS

All patients with OLP had normal liver function. HBsAg was not found in any of the patients with OLP or control group. None of the patients with OLP or control subjects were HCV seropositive.

CONCLUSION

Patients with OLP resident in Serbia do not have evidence of chronic liver disease or infection with HBV or HCV. The exact aetiological role between hepatic disease and OLP remains unclear.

Oral lichen planus, hepatitis C virus, and HIV: No association in a cohort study from an area of high hepatitis C virus endemicity

OBJECTIVES

We sought to assess the age-specific prevalence of oral lichen planus (OLP) in Mediterranean patients with chronic hepatitis C virus (HCV) and to evaluate the features of OLP in relation to sex, smoking, HCV genotype, HIV-1 coinfection, and antiviral treatments.

METHODS

In all, 178 anti-HCV-positive adults (60 women and 118 men; age range 20-66 years) recruited from two cohorts (104 HIV-negative patients and 74 patients with HIV coinfection) underwent oral examination.

RESULTS

Overall prevalence of OLP was 2.8% (5 of 178) (male/female ratio 0.2; odds ratio=0.119; 95% confidence interval=0.013-1.106), only among HIV-negative participants, always in the reticular pattern, and in the adult age. HCV genotype, tobacco smoking, and treatment (interferon alfa/ribavirin) were not significantly associated to OLP.

CONCLUSIONS

Among HCV-infected patients, we found a low prevalence of OLP. The absence of OLP in HIV-coinfected patients suggests immunosuppression secondary to defective CD4 functions.

Hepatitis C virus and lichen planus: A review

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.

Hepatitis C virus infection in Thai patients with oral lichen planus

OBJECTIVE

Many studies focusing on the association between hepatitis C virus (HCV) infection and oral lichen planus (OLP) have been conducted. Diversities of geographical locations could be a major factor influencing the prevalence of HCV. This study was aimed to define whether there was a relationship between the OLP and HCV infection in Thailand.

MATERIALS AND METHODS

Serum samples of 60 patients (with OLP) and 60 controls (without OLP), whose age and gender were matched, were respectively screened for anti-HCV by ELISA (third generation), and reverse transcription polymerase chain reaction (RT-PCR) for HCV-RNA.

RESULTS

We found five patients (8.33%) with OLP infected with HCV: three patients were positive for both anti-HCV and HCV-RNA; one patient was only positive for anti-HCV; and one patient was only positive for HCV-RNA; whereas all the controls were negative for both anti-HCV and HCV-RNA (P=0.029). Three of five cases of OLP with HCV infection had histories of blood transfusions over 10 years ago.

CONCLUSION

The present study reports a small, but statistically significant high prevalence of HCV infection among patients with OLP, although the underlying mechanism still remains unknown.