Homocysteine and other cardiovascular risk factors in patients with lichen planus

Potential relationship of dyslipidemia with dietary patterns in oral lichen planus patients-A case-control study

Background/purpose

Dyslipidemia and a high fat diet may increase the predisposition for accumulating body fat in patients with oral lichen planus (OLP). This study aimed to investigate the risk factors obesity, dietary patterns, and lipid metabolism.

Materials and methods

A population-based case-control study was conducted between September 2020 and October 2021, recruiting 275 pairs of OLP cases and controls. Information on lipid profiles, diet frequency and waist circumference were gathered. Principal component and factor analysis were used to analyze the semi-quantitative dietary frequency survey data of patients to extract specific dietary patterns.

Results

Univariate analysis showed that total cholesterol, triglycerides, and low-density lipoprotein were significantly higher in the OLP group than the control and other oral mucosal disease groups (P < 0.05, P < 0.001, and P < 0.001, respectively). Compared with the baseline group, obese and overweight patients were more common in the OLP group. Dyslipidemia was more common in the OLP group (68%) compared to the healthy mucosa group (32%; P < 0.001, OR = 4.52, 95% CI = 2.49-8.18). Four dietary patterns were described among the subjects. The traditional prone animal food pattern (OR: 24.81, 95% CI: 6.05-101.71, P < 0.001) and animal food pattern (OR: 28.77, 95% CI: 8.10-102.15, P = 0.001) were associated with an increased risk of OLP.

Conclusion

The results indicated that a high-fat diet, dyslipidemia and obesity were strongly linked to disease progression in OLP. A diet high in processed food and fat could increase the risk of OLP.

Lipid Alterations and Metabolism Disturbances in Selected Inflammatory Skin Diseases

Lipidomics is a term used to define the field that analyzes the structure, functions, and interactions of lipids. Inflammatory dermatoses and lipid disturbances are interrelated, especially due to chronic inflammatory conditions. This review discusses lipidomics in selected inflammatory skin diseases: psoriasis, lichen planus, and atopic dermatitis, as well as the less commonly mentioned hidradenitis suppurativa, rosacea, and acne vulgaris. Lipid homeostasis disorders are common; they are especially well-documented in psoriasis, lichen planus, and atopic dermatitis. Future studies are required for better insight into this issue, particularly on the skin lipidome. Understanding lipidomics, in particular skin diseases, increases our knowledge about their pathogenesis, and may become useful in adjusting tailored management for each patient as well establishing prognosis. Noteworthily, it seems advisable to alert doctors to the need to analyze lipid parameters and the complications of abnormal lipid metabolism in dermatological patients, which could decrease their comorbidities and improve the life quality and health condition of dermatological patients.

Lipid Aberrations in Lichen Planus

Lichen planus (LP) is a dermatosis without a fully understood etiopathogenesis, the frequency of which is estimated to be less than 1% among the population. LP may involve the glabrous skin, mucosal membranes, scalp, nails and genital area. Nowadays, there are reports of its association with lipid homeostasis aberrations. In this review, we present the contemporary view of this matter. Dyslipidemia, especially hypertriglyceridemia, seems to be an actual problem in this group of patients, and along with abnormal arterial vessel parameters, indicates an increased risk of atherosclerosis in these subjects. Dermatologists should be attentive to this relationship and aware that the patients may develop different metabolic complications. More studies are required to establish clear guidelines on the management of lipid aberrations in lichen planus.

Association between lichen planus and dyslipidemia: an experience from North India

Association between lichen planus (LP) and dyslipidaemia and other cardiovascular risk factors has been reported in many studies in the past, with variable results between studies. The aim: this study was undertaken to study the association of lichen planus with dyslipidaemia. Methods: this was a prospective hospital-based case control study conducted over a period of three years, on 105 prospective newly diagnosed male patients of lichen planus and equal number of age and sex matched controls. Fasting serum lipid profile including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) were measured, and comparison done between cases and controls. Results: dyslipidaemia was found in 44 (41.9 %) lichen planus patients (cases) as compared to 28 (26.7 %) controls, the difference being statistically significance (p 0.020). Triglycerides, total cholesterol, LDL cholesterol and VLDL cholesterol were significantly higher in cases than controls, whereas difference in the values of abdominal circumference and body mass index (BMI), although more in cases than controls was not statistically significant. Similarly, HDL-cholesterol values were less in cases than controls, but without statistical significance. Conclusion: dyslipidaemia was more common in lichen planus (LP) patients, as compared to controls, suggesting that LP patients are at a higher risk of developing derangements of serum lipids and should be routinely and regularly monitored for dyslipidaemia and other cardiovascular risk factors, to detect cardiovascular diseases well in time. The result of present study strengthens the evidence of association between LP and dyslipidaemia.

