Association of autoimmune comorbidities with lichen planus: A United States-based case-control study in the All of Us research program

Lichen Planus: A Cross-Sectional Evaluation of US Dermatologists' Comorbidity Screening and Management Patterns

INTRODUCTION

Lichen planus (LP) is a chronic inflammatory dermatosis affecting up to 0.91% of the US's population. LP is associated with various comorbid conditions, among them autoimmune conditions. LP has various treatment strategies, although none are US Food and Drug Administration (FDA)-approved; this is further complicated by the lack of any clinical or expert guidelines. This study aimed to explore dermatology practitioners' comorbidity screening patterns and treatment practices for management of LP.

METHODS

An institutional review board (IRB)-approved, anonymous survey was distributed to members of the ODAC Conference listserv, targeting dermatology practitioners. The survey collected data on demographics, comorbidity screening, and treatment strategies.

RESULTS

A total of 406 respondents (17.4% response rate) participated. Hepatitis C virus was the most screened for condition (91.0%), despite its overall low prevalence in patients with LP. Screening rates for highly prevalent comorbidities such as hypertension (10.1%), dyslipidemia (9.7%), depression (18.7%), and anxiety (17.3%) were low. Importantly, almost one-third (32.5%) of respondents reported performing no screening for any comorbid conditions. Topical corticosteroids were the most prescribed therapy (97.8%), followed by topical calcineurin inhibitors (67.7%) and intralesional corticosteroids (64.8%), consistent with high-level evidence for their use in LP treatment. Phototherapy and systemic treatments, including oral immunosuppressants and retinoids, were less frequently utilized despite strong evidence supporting their use.

CONCLUSION

These data highlight gaps in the comorbidity screening practices among dermatology practitioners managing LP, with significant underscreening for prevalent conditions. While respondents commonly relied on some evidence-based topical treatments, there is notable underutilization of systemic treatments for moderate to severe disease. These results emphasize the need for clinical guidelines for LP management, aiming to enhance patient care and outcomes.

Picolinate-mediated immunomodulation: insights from Mendelian randomization on the role of NK cell percentage in the pathogenesis of lichen planus

Background

Lichen planus (LP), an autoimmune disorder, remains incompletely understood in terms of its etiological mechanisms. This study aims to elucidate causal relationships among immune cell populations, plasma metabolites, and lichen planus using Mendelian randomization (MR) techniques.

Methods

Employing a two-sample, two-step MR approach, with single nucleotide polymorphisms (SNP) serving as genetic instruments for both exposures and mediators, this study minimizes biases from confounding and reverse causality. Leveraging summary statistics from genome-wide association studies (GWAS) involving 731 immune cell traits (N = 3757), 1091 plasma metabolite traits (N = 8299), and lichen planus (N = 367668), inverse variance weighting (IVW) is adopted as the primary MR analytical method. The total effect of immune cells traits on LP is decomposed into direct and indirect effects mediated by plasma metabolites.

Results

MR analysis reveals causal associations for 28 immune cell traits and 38 plasma metabolites with LP (PIVW < 0.05). Specifically, NK % lymphocyte shows a negatively correlated causal effect with LP (ORIVW = 0.952; 95% CI: [0.910, 0.995], PIVW = 0.030). Among mediators, Picolinate significantly contributes, explaining 16.4% (95% CI: [28.3%, 4.54%]) of the association between NK % lymphocyte and LP.

Conclusion

These findings support a potential protective causal effect of NK % lymphocyte on LP, partially mediated by Picolinate levels. Thus, interventions targeting Picolinate levels may mitigate LP burden attributed to low NK % lymphocyte counts. This study provides new evidence and insights into the pathogenesis of lichen planus, advancing our understanding of its underlying mechanisms.

Correlations between lichen planus and autoimmune diseases: a Mendelian randomization study

