Thyroid Autoimmunity and Lichen

EuroGuiderm guideline on lichen sclerosus-introduction into lichen sclerosus

INTRODUCTION

Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness. It may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are redness and oedema, typically followed by whitening of the genital skin; sometimes fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early.

OBJECTIVES

The guideline intends to provide guidance on the diagnostic of LS, highlight important aspects in the care of LS patients (part 1), generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow-up of patients with LS and inform about new developments and potential research aspects.

MATERIALS AND METHODS

The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF-EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives.

RESULTS

Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co-treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases.

CONCLUSIONS

LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long-term.

Possible Role of NRF2 in Cell Response to OZOILE (Stable Ozonides) in Children Affected by Lichen Sclerosus of Foreskin

Lichen sclerosus (LS) is a chronic inflammatory disease of the skin, and the gold standard for treatment is the use of the very potent topical steroids, but they can have side effects. Previously, we demonstrated that OZOILE (stable ozonides) were effective in children affected by LS, reducing the inflammatory process and stimulating tissue regeneration of the foreskin, showing a similar efficacy to steroid treatment. In this study, the modulation of inflammatory and oxidative stress pathways was evaluated by qRT-PCR and Western blotting in foreskins affected by LS removed from patients untreated or treated with OZOILE or corticosteroid cream formulations for 7 days before circumcision. OZOILE induced a significant increase in NRF2 and SOD2 levels, while it did not produce change in MIF, NF-kB subunits, and MMPs in comparison to untreated foreskins. Conversely, steroid topical treatment produced a significant reduction in the expression of p65, MIF, and MMP9, but it did not cause variation in NRF2 and SOD2 levels. These results demonstrate that the use of OZOILE as cream formulation exhibits effects on NRF2 signaling, and it does not induce NF-κB activation, unlike corticosteroids. On the basis of our biochemical data, further studies evaluating the role of NRF2 signaling cascade are necessary.

Endocrine and metabolic comorbidities in primary cicatricial alopecia: A nationwide population-based study

Primary cicatricial alopecia (PCA) is a rare, scarring, hair loss disorder. Due to its low incidence, little is known about endocrine and metabolic comorbidities in patients with PCA. Thus, we aimed to investigate the association between PCA and endocrine and metabolic disorders. This nationwide, population-based, cross-sectional study included patients diagnosed with PCA or non-cicatricial alopecia (NCA) and normal individuals without history of alopecia registered in the Korean National Health Insurance Service database between January 1, 2011, and December 31, 2020. We calculated the odds ratios of endocrine and metabolic comorbidities of patients with PCA compared to all patients or age- and sex-matched patients with NCA or normal individuals using multivariable logistic regression models. A total of 3 021 483 individuals (mean age [SD], 38.7 [15.0] years, 1 607 380 [53.2%] men), including 11 956 patients with PCA, 601 852 patients with NCA, and 2 407 675 normal participants, were identified. Patients with PCA had an increased risk for dyslipidemia (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.06-1.24), diabetes (aOR 1.38, 95% CI 1.24-1.53), and hypertension (aOR 1.10, 95% CI 1.02-1.19) compared to matched patients with NCA. Regarding PCA subtypes, lichen planopilaris/frontal fibrosing alopecia was positively associated with hypothyroidism (aOR 2.03, 95% CI 1.44-2.86) compared to NCA. Folliculitis decalvans and dissecting cellulitis were positively associated with dyslipidemia (aOR 1.16, 95% CI 1.05-1.28 and aOR 1.16, 95% CI 1.04-1.29, respectively), diabetes (aOR 1.38, 95% CI 1.20-1.58 and aOR 1.52, 95% CI 1.32-1.74, respectively), and hypertension (aOR 1.10, 95% CI 1.00-1.20 and aOR 1.14, 95% CI 1.02-1.27, respectively). Similar trends were observed when each PCA subgroup was compared with the normal control group. This study demonstrates that patients with PCA are more likely to have endocrine and metabolic comorbidities than patients without PCA. Further research on these comorbidities may improve the understanding of PCA.

The Potential Coexistence of Autoimmune Thyroid Diseases and Pediatric Vulvar Lichen sclerosus

INTRODUCTION

Vulvar lichen sclerosus (VLS), a chronic inflammatory skin disorder, often coexists with autoimmune thyroid disease (AITD). VLS presents with subtle symptoms including vulvar itching and discomfort. Clinically, a "Figure 8" pattern involving the labia minora, clitoral hood, and perianal region is often observed. It is prevalent both in pre-pubertal girls and women aged 40-60, and the link between VLS and AITD remains unclear, with proposed causes including autoimmune, hormonal or genetic factors, and environmental triggers. This study addresses the lack of research on the association in children, aiming to investigate the largest group of underage girls to date.