Metabolic Comorbidities in Vitiligo: A Brief Review and Report of New Data from a Single-Center Experience

Among disorders of pigmentation, vitiligo is the most common, with an estimated prevalence between 0.5% and 1%. The disease has gathered increased attention in the most recent years, leading to a better understanding of the disease’s pathophysiology and its implications and to the development of newer therapeutic strategies. A better, more integrated approach is already in use for other chronic inflammatory dermatological diseases such as psoriasis, for which metabolic comorbidities are well-established and part of the routine clinical evaluation. The pathogenesis of these might be linked to cytokines which also play a role in vitiligo pathogenesis, such as IL-1, IL-6, TNF-α, and possibly IL-17. Following the reports of intrinsic metabolic alterations reported by our group, in this brief review, we analyze the available data on metabolic comorbidities in vitiligo, accompanied by our single-center experience. Increased awareness of the metabolic aspects of vitiligo is crucial to improving patient care.

Can Pioglitazone Safeguard Patients of Lichen Planus Against Homocysteine Induced Accelerated Cardiovascular Aging and Reduced Myocardial Performance: A Systematic Review

Lichen planus (L.P.) is a long-standing mucocutaneous inflammatory condition. A less familiar but essential illness association is increased arterial stiffness, endothelial dysfunction, and advanced atherosclerosis. Enhanced cardiac reconditioning and reduced performance of the heart have been suggested. Thiazolidinediones were commenced to manage hyperglycemia in diabetes mellitus. Recently, the class attained popularity after its action on vascular physiology was discovered. With this review, we attempted to explore whether an antidiabetic drug, pioglitazone (PIO), a peroxisome proliferator‑activated receptor γ (PPAR gamma) agonist, can defend patients of lichen planus against increased arterial stiffness and cardiac changes. We methodically screened numerous databases using focused words and phrases for relevant articles. After a comprehensive exploration, we applied the inclusion and exclusion criteria and performed a quality appraisal. Items retained were exhaustively studied. High homocysteine (HHcy) levels in lichen planus play a significant role in modifying the arteries and leading to their dysfunction. Not only does homocysteine affect the precursor cells, but it also increases the free radical damage. Arterial damage and upraised resistance encountered by the heart reduce its performance. After an exhaustive analysis, in our opinion, pioglitazone works in various miscellaneous ways to mitigate the homocysteine mediated changes. Early inclusion of the drug in managing patients with lichen planus seems promising in minimizing the harmful effects of high homocysteine. Evaluating the risk-benefit ratio, we believe that a trial of pioglitazone could be given to patients without underlying cardiac conditions.

The relationship between lichen planus and metabolic syndrome

OBJECTIVE

Lichen planus (LP) is an idiopathic, chronic inflammatory disease. Chronic inflammatory diseases can cause metabolic complications. In the literature, data related to the relationship between lichen planus and metabolic syndrome (MS) are limited. We aimed to evaluate the relationship between MS and lichen planus with disease activity.

METHODS

The patients diagnosed with lichen planus at the dermatology outpatient clinic between January 2018 and January 2020 were retrospectively analyzed. 98 lichen planus cases, age- and sex-matched 99 controls, 197 cases in total were included in the study.

RESULTS

Of the 98 lichen planus cases included in the study, 60 (61%) were women. The mean age of the patients was 49.3 ± 14.4, and the average disease duration was 33.5 ± 31.4 months. 55 (55%) of the patients in the control group were female, and the mean age of the control group was 50 ± 13.2. The body mass index of LP cases was 29.5 ± 5.8, in the control group was 25.8 ± 3.7. Metabolic syndrome was found in 47 (48%) of 98 cases with lichen planus and 32.3% in the control group. MS in the lichen planus group was significantly higher than the control group (P = .025). Metabolic syndrome was detected in the oral lichen planus at the rate of 60% (12 cases). Although the incidence of MS was more common in the oral lichen planus, it was not statistically significant (P = .29). While no significant relationship was found between oral disease severity and metabolic syndrome (P = .19), a significant correlation was found between cutaneous disease severity and metabolic syndrome (P = .023).

DISCUSSION

The risk of mucosal malignancy that can occur when following LP cases has been known for a long time. According to our results, caution should be taken in terms of metabolic complications in the follow-up of LP cases, especially oral LP cases.

