The frequency of different morphological variants of lichen planus in HCV seropositive patients
Keywords:
lichen planus, morphological types, hepatitis C virus infectionAbstract
Background Pakistan has a high prevalence of hepatitis C virus (HCV) infection. There is a well known association between HCV infection and lichen planus (LP), which is an immune mediated mucocutaneous disorder. Objective To determine the frequency of different morphological variants of lichen planus in HCV seropositive patients in a tertiary care hospital. Materials and Methods In this cross-sectional study, a total of 200 patients of LP who were seropositive for HCV infection (detected by third generation ELISA) were enrolled after written informed consent. Cutaneous examination was done in all the patients and the morphological types of LP were ascertained. Results Out of 200 patients in the study, 101 (50.5%) were males and 99 (49.5%) were females. The mean age of the patients was 38.5 ± 13.7 years. Isolated variants were found in 89% (n=178) while mixed lesions (combination of 2 or more clinical types) were found in 11% (n=22) of patients. Among isolated variants, hypertrophic LP was the predominant clinical type (25%, n=50) followed by classic (21%, n=42), oral (17.5%, n=35), pigmented (11%, n=22), annular (5.5%, n=11), follicular (4.5%, n=9), atrophic (4%, n=8) and plaque-like (0.5%, n=1). Oral involvement was most common in hypertrophic LP and was absent in pigmented, annular, follicular, atrophic and plaque-like LP. Among the mixed variants, hypertrophic and classic was the most frequent combination (3.5%, n=7), followed by hypertrophic and pigmented (3%, n=6), classic and pigmented (1.5%, n=3), atrophic and follicular (1%, n=2), annular and follicular (0.5%, n=1), annular and atrophic (0.5%, n=1), annular and hypertrophic (0.5%, n=1) and classic and plaque-like (0.5%, n=1).. Conclusion There are various morphological types of lichen planus in association with HCV infection in our patients. Recognition of these types of LP should raise the vigilance for HCV workup. This would lead to early diagnosis of this miserable chronic infection and prevent its complications.References
Aly DG, Shahin RS. Oxidative stress in lichen planus. Acta Dermatovenereol APA Alp Panonica Adriat 2010; 19(1): 3-11.
Pittelkow MR, Daoud MS. Lichen planus. In: Wolff GK, Goldsmith L, Katz S, Gilchrest B, Paller A, eds. Dermatology in general medicine. 7th ed. New York: McGraw-Hill 2008; 244-55.
Eisen D. The evaluation of cutaneous, genital, scalp, nail, esophageal, and ocular involvement in patients with oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 88(4): 431-6.
Roopashree MR, Gondhalekar RV, Shashikanth MC, George J, Thippeswamy SH, Shukla A. Pathogenesis of oral LP - A review. J Oral Pathol Med 2010; 39(10): 729-34.
Bermejo-Fenoll A, Sánchez-Siles M, López-Jornet P, Camacho- Alonso F, Salazar-Sánchez N. A retrospective clinicopathological study of 550 patients with oral lichen planus in south-eastern Spain. J Oral Pathol Med 2010; 39(6): 491-6.
Irvine C, Irvine F, Champion RH. Long-term follow-up of lichen planus. Acta Derm Venereol 1991; 71: 242-4.
Parashar P. Oral lichen planus. Otolaryngol Clin North Am 2011; 44(1): 89-107.
Waheed Y, Shafi T, Safi SZ, Qadri I. Hepatitis C virus in Pakistan: A systematic review of prevalence, genotypes and risk factors. World J Gastroenterol 2009; 15(45): 5647-53.
Azfar NA, Zaman T, Rashid T, Jahangir M. Cutaneous manifestations in patients of hepatitis C. J Pak Assoc Dermatol 2008;18: 138-43.
Mokni M, Rybojad M, Puppin D Jr, Catala S, Venezia F, Djian R, Morel P. Lichen planus and hepatitis C virus. J Am Acad Dermatol. 1991; 24:792.
Das A, Das J, Majumdar G, Bhattacharya N, Neogi DK, Saha B, No association between seropositivity for Hepatitis C virus and Lichen Planus: A case control study. Indian J Dermatol Venereol Leprol 2006; 72:198-200
Ansar A, Zamanian A, Farschian M, Borouri R, Mobaien AR. Comparison of seropositivity of HCV between oral lichen planus and healthy control group in Hamedan province Our Dermatol Online 2011; 2(4): 181-184
Lodi G, Pellicano R, Carrozzo M. Hepatitis C virus infection and lichen planus: A systematic review with meta-analysis.
Strak SK, Al-Hamdi KI, Alabdood MH. A study of lichen planus and its association with Hepatitis C infection. J Taibah Univer of med Sciences,2015; 10(2): 222-26
Ukono AB, Uhunmwangho A. Prevalence of hepatitis C virus among lichen planus patients and its clinical patterns at the University of Abuja Teaching Hospital (U.A.T.H), Jwagwalada, Abuja, Nigeria. Global J Health Sci 2012; 4(5): 113-9.
Amer MA, El-Harras M, Attwa E, Raslan S. Lichen planus and Hepatitis virus infection prevalence and clinical presentations in Egypt. J European Academy of Dermatology and Venereology, 2007; 21(9): 1259-60
Nasreen S, Ahmed Ijaz, Wahid Z. Association of lichen planus: A study of 63 cases. J Pak Assoc Dermatol 2007; 17: 17-20.
Konidena A, Pavani BV. Hepatitis C virus infection in patients with oral lichen planus. Niger J Clin Pract 2011; 14(2): 228-31.
Bennion SD. Structure and function of the skin. In: Fitzpatrick JE, Morelli JG, eds. Dermatology secrets in color. India: Mosby Elsevier inc 2007:9-16
Akhter SJ, Shahid M, Iqbal J, Shakoor A, Raja M. Morphological patterns of lichen planus in patients with anti-hepatitis C antibodies. J Pak Assoc Dermatol 2007; 17: 225-230.
Hakkou F, Chbicheb S, Essaid E, El Wady W. Lichen planus and hepatitis C virus infection: An epidemiological study of 149 cases. Int J Odontostomat 2012; 6(2): 163-168.
Persić S, Mihić LL, Budimir J, Situm M, Bulatz V, Krolo I. Oral lesions in patients with lichen planus. Acta Clin Croat 2008; 47(2): 91-96.
Omal P, Jacob V, Prathap A, Thomas NG. Prevalence of oral, skin, and oral and skin lesions of lichen planus in patients visiting a dental school in southern India. Indian J Dermatol 2012; 57(2): 107-9
Gonzaga HF, Gonzaga LH, Buso L, Barbosa CAA, Jorge MA. Prevalence of oral lichen planus in Brazilian patients with cutaneous lichen planus. Rev. FOB 1999; 7(3/4): 71-5.
Bajaj DR, Khoso NA, Devrajani BR, Matlani BL, Lohana P. Oral Lichen Planus: A Clinical Study. J Coll Physicians Surg Pak 2010; 20(3): 154-7.