AIM

This study aimed to investigate the coexistence of thyroid autoimmune diseases in girls diagnosed with vulvar lichen sclerosus (VLS) and to assess the presence of antibodies for specific thyroid autoimmune diseases.

MATERIALS AND METHODS

Our study was conducted from July 2020 to February 2021, involving a sample of 55 girls aged 2-18 years old, all free from systemic diseases. The study group comprised 20 girls previously diagnosed with vulvar lichen sclerosus (VLS), while the control group included 35 girls without VLS. Legal guardians completed questionnaires detailing the medical history of their children. Blood samples were collected from all participants and subjected to biochemical analysis. The presence of human IgG antibodies against thyroid peroxidase and IgG antibodies against thyroglobulin was assessed using the immunoenzymatic method with commercially available ELISA kits.

RESULTS

In the study group, common symptoms included itching, soreness, burning sensation, excoriation, and erythema or pallor of the skin and perineal mucosa. An evaluation of anti-thyroglobulin and anti-thyroid peroxidase antibodies revealed no statistical significance between the study and control groups (anti-TG p = 0.379, anti-TPO p = 0.96). Family history of autoimmune diseases showed no significant correlation with anti-thyroid antibodies in girls. Although no significant relation between VLS occurrence and antibody levels was found, it emphasizes the need for multidisciplinary medical care. Further research with larger patient groups is necessary.

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

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

Lichen Sclerosus: A Current Landscape of Autoimmune and Genetic Interplay

Lichen sclerosus (LS) is an acquired chronic inflammatory dermatosis predominantly affecting the anogenital area with recalcitrant itching and soreness. Progressive or persistent LS may cause urinary and sexual disturbances and an increased risk of local skin malignancy with a prevalence of up to 11%. Investigations on lipoid proteinosis, an autosomal recessive genodermatosis caused by loss-of-function mutations in the extracellular matrix protein 1 (ECM1) gene, led to the discovery of a humoral autoimmune response to the identical molecule in LS, providing evidence for an autoimmune and genetic counterpart targeting ECM1. This paper provides an overview of the fundamental importance and current issue of better understanding the immunopathology attributed to ECM1 in LS. Furthermore, we highlight the pleiotropic action of ECM1 in homeostatic and structural maintenance of skin biology as well as in a variety of human disorders possibly associated with impaired or gained ECM1 function, including the inflammatory bowel disease ulcerative colitis, Th2 cell-dependent airway allergies, T-cell and B-cell activation, and the demyelinating central nervous system disease multiple sclerosis, to facilitate sharing the concept as a plausible therapeutic target of this attractive molecule.

Association of Hashimoto’s thyroiditis and anti-thyroid antibodies with oral lichen planus: A cross-sectional study

Hashimoto’s thyroiditis (HT) and its autoantibodies may be associated with oral lichen planus (OLP). In this cross-sectional study, we aimed to assess the relationship among HT, auto-anti-thyroid antibodies, and OLP in a Chinese population of 247 patients with oral lichen planus. Clinical manifestations of OLP were evaluated using the Thongprasom scoring system and clinical type. The diagnosis of HT was based on thyroid function, anti-thyroid peroxidase antibody (anti-TPOAb) and anti-thyroglobulin antibody (anti-TgAb) detection, and ultrasonography. The prevalence of HT in all patients with OLP was 39.68% (98/247); the prevalence in females with OLP was 46.24% (86/186), which was higher than that in males with OLP 19.67% (12/61) (P &lt; 0.01). The titers of the two HT autoantibodies in females with OLP were higher than those in males (P &lt; 0.01). The clinical manifestations of OLP, regardless of being evaluated using the Thongprasom system or clinical type, were not significantly associated with HT development or TPOAb (P = 0.864) or TgAb titers (P = 0.745). In this population-based southern Chinese cohort, the prevalence of HT in patients with OLP, particularly in female patients with OLP, was significantly higher than that in the general population. Female patients had higher HT autoantibody titers than male patients. However, the clinical manifestations of OLP were not significantly correlated with either HT development or auto-anti-thyroid antibody levels. The findings could help further elucidate the factors involved in the relationship between oral lichen planus and Hashimoto’s thyroiditis.

