Association between oral lichen planus and systemic conditions and medications: Case-control study

Association Between Autoimmune Thyroid disease and Oral Lichen Planus: A Multi-Omic Genetic Analysis

OBJECTIVE

The oral mucosa mirrors a range of latent systemic disorders, with potential clinical associations noted between autoimmune thyroid disease (AITD) and oral lichen planus (OLP). This study aims to explore the genetic relationship and underlying mechanisms mediating these conditions.

METHODS

A 2-step Mendelian randomization (MR) analysis was conducted to elucidate the genetic relationship and mediating factors between AITD and OLP. Linkage disequilibrium score regression was employed to assess heritability and genetic correlations among phenotypes, followed by genetic colocalization analysis to discern shared genetic variants. A transcriptome-wide association study (TWAS) was also performed to pinpoint gene expression profiles.

RESULTS

Genetically predicted AITD is associated with an increased risk of OLP (OR[95% CI]: 1.44[1.19,1.74], P=1.61 × 10-4), potentially mediated by hypothyroidism. There is strong evidence of colocalization between AITD and OLP, with a shared PTPN22 gene variant driving this association. TWAS further identified RNASET2 and FGFR1OP within the HLA region as high-confidence shared genes for both conditions.

CONCLUSION

Our study provides novel evidence of a possible genetic association between AITD and OLP. These findings highlight the critical role of endocrine alterations in maintaining oral immune homeostasis, though further research is warranted to validate our findings.

Clinical predictors of disease severity in oral lichen planus

BACKGROUND

The limited understanding of factors influencing the disease progression of oral lichen planus (OLP) poses challenges in delivering effective and personalized treatment for this condition, known to increase the risk of oral cancer and have an adverse impact on patients' quality of life.

OBJECTIVES

To systematically identify clinical predictors of disease severity in patients with OLP.

METHODS

This cross-sectional and single-site prospective study was conducted between December 2021 and February 2024 in the Departments of Oral Medicine and Oral & Maxillofacial Surgery (Aberdeen Royal Infirmary, Aberdeen, UK). Patients presenting with OLP aged 18 years or older diagnosed using Van der Meij and Van der Waal criteria were eligible for the study. Out of a total of 270 eligible patients with OLP presenting consecutively to the outpatient clinics during the study period, 89 patients agreed to participate and were enrolled into the study. Participants demographic and relevant clinical data, namely medical history, smoking status, alcohol consumption, perceived stress levels, oral hygiene status and haematological and biochemical parameters, including full blood count, haematinics and vitamin D, were recorded. The outcome measure was OLP disease severity measured as the Oral Disease Severity Score (ODSS), Gingival ODSS and the Reticular/hyperkeratotic, Erosive/erythematous, Ulcerative (REU scoring system).

RESULTS

In total, 89 participants were recruited into the study. The median age of the study population was 66 (interquartile range 58-73) years, and 65 (73%) patients were women. The median total ODSS score was 10 (range 0-44). After adjustment for confounding factors, patients with lichen planus affecting skin or other mucosal sites had a 5.76-unit higher OLP severity score [B = 5.76, 95% confidence interval (CI) = 0.74-10.78, P = 0.03] than those without extraoral involvement as measured by the ODSS. Patients with insufficient vitamin D exhibited a 5.49-unit increase in disease severity (B = 5.49, 95% CI = 1.13-9.84, P = 0.01) compared with those with adequate vitamin D levels.

CONCLUSIONS

This study identified the importance of cutaneous and/or genital lichen planus in phenotyping OLP disease severity. We also highlight the role of vitamin D as a significant predictor of disease severity of OLP, suggesting the importance of adequate vitamin D levels in patient management.

Association Between Oral Lichen Planus and Thyroid Disease: A Cross-Sectional Study

Background: In recent years, various authors have suggested a potential association between oral lichen planus (OLP) and thyroid disease (TD), although other studies have failed to confirm a significant relationship. The available literature presents inconsistent and sometimes contradictory findings. Additionally, other conditions-such as anxiety and depression, hypertension, diabetes mellitus, and dyslipidemia-have also been linked with OLP. Methods: A cross-sectional study was conducted involving 120 participants, comprising 60 patients diagnosed with OLP and 60 controls. Medical histories related to TD and other comorbidities were collected for both groups. Results: The prevalence of TD among the OLP patients was 20%, compared to 6.7% in the control group. The most frequently observed thyroid disorder was hypothyroidism, identified in 13.3% of the patients with OLP. Statistically, there was a moderate probability of an association between OLP and TD (p = 0.054). No statistically significant associations were found between OLP and hypertension (p = 0.378), type 2 diabetes mellitus (p = 0.550), dyslipidemia (p = 0.562), anxiety (p = 0.959), or depression (p = 0.532). Conclusions: Although the association between OLP and TD remains inconclusive, our findings suggest a moderate statistical probability of a relationship.

