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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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Tziotzios C, Lee JYW, Brier T, Saito R, Hsu CK, Bhargava K, Stefanato CM, Fenton DA, McGrath JA. Lichen planus and lichenoid dermatoses: Clinical overview and molecular basis. J Am Acad Dermatol 2019; 79:789-804. [PMID: 30318136 DOI: 10.1016/j.jaad.2018.02.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Deriving from the Greek word λειχήν for "tree moss" and the Latin word planus for "planar," lichen planus is a relatively uncommon and heterogeneous cutaneous disorder that typically develops in middle-aged adults. Despite the significant clinical burden associated with the disorder, little well-conducted molecular research has been undertaken, possibly because of heterogeneity impeding consistent and confident phenotyping. The multiple variants of lichenoid disease bear overlapping clinical and pathologic features despite manifesting as distinct clinical disorders. The first article in this 2-part continuing medical education series provides a comprehensive overview of the clinical and pathologic characteristics of cutaneous lichenoid dermatoses and links these manifestations to recent advances in our understanding of the underlying pathobiology of such diseases.
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Affiliation(s)
- Christos Tziotzios
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom.
| | - John Y W Lee
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Timothy Brier
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Ryo Saito
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Chao-Kai Hsu
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Kapil Bhargava
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Catherine M Stefanato
- Department of Dermatopathology, St. John's Institute of Dermatology, St. Thomas' Hospital, London, United Kingdom
| | - David A Fenton
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - John A McGrath
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
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Georgescu SR, Tampa M, Mitran MI, Mitran CI, Sarbu MI, Nicolae I, Matei C, Caruntu C, Neagu M, Popa MI. Potential pathogenic mechanisms involved in the association between lichen planus and hepatitis C virus infection. Exp Ther Med 2018; 17:1045-1051. [PMID: 30679972 DOI: 10.3892/etm.2018.6987] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
Lichen planus (LP) is an immune-mediated inflammatory disease that particularly affects the skin and mucous membranes. Its etiology remains elusive, however some trigger factors, including viral or bacterial antigens, drugs and metals, have been postulated. There is a higher prevalence of hepatitis C virus (HCV) infection among patients with LP, with some geographical variations. HCV is an enveloped RNA virus that belongs to the Flaviviridae family and in most instances causes chronic liver infections. It has been hypothesized that HCV may contribute to LP development, but the link between the two disorders is not fully understood. It is still debatable whether HCV leads to the occurrence of LP lesions directly by replication inside the infected cells or indirectly by activating immunological pathways. Molecular studies have revealed HCV RNA in specimens collected from patients with LP. The autoimmune theory was also suggested given that several studies have revealed viral replication and immune response activation associated with autoantibody synthesis. The aim of this review is to summarize the main potential mechanisms involved in the association between LP and HCV infection. Understanding the link between the two disorders may shed some light on the pathogenesis of LP, which is a challenging issue.
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Affiliation(s)
- Simona Roxana Georgescu
- Department of Dermatology, 'Victor Babes' Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania.,Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mircea Tampa
- Department of Dermatology, 'Victor Babes' Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania.,Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Madalina Irina Mitran
- Department of Dermatology, 'Victor Babes' Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania.,Department of Microbiology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cristina Iulia Mitran
- Department of Dermatology, 'Victor Babes' Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania.,Department of Microbiology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Maria Isabela Sarbu
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ilinca Nicolae
- Department of Dermatology, 'Victor Babes' Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania
| | - Clara Matei
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Constantin Caruntu
- Department of Dermatology, 'Prof. N. Paulescu' National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania.,Department of Physiology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Monica Neagu
- Department of Immunology, 'Victor Babes' National Institute of Pathology, 050096 Bucharest, Romania.,Faculty of Biology University of Bucharest, 050095 Bucharest, Romania
| | - Mircea Ioan Popa
- Department of Microbiology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,'Cantacuzino' National Medico-Military Institute for Research and Development, 050096 Bucharest, Romania
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Alaizari NA, Al-Maweri SA, Al-Shamiri HM, Tarakji B, Shugaa-Addin B. Hepatitis C virus infections in oral lichen planus: a systematic review and meta-analysis. Aust Dent J 2017; 61:282-7. [PMID: 26475515 DOI: 10.1111/adj.12382] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND A role for hepatitis C virus in oral lichen planus has been postulated. This systematic review and meta-analysis of the existing epidemiological studies was conducted to determine if there is a correlation between oral lichen planus and hepatitis C virus infection. METHODS We examined the association between hepatitis C virus and oral lichen planus by conducting a systematic review and meta-analysis of case-control studies that examined the prevalence of anti-HCV antibodies in the serum of cases and controls. We searched PubMed, Embase and The Cochrane Library databases from 2005 to January 2015. Associations were measured using random-effect odds ratios (ORs) combined with 95% confidence intervals. RESULTS Nineteen eligible studies, encompassing 1807 cases of OLP and 2519 controls, were retrieved and included in this review. The summary estimate OR for all studies was 6.07 (95% CI: 2.73-13.48), showing a statistically significant difference in the proportion of HCV seropositivity among oral lichen planus patients, compared with controls and substantial heterogeneity between studies (I(2) = 65%) as a result of a variety of geographical distributions. CONCLUSIONS The association of hepatitis C virus infection with oral lichen planus emphasizes the importance of hepatitis C virus screening in oral lichen planus patients.