Risk of metabolic syndrome in patients with lichen planus: A systematic review and meta-analysis

Background

Studies have investigated whether patients with lichen planus are at a high risk of metabolic syndrome; however, currently, no conclusive data are available in this regard.

Objective

This meta-analysis was performed to analyze the published literature investigating the association between metabolic syndrome and lichen planus.

Method

Two reviewers independently searched 4 databases (PubMed, Embase, the Cochrane Library and Web of Science) for observational studies assessing the prevalence of metabolic syndrome in patients with lichen planus. Review Manager 5.3 software was used to statistically analyze the data.

Results

200 relevant articles were searched. After a further reading, 12 studies with 1422 participants (715 with LP and 707 controls) fulfilled the eligibility criteria. Overall, the pooled odds ratio based on random effects analysis was 2.81 (95% confidence interval: 1.79–4.41, P<0.00001). This meta-analysis shows that compared with the general population, patients with lichen planus are more likely to develop metabolic syndrome. Subgroup analysis of prevalence of metabolic syndrome showed higher odds ratio in studies using International Diabetes Federation diagnostic criteria (odds ratio 4.65) and the Harmonized criteria (odds ratio 26.62) than studies using National Cholesterol Education Program Adult Treatment Panel III criteria (odds ratio 1.75), and thus might be more appropriate for diagnosing metabolic syndrome.

Conclusions

This meta-analysis shows that compared with the general population, patients with lichen planus are more likely to develop metabolic syndrome. Therefore, early diagnosis and prompt initiation of first-line therapy for metabolic disorders are important in patients with lichen planus.

Dyslipidemia in Lichen Planus: A Case-control Study

Objective:

Lichen planus (LP) is a chronic inflammatory disease that affects the skin, mucous membranes, scalp and nails. It has been reported that diabetes mellitus and dyslipidemia prevalence were higher in patients with LP. However, most of these reports were retrospective, database search, which included patients who were on lipid-lowering drugs. This study aims to conduct a prospective case-control study to investigate the association between LP and dyslipidemia.

Methods:

Methods: This study was conducted on 49 patients with LP (mucosal or cutaneous) and 99 healthy controls. All patients were subjected to clinical and histological examination, whereas controls were subjected to clinical examination. The variables analyzed were age, sex, tobacco consumption, hypertension, lipid profiles and fasting blood glucose.

Results:

Results: Serum levels of triglycerides, total cholesterol and LDL cholesterol were higher in patients with LP. However, there was no significant difference between patients with LP and controls. No significant differences between LP patients and controls were observed with the average age, sex, tobacco consumption and hypertension.

Conclusion:

Conclusion: This prospective case-control study demonstrated that dyslipidemia was more common among patients with LP. Physicians should be aware of this association and consider screening them for dyslipidemia.

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.

Cardiovascular and Metabolic Risk Assessment in Patients with Lichen Planus: A Tertiary Care Hospital-based Study from Northern India

Background:

The association between lichen planus (LP) and cardiovascular disease (CVD) risk factors has been demonstrated in previous reports. However, the evidence of CVD risk factors in Indian patients with LP is limited.

Objective:

To compare CVD risk factors in LP patients and healthy controls.

Methods:

We performed a cross-sectional study on 122 subjects, 61 LP patients, and 61 controls who visited the outpatient clinic of the dermatology department of a tertiary care hospital. Patients with skin diseases known to be associated with CV risk, pregnant, and lactating women were excluded from the study. CVD risk factors were compared between LP cases and controls using anthropometric measures, hemodynamic and metabolic parameters, and inflammatory marker (ESR).

Results:

The proportion of metabolic syndrome (MS) was significantly higher in LP patients than the controls (29.5% vs. 9.8%, odds ratio [OR] 3.83; 95% confidence interval [CI] 1.40–10.50; P = 0.006). The proportion of dyslipidemia was also significantly higher in LP patients (70.5% vs. 42.6%; P = 0.002). LP patients had a high proportion of obesity (P = 0.004), hypertension (P = 0.004), impaired fasting glucose (P = 0.025), and raised ESR (P = 0.006) as compared to controls. A multivariate regression model demonstrated that dyslipidemia and obesity were significantly associated with LP even after controlling for confounders such as age, gender, sedentarism, dietary habits, alcohol, and impaired fasting glucose. There was no significant association between the extent of LP and the proportion of MS or dyslipidemia.

Conclusion:

The present study found a significant association of LP with individual CVD risk factors as well as MS.