Previous observational studies have found that lichen planus (LP) is associated with autoimmune diseases. To determine the association between LP and 15 autoimmune diseases, we applied the Mendelian randomization (MR) approach, which uses genetic variants as a tool to improve causal inference. We performed a two-sample MR with the genetic instruments identified for 15 autoimmune diseases. Genome-wide association study (GWAS) data was sourced from the IEU Open GWAS database. The instrumental variables (IVs) for LP (1865 cases and 212,242 non-cases) were genetic variations highly associated (P < 5 × 10-6) with LP in the European population. To calculate causal effects, odds ratios (ORs) with 95% confidence intervals (CIs) are employed. MR showed that the genetic risk of psoriasis was positively associated with atopic dermatitis (OR [95%CI] = 0.964[0.936, 0.992], PIVW = 0.013), ankylosing spondylitis (OR [95%CI] = 0.879[0.774, 0.999], PIVW = 0.047) and Type 1 diabetes (OR [95%CI] = 1.074[1.008, 1.145], PIVW = 0.027). These results didn't exhibit horizontal pleiotropy, and "leave-one-out" analysis demonstrated result stability. The MR study indicates a causal relationship between atopic dermatitis, ankylosing spondylitis and Type 1 diabetes in Europe. Further research is necessary to clarify the biological mechanisms that underlie these associations.

Lichen Planus: What is New in Diagnosis and Treatment?

Lichen planus (LP), an idiopathic, multifaceted chronic inflammatory disease with a heterogeneous clinical presentation, affects approximately 0.5-1% of the population. The various clinical manifestations of LP fall into three broad categories, namely cutaneous, appendageal, and mucosal, with further subclassification depending on the morphology and distribution patterns of individual lesions. There is mounting evidence that LP has systemic associations, including autoimmune conditions, glucose intolerance, dyslipidemia, and cardiovascular disorders. Cutaneous hypertrophic and mucosal forms of LP are at a heightened risk for malignant transformation. Familiarity with these potential associations in conjunction with long-term follow-up and regular screening could lead to a timely diagnosis and management of concomitant conditions. In addition, the frequent quality of life (QoL) impairment in LP underscores the need for a comprehensive approach including psychological evaluation and support. Several treatment strategies have been attempted, though most of them have not been adopted in clinical practice because of suboptimal benefit-to-risk ratios or lack of evidence. More recent studies toward pathogenesis-driven treatments have identified Janus kinase inhibitors such as tofacitinib, phosphodiesterase-4 inhibitors such as apremilast, and biologics targeting the interleukin-23/interleukin-17 pathway as novel therapeutic options, resulting in a dramatic change of the treatment landscape of LP. This contemporary review focuses on the diagnosis and management of LP, and places emphasis on more recently described targeted treatment options.

Correlations between schizophrenia and lichen planus: a two-sample bidirectional Mendelian randomization study

Background

Several existing studies have shown a correlation between schizophrenia and lichen planus (LP). However, the causality of this relationship remains uncertain. Thus, this study aimed to examine the causal association between schizophrenia and LP.

Methods

A two-sample Mendelian randomization (MR) study was carried out to investigate whether schizophrenia is causally related to LP and vice versa, and genetic variants in this study were taken from previous genome-wide association studies. We used the inverse variance weighted (IVW) method as the main analysis. Furthermore, several sensitivity analyses were performed to assess heterogeneity, horizontal pleiotropy, and stability.

Results

Our results show that schizophrenia has a protective effect on LP (OR = 0.881, 95%CI = 0.795-0.975, p = 0.015). Conversely, we observed no significant relationship between LP and schizophrenia in reverse MR analysis (OR = 0.934, 95%CI = 0.851-1.026, p = 0.156).

Conclusion

Our two-sample Mendelian randomization study supports a significant causal relationship between LP and schizophrenia and finds that schizophrenia can reduce the incidence of LP. This is in contrast to previous findings and provides new insights into the relationship between LP and schizophrenia, but the exact mechanism needs further investigation.

Comprehensive Insight into Lichen Planus Immunopathogenesis

Lichen planus is a chronic disease affecting the skin, appendages, and mucous membranes. A cutaneous lichen planus is a rare disease occurring in less than 1% of the general population, while oral illness is up to five times more prevalent; still, both forms equally impair the patient's quality of life. The etiology of lichen planus is not entirely understood. Yet, immune-mediated mechanisms have been recognized since environmental factors such as hepatitis virus infection, mechanical trauma, psychological stress, or microbiome changes can trigger the disease in genetically susceptible individuals. According to current understanding, lichen planus immunopathogenesis is caused by cell-mediated cytotoxicity, particularly cytotoxic T lymphocytes, whose activity is further influenced by Th1 and IL-23/Th-17 axis. However, other immunocytes and inflammatory pathways complement these mechanisms. This paper presents a comprehensive insight into the actual knowledge about lichen planus, with the causal genetic and environmental factors being discussed, the immunopathogenesis described, and the principal effectors of its inflammatory circuits identified.