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Affiliation(s)
- N A Alaizari
- Department of Oral Medicine and Diagnostic Sciences, Faculty of Dentistry, Al-Farabi Colleges, Riyadh, Saudi Arabia
| | - S A Al-Maweri
- Department of Oral Medicine and Diagnostic Sciences, Faculty of Dentistry, Al-Farabi Colleges, Riyadh, Saudi Arabia
| | - H M Al-Shamiri
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Al-Farabi Colleges, Riyadh, Saudi Arabia
| | - B Tarakji
- Department of Oral Medicine and Diagnostic Sciences, Faculty of Dentistry, Al-Farabi Colleges, Riyadh, Saudi Arabia
| | - B Shugaa-Addin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Al-Farabi Colleges, Riyadh, Saudi Arabia
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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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Floristán U, Feltes R, Ramírez-Marín P, Herranz-Pinto P. [Interferon-alpha and hepatitis C virus: the skin matters]. Rev Clin Esp 2011; 211:92-7. [PMID: 21376938 DOI: 10.1016/j.rce.2010.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 05/31/2010] [Indexed: 12/16/2022]
Abstract
Chronic hepatitis C virus infection (HCV) is classically associated with such dermatologic conditions as mixed cryoglobulinemia (MC), porphyria cutanea tarda (PCT) and lichen planus. This review focuses on the response of these entities to interferon alpha (IFN) therapy, which has an immunomodulatory activity and may modify their course. The presence of certain HCV-associated dermatologic disorders, as PCT, may predict the patients virological response to IFN therapy. On the other hand, the course of some dermatologic disorders, as MC, during treatment with IFN, may be an early indicator of virologic response. In any case, physicians should know how to handle the most common dermatologic side effects of IFN, which may affect the quality of life of patients, complicating the adherence to treatment.
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Affiliation(s)
- U Floristán
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España.
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Birkenfeld S, Dreiher J, Weitzman D, Cohen AD. A study on the association with hepatitis B and hepatitis C in 1557 patients with lichen planus. J Eur Acad Dermatol Venereol 2011; 25:436-40. [PMID: 20666875 DOI: 10.1111/j.1468-3083.2010.03809.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous reports have demonstrated contradicting results on the association between lichen planus and hepatitis. OBJECTIVES The aim of this study was to investigate the association between lichen planus and viral hepatitis. METHODS Patients with lichen planus were compared with controls regarding the prevalence of viral hepatitis in a case-control study using logistic multivariate regression models. The study was performed utilizing the medical database of Clalit Health Services. RESULTS The study included 1557 lichen planus patients over the age of 20 years and 3115 age- and gender-matched controls. The prevalence of hepatitis C in patients with lichen planus was higher than that in the control group (1.9%, 0.4% respectively, P<0.001). In a multivariate analysis, lichen planus was associated with hepatitis C (OR 4.19, 95% CI 2.21; 7.93). The prevalence of hepatitis B in patients with lichen planus was similar to that in the control group (0.9%, 0.5% respectively, P=0.12). A multivariate analysis revealed that lichen planus was not associated with hepatitis B (OR 1.69, 95% CI 0.82; 3.47). CONCLUSION Lichen planus is associated with hepatitis C but not with hepatitis B. Physicians who care for patients with lichen planus should consider screening patients with lichen planus for hepatitis C.