Impairment of myocardial functions and arterial stiffness in patients with lichen planus

BACKGROUND

Lichen planus is a chronic inflammatory mucocutaneous disease. Recent studies have suggested that it is associated with an increased risk of cardiovascular comorbidities.

OBJECTIVE

The purpose of this study was to assess and compare arterial stiffness and cardiovascular hemodynamics in patients with lichen planus and a healthy control group.

METHODS

Fifty-five patients with lichen planus and 42 healthy controls were enrolled. All patients underwent echocardiographic examination, and arterial stiffness was measured using applanation tonometry.

RESULTS

No statistically significant difference was determined between the patient and control groups in terms of arterial stiffness, but stiffness was markedly higher in patients with erosive lichen planus compared to the control group and other patients (p=0.006, and p=0.023, respectively). Moderate positive correlation was determined between duration of disease and arterial stiffness. Impairment of systolic and diastolic functions was also determined in patients with lichen planus compared to the control group (p<0.001, and p=0.005, respectively).

STUDY LIMITATIONS

Relatively low number of patients.

CONCLUSION

The positive correlation observed between duration of disease and arterial stiffness in patients with lichen planus suggests that these patients should be followed-up in terms of cardiovascular risk in the presence of resistant and long-term disease, particularly in case of erosive lichen planus.

Hyperhomocysteinemia Associated with Multiple Organ Failure in Acute Pancreatitis Patients

Objective

This study aimed to evaluate the potential effect of hyperhomocysteinemia on multiple organ failure (MOF) in patients with acute pancreatitis (AP).

Method

In this cohort study, a total of 1880 AP patients were enrolled and divided into the hyperhomocysteinemia group (study group) and the control group based on serum homocysteine (HCY) levels. Clinical data including demographics, clinical outcomes, and characteristics were collected for analysis. Risk factors of MOF in AP patients were determined by univariate and multivariate logistic regression analyses.

Results

The hyperhomocysteinemia group showed higher multiple organ failure rates (31.83% vs 20.77%, P < 0.001), compared with the control group. A positive correlation between homocysteine level and APACHE II score was obtained by Pearson correlation analysis (r = 0.420, P < 0.001), compared with the control group. A positive correlation between homocysteine level and APACHE II score was obtained by Pearson correlation analysis (P < 0.001), compared with the control group. A positive correlation between homocysteine level and APACHE II score was obtained by Pearson correlation analysis (

Conclusion

A high serum homocysteine level may be an independent risk factor of multiple organ failure in patients with acute pancreatitis.

Association of Hyperhomocysteinemia with Increased Coronary Microcirculatory Resistance and Poor Short-Term Prognosis of Patients with Acute Myocardial Infarction after Elective Percutaneous Coronary Intervention

Background

This study aims to investigate the coronary microcirculatory resistance and prognosis of patients with acute myocardial infarction (AMI) concomitant with hyperhomocysteinemia (HHcy) after an elective percutaneous coronary intervention (PCI).

Methods

A total of 101 patients that underwent elective PCI between May 2015 and July 2018 due to AMI were consecutively enrolled in this study. Patients were divided into a HHcy group (53) and a normal Hcy group (control; 48) based on their plasma homocysteine concentration. The characteristics of coronary angiography, the index of microcirculatory resistance (IMR) of infarct-related vessels (IRV), changes in left ventricular end diastolic diameter (LVEDd) and left ventricular ejection fraction (LVEF) before and after PCI, and the incidence of major adverse cardiovascular events (MACE) three months after PCI were compared between these groups.

Results

Compared to the results from the Hcy group, the HHcy group had a higher IMR. The HHcy group had significantly higher LVEDd and a lower LVEF than the Hcy group 3 months after PCI. Additionally, the incidence of MACE at three months after PCI was higher in the HHcy group than in the Hcy group. Pearson correlation analysis revealed a positive correlation with IMR in the HHcy group. Furthermore, there was a difference in the LVEDd measured at one day after PCI and at three months after PCI in the HHcy group.

Conclusion

AMI patients concomitant with HHcy that undergo elective PCI are prone to coronary microcirculatory dysfunction and have a poor cardiac function and poor prognosis at three months after PCI.

Comparison of serum lipid parameters between patients with classic cutaneous lichen planus and oral lichen planus

OBJECTIVES

Previous studies have shown that patients with lichen planus (LP) have an increased occurrence of inflammation-related dyslipidemia. Although classic cutaneous LP (CCLP) and oral LP (OLP) are basically known as the different subtypes of the same disease sharing the common histopathological features, they actually have significant differences both in the clinical behavior and in the molecular inflammatory pathogenesis. We aimed to compare the lipid profile of patients with CCLP and OLP.