Study on the potential links between clinical features of oral lichenoid mucositis and systemic diseases

OBJECTIVE

This study aimed to analyze the clinical characteristics of oral lichenoid disease and investigate its potential association with systemic diseases.

METHODS

This study was a retrospective cross-sectional analysis. The study comprised 116 patients who had been diagnosed with oral lichenoid disease, including 70 with oral lichen planus and 46 with lichenoid lesions. The study meticulously documented the distribution and types of lesions in oral lichenoid disease patients.

RESULTS

The average age was 46 years, with females representing 69.8% and males 30.2%. The prevalence of major systemic diseases among these patients was notable: thyroid disorders were observed in 64.7%, dyslipidemia in 44.0%, hyperuricemia in 36.2%, hypertension in 28.5%, and diabetes in 21.6%. Significant associations were found between specific lesion sites and systemic diseases. Network-like lesions in the gingival-buccal groove were highly correlated with thyroid disorders (P < 0.000). Lichenoid lesions on the lips were significantly associated with dyslipidemia (P < 0.002). Furthermore, lesions on both the dorsal (P < 0.000) and ventral (P < 0.038) surfaces of the tongue, particularly patchy lesions on the dorsal surface, showed a strong association with hyperuricemia.

CONCLUSION

These findings indicated a significant correlation between the clinical manifestations of oral lichenoid disease and systemic conditions such as thyroid disorders, dyslipidemia, and hyperuricemia.

New-onset cutaneous lichen planus following Vaxzevria (Oxford-AstraZeneca) COVID-19 vaccination

We report a 56-year-old male who developed cutaneous lichen planus (LP) following Vaxzevria (Oxford-AstraZeneca) COVID-19 vaccination. Multiple topical and systemic therapies were tried with limited success; however, partial improvement was observed with narrow-band UVB (NB-UVB) phototherapy. This report adds to the growing evidence of new-onset LP following COVID-19 vaccination and underscores the need for careful reporting, monitoring, and management of vaccine-related adverse effects.

History of Breast Cancer in Patients with Oral Lichen Planus: A Case-Control Study

Objectives: The purpose of this study was to determine the association between oral lichen planus (OLP) and the history of cancer outside of oral cavity and the predominance of its location. Methods: This case-control study included 600 OLP patients and 600 control subjects evaluated in the same section, matched for age and sex to the OLP patients. OLP patients were diagnosed clinically and histologically. Initially, the prevalence of the most frequent types of cancers was described. A Pearson chi-squared test model was used to determine the association of cancer history and OLP. It was considered statistically significant whether p value was ≤0.05. The final multivariate regression model was built after applying a backward selection method to the complete multivariate model considering the odds ratio (OR) with a 95% confidence interval (CI). Results: The history of cancer was significantly associated with OLP regardless of age, sex, tobacco and or alcohol use in both univariate [OR = 2.26 (95%CI: 1.26-4.24); p = 0.008] and multivariate analyses [OR = 2.21 (95%CI: 1.21-4.19); p = 0.012]. According to the location of cancer, there was an association between OLP and history of breast cancer [OR = 3.71 (95%CI = 1.03-13.38); p = 0.032]. Conclusions: This case-control study suggests a higher frequency of cancer, particularly breast cancer, among patients with OLP compared to the control group. Due to the study's design and sample limitations, these findings should be interpreted cautiously. Future longitudinal, multi-institutional studies with rigorous control for cancer history and other confounding factors are essential to further explore the association between OLP and cancer, particularly breast cancer.

Genetic and therapeutic for oral lichen planus and diabetes mellitus: a comprehensive study

BACKGROUND

This study employed a bidirectional Mendelian Randomization (MR) approach to explore the causal relationships between Oral Lichen Planus (OLP), diabetes mellitus (DM), and glycemic control. It also aims to identify potential pharmacological and herbal treatments that effectively address both OLP and the metabolic dysfunctions associated with DM.