Lipid Profiles and Cardiovascular Risk in Patients with Oral Lichen Planus

Background: It has been reported that dyslipidemia prevalence and cardiovascular disease risk were increased in subjects with oral lichen planus diagnose. On the other hand, so far, there is no available data on the topic of cardiovascular risk (CVR) in subjects with oral lichen planus (OLP). The main aim of this study, due to lack of any other study covering this topic, was to investigate lipid profile and assess CVR in patients with OLP. Materials and Methods: To create a routine lipid profile, we collected triglyceride serum levels, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol from 63 OLP patients and 63 healthy people representing control subjects. For every patient their individual cardiovascular risk was measured. Results: In comparison with the tested control subjects, patients with OLP had all parameters of the lipid profile elevated, with no differences of statistical importance. Furthermore, the experimental (OLP) and control groups shared similar mean values of the lipid profile parameters. Conclusions: The association of OLP with cardiovascular risk was not established and further studies with more subjects involved are required to validate this connection.

Decreased recurrence of symptoms in oral lichen planus with intralesional injection of hyaluronic acid and triamcinolone

Oral lichen planus (OLP) is a chronic non-infectious, inflammatory, immunological disease. In contrast to skin lesions, which are often self-limiting, oral lesions rarely heal on their own and can be resistant to local and systemic treatments. In this clinical trial, hyaluronic acid (HA) was mixed with triamcinolone for intralesional injection to reduce side effects in the treatment of OLP. This randomized clinical trial with a split-mouth design was performed on 28 patients with OLP. The mouth was divided randomly into two sides: a test side, which received HA combined with triamcinolone, and a control side, which received triamcinolone alone. The rate of symptom recurrence was 74.1% on the control side and 11.1% on the test side (significant difference, P<0.01). Pain scores did not differ between the two groups when assessed after 2 weeks. The group treated with a combination of HA and triamcinolone experienced a significantly better resolution of lesions and symptoms. Considering the role of HA in tissue healing and in regulating inflammatory responses, as well as its antioxidant and hydration properties, it appears that HA could be effective in improving of OLP and decreasing the rate of symptom recurrence.

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

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

Possible Mechanisms Involved in the Cooccurrence of Oral Lichen Planus and Hashimoto's Thyroiditis

Oral lichen planus (OLP) is a chronic inflammatory oral mucosal disorder mediated by T cells, with a multifactorial etiology. Hashimoto's thyroiditis (HT) is a common autoimmune disease characterized by hypothyroidism. Although many clinical studies conducted over the past several decades have reported the cooccurrence of OLP and HT, the underlying mechanism remains unclear. This review summarizes potential mechanisms that might be involved in the cooccurrence of OLP and HT. We find that OLP and HT share a common or overlapping pathogenesis in terms of immune, heredity, environmental, and hormonal factors, which might cause cooccurrence. Furthermore, considering the latency of HT, a routine screen for thyroid diseases, particularly HT, is suggested for confirmed OLP patients.

A Cross-Sectional Study of Oral Lichen Planus Associated With Thyroid Diseases in East China

Objective: To investigate the prevalence of thyroid diseases in patients with oral lichen planus (OLP) and to explore the correlation between the two diseases. Methods: A cross-sectional study was conducted to investigate the history of thyroid disease in 585 patients with oral lichen planus diagnosed in the Department of Oral Mucosal Diseases of the Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine from June 2017 to April 2018 and in 10,441 normal people in an epidemiological survey conducted by endocrinology department of Ninth People's Hospitalin eastern China from 2014 to 2015. Personal medical history of thyroid disease was obtained through questionnaire and thyroid function was also tested. Results: Of the 585 patients with OLP, 190 (32.48%) had thyroid disease (excluding coexistence of multiple thyroid diseases), 62 (32.6%) had thyroid nodules, and 71 (37.4%) had Hashimoto's thyroiditis. Hyperthyroidism was diagnosed in six patients (3.2%), hypothyroidism in seven patients (3.7%), and thyroid cancer in 11 patients (5.8%). The prevalence of Hashimoto's thyroiditis was significantly higher in patients with oral lichen planus than in the general population. The probability of thyroid disease was significantly higher in women with OLP than in men with OLP (P < 0.001). Conclusion: OLP is associated with a high probability of developing thyroid disease, especially Hashimoto's thyroiditis. In the management of OLP patients, especially in female patients, thyroid disease must be screened.

Lichen sclerosus: the role of oxidative stress in the pathogenesis of the disease and its possible transformation into carcinoma

Lichen sclerosus (LS) is an autoimmune chronic inflammatory disease usually involving the anogenital skin of both sexes; more rarely LS exclusively involves extragenital areas. As a chronic inflammatory disease, in most cases, LS evolves and progresses causing scleroatrophy of the skin or scars which may cause stenosis in the affected areas. A few LS patients are at risk of developing squamous cell carcinoma in their lifetime, but appropriate long-term treatment diminishes the possibility of a malignant evolution. Oxidative stress (OS) has been proven to play a role not only in the pathogenesis of LS, but also in the development and progression of the disease. OS, by causing DNA damage and lipid peroxidation, contributes directly to the possible malignant transformation of LS. Moreover, the increase in oxidative DNA damage is associated with mutations in tumor suppressor genes. Considering the role that OS plays in LS, therapeutic use of antioxidants appears to be rational and possible, in association with other treatments. Antioxidants would counteract the oxidative DNA damage, which is the most important factor for the progression of LS and its malignant transformation.