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Affiliation(s)
- S Birkenfeld
- Clalit Health Services Siaal Research Center for Family Medicine and Primary Care Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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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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Rübsam K, Schroll A, Weisenseel P, Multhaup S, Ruzicka T, Prinz JC. Lichen planus and hepatitis virus infections: causal association? J Dtsch Dermatol Ges 2011; 9:464-8. [PMID: 21410879 DOI: 10.1111/j.1610-0387.2011.07619.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The causal association between hepatitis virus infections and lichen planus (LP) remains a matter of controversy. Reliable figures for German patients are still lacking. PATIENTS AND METHODS We analyzed the prevalence of serum antibodies against hepatitis B and C viruses (HBV, HCV) in 265 LP patients and compared the results to 257 patients with chronic urticaria (URT) and 222 patients with malignant melanoma (MM). Additionally, we analyzed age- and sex-specific differences. RESULTS The prevalence of HBV (13.2 % or 14.7 %) antibodies was significantly higher in patients with LP and URT patients than in the MM control group (HBV: 5.4 %, p < 0.001). The prevalence of HCV antibodies among LP and URT patients (2.6 % or 0.8 %) was not significantly greater (p > 0.05) than in MM patients (0.4 %). The prevalences of HBV and HCV in the MM control group were comparable to those in the general German population (HBV: 5-8 %, HCV: 0.4-0.7 %). An analysis by sub-groups showed that these differences resulted from sex- and age-dependent prevalences. HBV antibodies were significantly more common only in male LP patients (16.1 %) and in male (20.0 %) and female URT patients (15.6 %) aged 31-60 years. The greater prevalence of HCV in female LP patients older than 60 years of age was not significant. CONCLUSIONS LP is not specifically associated with hepatitis B or C antibodies in the Caucasian population of Germany. The higher prevalences of HBV antibodies found in LP and URT patients may be a reflection of age- and sex-related factors rather than disease-specific exposure to HBV infections. The increased prevalences seen in patients with LP or URT compared to MM patients may suggest that HBV infection serves as an unspecific trigger for a specific immune reaction of another origin.
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Affiliation(s)
- Katharina Rübsam
- Clinic and Polyclinic for Dermatology and Allergology, Ludwig-Maximilian-University of Munich, Germany.
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Al-Mutairi N, El-Khalawany M. Clinicopathological characteristics of lichen planus pigmentosus and its response to tacrolimus ointment: an open label, non-randomized, prospective study. J Eur Acad Dermatol Venereol 2009; 24:535-40. [PMID: 19840200 DOI: 10.1111/j.1468-3083.2009.03460.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lichen planus pigmentosus (LPP) is an uncommon variant of lichen planus, for which no effective treatment is available. Objectives The aim of this study was to determine the clinical, epidemiological and histopathological characteristics of LPP patients in Kuwait. METHODS Thirty-three LPP patients who attended the Dermatology outpatient clinics at Farwaniya Hospital, Kuwait from the year 2002 to 2008 were studied for clinical, epidemiological and histopathological findings. Thirteen of these patients were treated with topical tacrolimus 0.03%. Ointment applied topically twice daily for the duration varying from 6 to 12 weeks. RESULTS Of the 33 patients, 21 were men and 12 were women. The duration of eruption ranged from 6 weeks to 3 years. The face and neck were the commonest sites, affecting 18 (54.5%) patients. The pattern of pigmentation was diffuse in 18 (54.54%) patients, reticular in seven (21.2%), blotchy in five (15.2%), linear in two (6.1%) and perifollicular in one (3%). Twenty patients had positive serology for hepatitis C virus (HCV), with significantly higher serum liver enzymes (ALT and AST). Of the 13 patients, who were treated with tacrolimus Ointment, seven (53.8%) showed appreciable lightening of the pigmentation after an average of 12 weeks. CONCLUSIONS We conclude that HCV may be one of the factors associated with LPP, in those who have a tendency to develop LPP. However, this possible association should be interpreted carefully. In addition, tacrolimus ointment could have a beneficial role in the treatment of LPP.
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Affiliation(s)
- N Al-Mutairi
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.
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