METHODS

This study employs a two-way MR approach to investigate the potential causal relationships between diabetes type and glycated hemoglobin (HbA1c) levels, and the risk of OLP. We analyzed differentially expressed genes from the OLP dataset in the Genomics Expression Omnibus (GEO) database, cross-referencing these with HbA1c-related genes for enrichment analysis. Additionally, the Drug-Gene Interaction Database (DGIdb) and Traditional Chinese Medicine Systems Pharmacology Database (TCMSP) were utilized to assess the effectiveness of specific drugs, herbs, and ingredients in treating OLP while managing blood glucose levels.

RESULTS

The MR analysis revealed a significant association between Type 1 Diabetes mellitus (T1DM) and an increased risk of OLP, unlike Type 2 Diabetes mellitus (T2DM). This finding indicates a unique immunological interaction in T1DM that may predispose individuals to OLP. The drug prediction analysis focused on core targets linked to OLP and HbA1c, evaluating the therapeutic potential of retinoic acid, prednisone, and thalidomide for treating OLP and regulating blood glucose levels. Additionally, herbal medicines such as Ecliptae herbaand Amygdalus communis vas, along with herbal ingredients like quercetin, luteolin, and 17-beta-estradiol, were identified for their anti-inflammatory properties and potential to mitigate metabolic dysfunction in diabetes.

CONCLUSION

The study highlighted a complex interplay between diabetes and OLP, underscoring the efficacy of integrated therapeutic strategies that target both conditions. The findings suggest that both pharmaceutical and herbal treatments can effectively manage the clinical manifestations of OLP and associated metabolic challenges. This holistic approach to treatment could significantly enhance patient outcomes by addressing the interconnected aspects of these chronic conditions.

Role of Vitamin D in Oral Lichen Planus: A Case Control Study

BACKGROUND

It has been reported that vitamin D deficiency may be associated with the development of oral lichen planus (OLP). Given the high prevalence of vitamin D deficiency in many countries, we sought to determine whether it constitutes a comorbidity of OLP.

METHODS

One hundred and twenty patients clinically and histologically diagnosed with OLP were evaluated for their serum vitamin D levels. The results were compared to results from a control series of the same number of subjects matched for age and sex.

RESULTS

Vitamin D deficiency was diagnosed in 45% (n = 54) of OLP patients and in 26.7% (n = 32) of the control group. Vitamin D supplements were being taken by 32 (26.7%) OLP patients and 15 (12.5%) subjects in the control group. A multivariate logistic regression model showed that OLP was associated with vitamin D deficiency [OR: 2.24 (1.28-3.98, p = 0.005)] and vitamin D supplementation [OR: 2.51 (1.25-5.22, p = 0.011)], even after controlling for confounding variables such as sex, age ≤60>, tobacco, and alcohol.

CONCLUSION

The association between OLP patients and vitamin D deficiency or vitamin D supplementation suggests that further research might explore the benefits of vitamin D supplements in managing OLP patients.

Prevalence of oral lichen planus in patients with diabetes mellitus: A cross-sectional study

OBJECTIVES

Oral lichen planus, a chronic inflammatory immune disease, occurs in the oral mucosa. We aimed to assess the prevalence and possible influencing factors of oral lichen planus in patients with diabetes mellitus.

SUBJECTS AND METHODS

This cross-sectional study involved 525 patients with diabetes mellitus and 525 controls. We collected information on blood glucose level, duration of diabetes, diabetic complications, treatment methods, other systemic diseases and medication history.

RESULTS

Oral lichen planus was significantly more prevalent in the diabetes mellitus/type 2 diabetes mellitus group than in the controls (2.3%/2.2% vs. 0.6%, p = 0.019/0.022). There was no significant association between patients with diabetes mellitus with and those without oral lichen planus in age (p = 0.195), sex (p = 0.390), blood glucose level (p = 1), duration of diabetes (p = 0.638), diabetic complications (p = 1), treatment methods (p = 0.962), other systemic diseases (p = 0.891) and medication history (p = 0.848).

CONCLUSIONS

Diabetes mellitus was associated with oral lichen planus; there was a higher prevalence of oral lichen planus in patients with diabetes mellitus/type 2 diabetes mellitus than in those without diabetes. Oral lichen planus development in patients with diabetes mellitus was not significantly associated with age, sex, blood glucose level, duration of diabetes, diabetic complications, treatment methods, other systemic diseases and medication history.