MATERIALS AND METHODS

This study included 120 patients, 30 with isolated CCLP, 30 with isolated OLP, 30 with CCLP + OLP, and 30 controls consecutively admitted to the outpatient clinics of Dermatology Department of Dokuz Eylul University Hospital, Izmir, Turkey.

RESULTS

Triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) values, TC/high-density lipoprotein cholesterol (HDL-C), and LDL-C/HDL-C atherogenic indexes were significantly higher, and HDL-C values were significantly lower in all LP subtypes compared with the controls. Among LP subtypes, although the differences were not statistically significant, TG, TC, and LDL-C values were markedly higher in OLP and OLP + CCLP patients compared with CCLP patients. OLP and CCLP + OLP patients also showed significantly higher TC/HDL-C and LDL-C/HDL-C atherogenic indexes compared with CCLP patients.

CONCLUSIONS

Patients with OLP have a more impaired lipid metabolism and significantly higher atherogenic indexes compared with patients with CCLP. The differences in the molecular inflammatory pathways between OLP and CCLP and the longer disease duration of OLP leading to long-lasting inflammation may elucidate this distinction.

CLINICAL RELEVANCE

We recommend to pay close attention to the early recognition of coexisting atherogenic dyslipidemia and to apply the early protective measures against the development of cardiovascular disease in OLP patients.

Metabolic Syndrome and Dyslipidemia among Nigerians with Lichen Planus: A Cross-Sectional Study

Background:

Lichen planus (LP) is an inflammatory skin disease of unknown etiology associated with chronic inflammation, oxidative stress induction, and cardiovascular risk factors.

Objectives:

To document the prevalence of metabolic syndrome (MetS), dyslipidemia, and associated factors in Nigerian patients with LP.

Methods:

A cross-sectional design was made to evaluate 90 patients with LP and 90 controls for MetS and dyslipidemia in two Nigerian teaching hospitals. Diagnosis of LP was made with the aid of histology, and MetS and dyslipidemia were diagnosed using the National Cholesterol Education Program Adult Treatment Panel III criteria.

Results:

The prevalence of MetS was insignificantly higher in LP than in control (18.9% vs. 13.5, P = 0.311), and dyslipidemia was significantly associated with LP (60% vs. 40%, P = 0.007). LP was associated with higher mean of serum triglyceride (1.21 ± 0.34 vs. 1.08 ± 0.32 mmol/L, P = 0.003), low-density lipoprotein cholesterol (3.47 ± 0.89 vs. 3.12 ± 0.77 mmol/L, P = 0.007), and T-cholesterol (5.32 ± 0.88 vs. 4.92 ± 0.86, P = 0.002). LP patients with MetS were older (P < 0.001) and less likely to have Wickham's striae (P = 0.028) compared to those without MetS. Female LP patients were older (P = 0.047), obese (P = 0.043), and had insignificant increase in MetS prevalence compared to the males. Hypertrophic LP was more frequent in patients with dyslipidemia (63.0% vs. 27.8%, P = 0.002), and the family history of diabetes mellitus (DM) was an independent predictor of MetS in LP patients (odds ratio: 4.4, confidence interval: 1.0–19.1, P = 0.047).

Limitation:

Availability of fund is a significant factor that limited the sample size to the minimum required as always in a poor-resource setting.

Conclusions:

LP has an insignificant association with MetS and a significant association with dyslipidemia among Nigerians. The family history of DM is an independent predictor of MetS in LP patients. LP patients should be routinely screened for MetS and its components.

Evaluation of ocular findings in patients with lichen planus

Introduction

Lichen planus (LP) is a chronic, inflammatory disease of unknown etiology.

Aim

To evaluate the tear functions and the retinal and choroidal thickness (CT) in patients with LP.

Material and methods

In total, 33 patients and 30 healthy controls were enrolled. All participants were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer 1 test (with anesthesia), tear break-up time (TBUT) test, intraocular pressure (IOP), axial length (AL), and central corneal thickness (CCT). The measurements of retinal thickness (RT) and CT were obtained by spectral domain optical coherence tomography.