Oral lichen planus and thyroid gland diseases: possible associations

Background

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

Methods

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

Results

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

Conclusions

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

Genomic Profiling of Vulvar Lichen Sclerosus Patients Shows Possible Pathogenetic Disease Mechanisms

OBJECTIVE

Vulvar lichen sclerosus (LS) is known to occur in families, suggesting a genetic link. Genomic profiling of patients with vulvar LS was investigated to find underlying pathogenetic mechanisms, with the hope that targeted therapies and future clinical research will arise.

METHODS

Two unrelated families with vulvar LS were investigated using whole-exome sequencing. Five affected sisters from 1 family were compared with their unaffected paternal aunt (unaffected control). A mother-daughter pair from a second affected family was compared with the first family. The results of the sequencing were compared with population-specific allele frequency databases to prioritize potential variants contributing to vulvar LS development.

RESULTS

Recurrent germ-line variants in 4 genes were identified as likely to be deleterious to proper protein function in all of the 7 affected patients, but not in the unaffected control. The genes with variants included CD177 (neutrophil activation), CD200 (inhibitory signal to macrophages), ANKRD18A (ankyrin repeat protein, epigenetic regulation), and LATS2 (co-repressor of androgen signaling).

CONCLUSIONS

Although many providers may see a mother and daughter with vulvar LS, this condition is rarely seen in multiple family members who are available for genetic testing. This is the first report to detail genomic profiling related to a familial association of vulvar LS.

Lichen Sclerosus: An autoimmunopathogenic and genomic enigma with emerging genetic and immune targets

Lichen sclerosus (LS) is an inflammatory dermatosis with a predilection for anogenital skin. Developing lesions lead to vulvar pain and sexual dysfunction, with a significant loss of structural anatomical architecture, sclerosis, and increased risk of malignancy. Onset may occur at any age in both sexes, but typically affects more females than males, presenting in a bimodal fashion among pre-pubertal children and middle-aged adults. A definitive cure remains elusive as the exact pathogenesis of LS remains unknown. A general review of LS, histologic challenges, along with amounting support for LS as an autoimmune disease with preference for a Th1 immune response against a genetic background is summarized. In addition to the classically referenced ECM1 (extracellular matrix protein 1), a following discussion of other immune and genetic targets more recently implicated as causative or accelerant agents of disease, particularly miR-155, downstream targets of ECM1, galectin-7, p53, and epigenetic modifications to CDKN2A, are addressed from the viewpoint of their involvement in three different, but interconnected aspects of LS pathology. Collectively, these emerging targets serve not only as inherently potential therapeutic targets for treatment, but may also provide further insight into this debilitating and cryptic disease.

Oxidative Stress and Oral Mucosal Diseases: An Overview

BACKGROUND

Reactive oxygen species (ROS) and free radicals are physiologically produced during cellular metabolism. When their balance is disrupted in favor of ROS, a condition called oxidative stress occurs. Oxidative stress represents a widespread phenomenon involved in several pathological conditions. The aim of the present review was to report current knowledge on oxidative stress related to oral mucosal diseases.

MATERIALS AND METHODS

Articles from 2000 to 2018 were selected for relevance, validity and quality, from results obtained in PubMed, MEDLINE and Google Scholar using the following search terms: oxidative stress and oral lichen, oral pemphigus, aphthous stomatitis, oral leukoplakia, oral cancer, oral squamous cell carcinoma and oral carcinoma. All articles were independently screened for eligibility by the authors.

RESULTS

This narrative review integrates extensive information from all relevant published studies focusing on oxidative stress in oral mucosal diseases. We outline the pathogenetic function of oxidative stress in the most frequent inflammatory, potentially malignant and malignant diseases of the oral mucosa and provide detailed findings from human research.

CONCLUSION

Although variability in findings between individual studies exists, it justifies the conclusion that oxidative stress is a significant process in the oral mucosal diseases pathogenesis.

Association of OLP and thyroid disorder: Case report and review of literature

Oral lichen planus is a chronic T cell mediated inflammatory condition with multifactorial etiology. Being autoimmune mediated condition, it has been associated with other autoimmune disorders. This case report discusses the possible presentation of oral lichen planus in hypothyroid patients as a marker of severity of the thyroid deficient status and the possible pathogenetic link between both the conditions.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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