An Evidence-Based Update on the Potential for Malignancy of Oral Lichen Planus and Related Conditions: A Systematic Review and Meta-Analysis

A systematic review and a meta-analysis is presented on published articles on the malignant transformation of oral lichen planus (OLP) and related conditions, which, based on current evidence, updates an earlier systematic review published by our research group that included publications until November 2018. In this updated study (Nov-2023) we searched MEDLINE, Embase, Web of Science, and Scopus. We evaluated the methodological quality of studies (QUIPS tool) and carried out meta-analyses. The inclusion criteria were met by 101 studies (38,083 patients), of which, 20 new primary-level studies (11,512 patients) were published in the last 5 years and were added to our updated study. The pooled malignant transformation ratio was 1.43% (95% CI = 1.09-1.80) for OLP; 1.38% (95% CI = 0.16-3.38) for oral lichenoid lesions; 1.20% (95% CI = 0.00-4.25) for lichenoid reactions; and 5.13% (95% CI = 1.90-9.43) for OLP with dysplasia. No significant differences were found between the OLL or LR groups and the OLP subgroup (p = 0.853 and p = 0.328, respectively), and the malignant transformation was significantly higher for the OLP with dysplasia group in comparison with the OLP group (p = 0.001). The factors that had a significant impact with a higher risk of malignant transformation were the presence of epithelial dysplasia, a higher methodological quality, the consumption of tobacco and alcohol, the location of lesions on the tongue, the presence of atrophic and erosive lesions, and infection by the hepatitis C virus. In conclusion, OLP behaves as an oral potentially malignant disorder (OPMD), whose malignancy ratio is probably underestimated as a consequence essentially of the use of inadequate diagnostic criteria and the low methodological quality of the studies on the subject.

Bidirectional Association between Lichen Planus and Hepatitis C-An Update Systematic Review and Meta-Analysis

Lichen planus (LP) is a chronic, inflammatory mucocutaneous disorder associated with systemic diseases such as hepatitis C (HCV). The objective of this study is to evaluate the association between LP and HCV bidirectionally through a systematic review and meta-analysis. A comprehensive search of studies published was performed in the databases of PubMed, Embase, and Web of Science. Out of 18,491 articles, 192 studies were included. The global prevalence of HCV positive (HCV+) in LP patients registered from 143 studies was 9.42% [95% confidence interval (CI), 7.27-11.58%], and from these, 84 studies showed HCV+ 4-fold more frequent in LP than a control group (OR, 4.48; 95% CI, 3.48-5.77). The global prevalence of LP in patients HCV+ recorded from 49 studies was 7.05% (95% CI, 4.85-9.26%), and from these, 15 registered a 3-fold more LP in HCV (OR, 3.65; 95% CI, 2.14-6.24). HCV+ in LP patients showed great geographic variability (OR, 2.7 to 8.57), and the predominantly cutaneous location was higher (OR, 5.95) than the oral location (OR, 3.49). LP in HCV+ patients was more frequent in the Eastern Mediterranean (OR, 5.51; 95% CI, 1.40-15.57). There is a higher prevalence of HCV+ in LP and vice versa than in the control group, especially in certain geographical areas that should be taken into consideration when doing screening in countries with an upper prevalence of HCV among the general population.

Immunological Aspects of EBV and Oral Mucosa Interactions in Oral Lichen Planus

Oral lichen planus (OLP) is considered a T cell-mediated chronic inflammatory process activated by an unknown antigen, making basal keratinocytes vulnerable to a cytotoxic cell mediated immune response. The aim of this review is to summarize information on the role and pathways of Epstein–Barr virus (EBV) and immune cells in inducing OLP as an autoimmune lesion. The pathogenesis of OLP is analyzed from immunological aspects of interactions between EBV and oral mucosa. The results of the available studies allow us to assume that EBV can act both as an exogenous and an endogenous antigen in the pathogenesis of OLP. We emphasized the role of antigen-presenting cells (APC), such as dendritic cells (Langerhans cells, LC), in detecting and capturing antigens and modulating the adaptive immune response. Although EBV shows tropism for B cells and epithelial cells, under certain conditions it can infect monocytes, LCs, NK, and T lymphocytes. It means that under some circumstances of the chronic inflammatory process, EBV particles can react as endogenous agents. During the development of the autoimmune process, a decisive role is played by the loss of immune tolerance. Factors like the activity of cytokines, chemokines, and autoantibodies secreted by EBV-positive plasma cells, autoantigens formed due to virus protein mimicry of human proteins, new self-peptides released from damaged tissues, self-reactive B and T cells, dysregulation of LC function, the anti-apoptotic effect of EBV early lytic antigens, and an imbalance between inflammatory and anti-inflammatory immune cells facilitate the development of an autoimmune process.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Autoimmune disorders in oral lichen planus: systematic review and meta-analysis