Results

No significant difference was observed between the groups in IOP, AL, CCT, or RT (p > 0.05 in each group). There was a significant difference in the Schirmer 1 test, TBUT, and OSDI questionnaire (p < 0.05 in each group). Choroidal thickness in LP patients was thinner than that in the controls (p = 0.001 in each location). There was a moderate negative correlation between the disease duration and Schirmer 1 test, TBUT, and subfoveal CT (r = –0.426, r = –0.555, r = –0.637; p = 0.001, p = 0.001, p = 0.001, respectively). There was a moderate negative correlation between the oral mucosal involvement and Schirmer 1 test, TBUT, and subfoveal CT (r = –0.345, r = –0.392, r = –0.467; p = 0.006, p = 0.001, p = 0.001, respectively). There was a positive correlation between disease duration, oral mucosal involvement and OSDI score (r = 0.717, r = 0.345; p = 0.001, p = 0.006, respectively).

Conclusions

Lichen planus may influence tear function tests and may cause dry eye. Patients with LP had lower CT values than healthy controls. Further studies are needed to clarify the effect of LP on the eyes.

Metabolic syndrome and the skin: a more than superficial association. Reviewing the association between skin diseases and metabolic syndrome and a clinical decision algorithm for high risk patients

There is ongoing scientific interest regarding comorbidities associated with the metabolic syndrome (MeTS). MeTS comprises a combination of parameters that predispose individuals to the development of type 2 diabetes and cardiovascular disease (CVD). Three or more of the following criteria are necessary: fasting glucose > 110 mg/dl (5.6 mmol/l), hypertriglyceridemia > 150 mg/dl (1.7 mmol/l), HDL levels < 40 mg/dl (men)/< 50 mg/dl (women), blood pressure > 130/85 mmHg, waist circumference (values for Mediterranean populations > 94 cm (men)/> 89 cm (women). In this review we attempted to summarize relevant data by searching dermatological literature regarding associations between various skin conditions and MeTS. A multitude of studies was retrieved and a further goal of the present article is to present plausible mechanistic connections. The severity of skin conditions like psoriasis has been linked with MeTS. Parameters of MeTS like insulin resistance are present in patients with early onset androgenic alopecia, hidradenitis suppurativa acne and rosacea. Since MeTS can lead to CVD and type 2 diabetes early detection of patients would be very important. Also therapeutic intervention on MeTS could lead to improvement on the severity of skin conditions. This reciprocal relationship between skin diseases and MeTS in our opinion holds great interest for further investigation.

Autoimmune skin diseases and the metabolic syndrome

The metabolic syndrome represents an important association of cutaneous maladies with cardiovascular illnesses. Chronic inflammation, shared risk factors (ie, smoking and alcohol consumption), treatment (ie, immunosuppressive agents and drugs that alter the lipid profile), and shared genetic risk loci have been proposed to the cause metabolic syndrome and cardiovascular morbidity of autoimmune diseases. There are many possible inflammatory mediators that are suggested to play a role in insulin resistance pathogenesis, such as tumor necrosis factor-α, interleukin-6, leptin, and adiponectin. These mediators are also abnormal in autoimmune skin disorders. We discuss several autoimmune skin diseases, connective tissue diseases, bullous diseases, vitiligo, psoriasis, lichen planus, chronic urticaria, and atopic dermatitis.

Can atrophic-erosive oral lichen planus promote cardiovascular diseases? A population-based study

OBJECTIVE

Lichen planus has been recently associated with an increased risk of cardiovascular diseases (CVDs). The oral manifestations can be divided into white hyperkeratotic lesions (WL) and atrophic and erosive lesions (RL). The aim of this report was to compare the presence of CVDs between patients affected by WL or RL, to test the hypothesis that RL are associated with an increased incidence of CVDs.

SUBJECTS AND METHODS

Patients were analysed through a complete collection of all the risk factors for CVDs. The primary endpoint was the occurrence of a cardiovascular event-acute coronary syndrome (ACS), any revascularization or stroke/TIA. A multivariable logistic regression model, adjusted for age at diagnosis, body mass index, smoking, alcohol consumption, diabetes, hypertension, CVDs familiarity and periodontitis, was performed.

RESULTS

A prospective cohort of 307 patients has been evaluated; 185 (60.3%) had WL and 122 RL (39.7%). Twenty-four patients had a CVD. ACS occurred more frequently in RL (adjusted odds ratio 5.83; 95% CI: 1.16-29.39), mainly due to the higher risk of it after the histological diagnosis of Oral lichen planus OLP (odds ratio 4.23; 95% CI: 0.66-27.23).

CONCLUSION

Patients with RL could possibly have a higher risk of developing ACS. Further analysis on larger cohort is however warranted.