OBJECTIVES

The association of OLP with other autoimmune processes points to the possibility that OLP-affected patients are actually developing an autoimmune status that predisposes them to autoaggression against different targets. This systematic review and meta-analysis aims to evaluate the current evidence on the prevalence of autoimmune disorders in patients with OLP and their magnitude of association.

METHODS

We searched PubMed, Embase, Web of Science, Scopus databases for studies published before May 2021, with no limitation in regards to their publication date or language. We evaluated the quality of studies, carried out meta-analyses and performed heterogeneity, subgroups, meta-regression and small-study effects analyses.

RESULTS

Inclusion criteria were met by 153 studies (23,327 patients). Our results indicate the existence of high prevalences and a frequent association between OLP and some autoimmune disorders, especially in regards to thyroid disease (PP=7.96%,95%CI=6.32-9.75; OR=1.99, 95%=1.60-2.49,p<0.001) and diabetes mellitus (PP=9.41%,95%CI=8.16-10.74; OR=1.64, 95%CI=1.34-2.00,p<0.001).

CONCLUSIONS

Our study demonstrates the existence of a comorbidity between autoimmune thyroid diseases an as well as between diabetes mellitus and OLP, respectively. Quality of evidence should be upgraded on other autoimmune diseases (fibromyalgia, gastrointestinal disorders, rheumatic diseases, Sjögren's syndrome, lupus erythematosus and dermatological diseases) for which the current data do not allow us to know whether they are really associated with OLP.

Oral lichenoid contact lesions related to dental metal allergy may resolve after allergen removal

Background/ purpose

Distinguishing oral lichenoid contact lesions (OLCLs) from oral lichen planus (OLP) is challenging. This study aimed to identify clinicopathological findings to distinguish OLCLs from OLP, and to evaluate the effectiveness of removing metal allergens in the treatment of OLCLs.

Materials and methods

This study retrospectively evaluated 30 patients diagnosed with OLCLs, and 30 age- and sex-matched OLP patients. We also evaluated the effectiveness of removing dental metal containing positive metal allergen, confirmed by skin patch test and metal component analysis in patients with OLCLs.

Results

Palladium and gold were the most common patch test-positive metals observed in the oral cavity of patients with OLCLs. The patients with OLCLs were more likely to present with white type lesions in the buccal mucosa and gingiva than were the patients with OLP (p = 0.030, 0.009, respectively). Overall, 50.0% of patients with OLCLs failed to meet the histopathological diagnostic criteria of OLP. Twenty-three of 24 (95.8%) patients with OLCLs showed a complete or partial improvement after the removal of dental metal.

Conclusion

The present findings suggest the importance of a skin patch test and metal component analysis to confirm suspected OLCLs related to dental metal allergy, as these lesions may improve with the removal of the allergy-inducing metal.

An appraisal of highest quality studies reporting malignant transformation of oral lichen planus based on a systematic review

OBJECTIVES

We present a critical review of the papers published in the international scientific literature on malignant transformation of oral lichen planus (OLP). Our aim is to report the most realistic estimate of the proportion of OLP cases with malignant transformation based on the highest quality of evidence.

MATERIALS AND METHODS

Following a literature search, we selected 89 papers that were published on this topic until November 2020. We applied to these papers an adaptation of the methodological quality criteria of the QUIPS tool and we ordered all of them according to their methodological quality. The papers that were in the upper quartile of methodological quality (10 papers) were selected and analyzed.

RESULTS

The pooled proportion (expressed as percentage) of malignant transformation of OLP reported in these high methodological quality papers was 2.28% (95% confidence intervals = 1.49-3.20).

CONCLUSIONS

We observe that the proportion of malignancy is higher in research carried out under strict methodological quality criteria. In this critical review, we propose criteria for conducting follow-up studies on OLP to report on malignant transformation under strict quality standards.