Studying the association between methylenetetrahydrofolate reductase (MTHFR) 677 gene polymorphism, cardiovascular risk and lichen planus

BACKGROUND

There is a reported relation between hyperhomocysteinemia and lichen planus (LP). An increase in homocysteine (Hcy) and the risk of cardiovascular disease (CVD) in patients with methylenetetrahydrofolate reductase (MTHFR) mutation has been described.

OBJECTIVE

To detect MTHFR (C677T) gene polymorphism, and to find its association with CVD risk, Hcy and folic acid levels in patients with LP.

METHODS

This hospital-based case-control study included 110 patients with LP: 70 with cutaneous LP (CLP) and 40 with oral LP (OLP). A total of 120 age- and sex-matched healthy subjects were used as controls. Three millilitre venous blood sample was taken for detection of MTHFR gene polymorphism by PCR-RFLP technique and for measurement of the lipid profile. Hcy and folic acid were measured by ELISA. Hypertension was evaluated.

RESULTS

There were significantly higher prevalence of hypertension with higher Hcy, triglycerides and cholesterol levels and lower folic acid and HDL levels among patients' groups. Hypertension with higher Hcy and cholesterol levels together with lower folic acid and HDL levels have been found in OLP when compared to CLP. Patients showed a significant higher percentage of the MTHFR 677 TT genotype (P=.003) and of the MTHFR 677 T allele (P=.042) compared to controls. Moreover, there was a higher prevalence of MTHFR 677 T allele in patients with CLP.

CONCLUSION

MTHFR 677 gene polymorphism may be a risk factor for the development of the LP, and to predispose these patients to higher risk of CVD.

Assessment of systemic inflammation with neutrophil-lymphocyte ratio in lichen planus

Introduction

Lichen planus (LP) is a papulosquamous eruption of the skin and mucous membranes. Although the exact pathogenesis of the disease remains unclear, it is believed that LP represents an inflammatory disorder. Neutrophil-lymphocyte (N/L) ratio is considered a systemic inflammatory marker that correlated with severity of the diseases.

Aim

To investigate whether N/L ratio increases in LP and may be an independent severity marker for LP lesions.

Material and methods

White blood cell (WBC), neutrophil and lymphocyte counts, N/L ratio, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were statistically compared between the patient (n = 55) and the control group (n = 48). The relationship of N/L ratio and the body surface area (BSA) was assessed.

Results

Erythrocyte sedimentation rate and CRP were statistically higher in patients with LP than in controls (p < 0.0001). Our analysis revealed a significantly higher level of N/L ratio in patients with LP compared with controls, respectively (2.5 ±1.1 (1.2–7.3) vs. 1.4 ±0.4 (0.8–2.7), p < 0.0001). Body surface area (p = 0.001), CRP (p = 0.006), and ESR (p = 0.003) were identified as possible predictors of N/L ratio, but only BSA (p = 0.002) and ESR (p = 0.003) were found as significant independent predictors in a multiple linear regression model.

Conclusions

The inflammatory process in LP was supported by our results. N/L ratio may have an impact to show the inflammatory status in patients with LP as an inexpensive, simple and effective predictor. It may be used for the severity and treatment option of LP. But, N/L ratio and LP relationship could be confirmed by other large prospective studies.

[New populations at increased cardiovascular risk: Cardiovascular disease in dermatological diseases]

The increased cardiovascular risk in some dermatological diseases has been demonstrated in recent decades. Diseases such as psoriasis and systemic lupus erythematosus are currently included in the guidelines for prevention of cardiovascular disease. Other diseases such as androgenic alopecia, polycystic ovary syndrome, hidradenitis suppurativa or lichen planus have numerous studies that point to an increased risk, however, they have not been included in these guidelines. In this article we review the evidence supporting this association, in order to alert the clinician to the need for greater control in cardiovascular risk factors in these patients.

Lichen planus and dyslipidemia: a systematic review and meta-analysis of observational studies

BACKGROUND

Lichen planus (LP) is a chronic inflammatory disease that has been shown to be positively associated with dyslipidemia. However, the magnitude and types of the underlying lipid abnormalities have not been investigated. This study aims to conduct a systematic review and meta-analysis to investigate the qualitative and quantitative association between LP and dyslipidemia.

METHODS

A systematic search of studies published from inception to April 1, 2015, was conducted using MEDLINE, EMBASE, Web of Science, and Cochrane library databases. Meta-analyses of observational studies with both categorical and continuous outcome were performed. DerSimonian and Lard random effects models were utilized to calculate the pooled odds ratio and weighted mean difference (WMD). Publication bias was evaluated by funnel plot and Egger's test.

RESULTS

Seven studies with 5242 subjects were included in this meta-analysis. Patients with LP were significantly more likely to have dyslipidemia, with a pooled odds ratio of 1.74 (95% confidence interval [CI]: 1.19-2.54, P = 0.004). LP was associated with higher levels of triglycerides (WMD 83.37 mg/dl, 95% CI 0.62-166.12, P = 0.048), low-density lipoprotein (18.75 mg/dl, 95% CI -17.21 to 54.72, P = 0.307), total cholesterol (19.22 mg/dl, 95% CI -8.80 to 47.25, P = 0.179), and lower levels of high-density lipoprotein cholesterol (-8.96 mg/dl, 95% CI -21.22 to 3.30, P = 0.152).

CONCLUSIONS

Despite considerable heterogeneity, this study demonstrated that LP was significantly associated with an increased risk of dyslipidemia and higher triglyceride levels. For patients presenting with LP, physicians should be cognizant of this association and consider screening them for dyslipidemia.

Aortic Elastic Properties and Myocardial Performance Index Are Impaired in Patients with Lichen Planus

OBJECTIVES

The aim of this study was to investigate the elastic properties of the aorta and the myocardial performance index of the left ventricle (LV) in patients with lichen planus (LP).

SUBJECTS AND METHODS

A total of 54 patients with LP and 50 controls were enrolled in the study. The 2 groups were well-matched regarding age, gender, body mass index, any smoking history, diabetes mellitus and systolic and diastolic blood pressure (SBP and DBP). The echocardiographic examination was performed on the study subjects and the controls. Aortic elasticity parameters and the myocardial performance index of the LV were calculated. The Student t test, the x03C7;2 test and multiple linear regression were used for the statistical analysis.

RESULTS

Aortic strain (AS, 4.77 ± 1.81 vs. 8.95 ± 2.22; p < 0.001) and aortic distensibility (AD, 0.25 ± 0.009 vs. 0.42 ± 0.120; p < 0.001) were significantly lower, and aortic stiffness index β (ASIβ, 3.65 ± 1.03 vs. 2.70 ± 0.91; p < 0.001) was significantly higher in the LP group than in the controls. The myocardial performance index (Tei index) was significantly higher in the LP group than in the control group (p = 0.001). The duration of the LP was negatively correlated with AS (r = -0.364, p < 0.001) and AD (r = -0.279, p = 0.006), and positively correlated with the Tei index (r = 0.324, p = 0.001) and ASIβ (r = 0.364, p < 0.001). After adjustment for relevant confounders (age, male gender, smoking, SBP, DBP, diabetes mellitus and low- and high-density lipoprotein cholesterol), LP and its duration were still associated with AS, AD and ASIβ.

CONCLUSION

In this study, AS and AD were lower and ASIβ and myocardial performance index higher in LP patients than in controls.

Prevalence of Metabolic Syndrome in Patients with Mucosal Lichen Planus: A Case-Control Study

BACKGROUND

Previous reports have demonstrated an association between chronic inflammation with metabolic syndrome (MS) and cardiovascular risk factors.

AIM

As lichen planus (LP) is a chronic inflammatory disease, the purpose of this study was to assess the prevalence of MS, dyslipidemia, insulin resistance and obesity in LP patients.

METHODS

A total of 79 patients with LP and 79 controls were examined in this case-control study. Both groups were evaluated for the presence of MS, dyslipidemia, obesity and insulin resistance, and other cardiovascular risk factors. Erythrocyte sedimentation rate, fibrinogen and C-reactive protein were measured as inflammation markers.

RESULTS

The prevalence of MS was significantly higher in the patients with LP than in controls (26.6 vs. 12.7%; P = 0.045). It was also significantly higher in LP patients with mucosal involvement than without (34.5 vs. 8.3%; P = 0.032). Among the MS criteria, mean fasting blood glucose and diastolic blood pressure were also significantly higher in LP patients than in controls (P = 0.012 and P = 0.021, respectively). No significant differences between LP patients and controls were observed with respect to prevalence of dyslipidemia and insulin resistance (P = 0.866 and P = 1.000, respectively). However, duration of disease was significantly longer in patients with insulin resistance than in those without (P = 0.034).

CONCLUSIONS

The patients with LP, particularly those with mucosal involvement, have a higher prevalence of MS, which is associated with a risk for cardiovascular diseases and diabetes mellitus.