Background: Lichen planus is an idiopathic inflammatory disease of the skin, nail, hair and mucous membranes. Oral lichen planus (LP) is a chronic inflammatory condition that affects the oral mucous membranes with a variety of clinical presentations. Various etiologies include HCV suggested for LP, and the aim of this study was comparison of seropositivity of HCV in LP patients and control group. Methods: All  oral LP patients that were referred to dermatology clinic of farshchian hospitalwere entered in the study. Five cc of clot blood was taken from each patient  and tested for anti-HCVand  when anti-HCV tested  positive another 2cc clot bloodwas taken for HCV-Rt-PCR test. The results were analyzed with SPSS 16. Results: This prospective cross-sectional study was conducted on 30 oral lichen planus patients [males 13(43.3%) females 17(56.7%)] with mean ages of 46±13.7years and 60 healthy individual [males 26(43.3%) females 34(56.7%)]. There was no oral lichen planus patients who had anti-HCV positive whiles 2 males(3.3%) of healthy group had anti-HCV positive which was confirmed by HCV-Rt-PCR. Conclusions: This study showed that there is no correlation between seropositivity of HCV and oral lichen planus in our patients in the west of Iran

Abbas Zamanian

Ahmad Reza Mobaien

Akram Ansar

Mahmood Farschian

Rahim Sorouri

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  181    COMPARISON OF SEROPOSITIVITY OF HCV BETWEEN  ORAL LICHEN PLANUS AND HEALTHY CONTROL GROUP IN HAMEDAN PROVINCE (WEST OF IRAN)  PORÓWNANIE POMIĘDZY HCV SEROPOZYTYWNYMI PACJENTAMI  Z LISZAJEM PŁASKIM JAMY USTNEJ A ZDROWĄ KONTROLNĄ GRUPĄ Z PROWINCJI HAMEDAN (ZACHODNI IRAN)  Akram Ansar1, Abbas Zamanian2, Mahmood Farschian1,  Rahim Sorouri3, Ahmad Reza Mobaien4  1 Department of Dermatology, Sina Hospital, Hamedan University of Medical Sciences,  Iran 2 Department of Dermatology, Tehran University of medical science, Tehran, Iran abbaszamanian@yahoo.com 3 Department of Microbiology, Zanjan University of medical science, Vali-asr Hospital,  Fazlolah st. Zanjan, Iran 4 Department of Infectious diseases, Zanjan University of medical science, Vali-asr  Hospital, Fazlolah st. Zanjan, Iran     Corresponding author: Dr. Ahmad Reza Mobaien      amobaien@yahoo.com   Our Dermatol Online. 2011; 2(4): 181-184                               Date of submission: 26.02.2011 / acceptance: 07.07.2011                                                                                                                                                     Conflicts of interest: None   Abstract Background: Lichen planus is an idiopathic inflammatory disease of the skin, nail, hair and mucous membranes. Oral lichen planus (LP) is a chronic inflammatory condition that affects the oral mucous membranes with a variety of clinical presentations. Various etiologies include HCV suggested for LP, and the aim of this study was comparison of seropositivity of HCV in LP patients and control group. Methods:All  oral LP patients that were referred to dermatology clinic of farshchian hospitalwere entered in the study. Five cc of clot blood was taken from each patient  and tested for anti-HCVand  when anti-HCV tested  positive another 2cc clot bloodwas taken for HCV-Rt-PCR test. The results were analyzed with SPSS 16. Results: This prospective cross-sectional study was conducted on 30 oral lichen planus patients [males 13(43.3%) females 17(56.7%)] with mean ages of 46±13.7years and 60 healthy individual [males 26(43.3%) females 34(56.7%)]. There was no oral lichen planus patients who had anti-HCV positive whiles 2 males(3.3%) of healthy group had anti-HCV positive which was confirmed by HCV-Rt-PCR. Conclusions: This study showed that there is no correlation between seropositivity of HCV and oral lichen planus in our patients in the west of Iran.  Streszczenie Wstęp: Liszaj płaski jest idiopatyczną zapalną chorobą skóry, paznokci, włosów i błon śluzowych. Liszaj płaski jamy ustnej (LP) jest przewlekłą chorobą zapalną, która wpływa na błony śluzowe jamy ustnej w róŜnych klinicznych prezentacjach. Jednym z czynników etiologicznych PL jest HCV, a celem tego badania było porównanie dodatniego HCV u pacjentów z LP oraz w grupie kontrolnej. Metody: Pacjenci Kliniki Dermatologii szpitala w Farshchian z pełną ustną postacią LP zakwalifikowali się do badania. Od kaŜdego pacjenta pobrano próbki po 5 cm2 skrzepów krwi i badano na obecność przeciwciał anty-HCV, gdy wyniki anty-HCV były pozytywne skrzepy krwi badano testem HCV-RT-PCR. Następnie wyniki analizowano z SPSS 16. Wyniki: To prospektywne badanie przekrojowe było przeprowadzone na 30 pacjentach z liszajem płaskim jamy ustnej [13 męŜczyzn (43,3%), 17 kobiet (56,7%)] w średnim wieku 46 ± 13,7  lat  oraz  na  60  zdrowych  osobach,  [26  męŜczyzn  (43,3%),  34  kobiet  (56,7%)].  Liszaj  płaski  jamy  ustnej  nie  występował  u pacjentów, którzy byli anty-HCV, z kolei u 2 męŜczyzn (3,3%) z grupy zdrowych stwierdzono pozytywne wyniki anty-HCV, które potwierdzone były w badaniu HCV-RT-PCR. Wnioski: Badanie wykazało, Ŝe nie znaleziono korelacji między dodatnim wynikiem HCV i liszajem płaskim jamy ustnej u naszych pacjentów w zachodniej części Iranu.  Key words: lichen planus; anti-HCV; HCV-Rt-PCR Słowa klucze: liszaj płaski; anti-HCV; HCV-Rt-PCR      Original Articles / Prace Oryginalne  © Our Dermatol Online 4.2011   182Introduction  Lichen  planus  is  a  skin  disease  with  the emergence of clinically flat papules with the appearance of  a  shiny  purple  polygon  with  different  sizes.    The disease can anywhere  affect the body but most common  sites are wrist, waist and around the ankle area. Mucosal involvement is very common. Approximately, 30-70% of patients have mucosal lesions [1]. Mucosal involvement, even alone and without skin symptoms can occur. In the mouth,  the  most  common  site  is  buccal  mucosa  and tongue  [1,2].  Oral  lichen  planus  is  a  chronic inflammatory  condition  of  oral  mucous  membranes. Patterns  of  mucosal  involvement  in  oral  lichen  planus include;  reticular,  papular,  plaque-like,  atrophic,  and ulcerative.  Prevalence  of  oral  lichen  planus  in  the community is 1-4%. It is a disease of middle aged people (between 30 to 70 years ) and is more common to women than  men  [3].  Different  etiologies  for  it    include autoimmune  disease,  drug  reaction,  diabetes  mellitus, hypertension,  kidney  stones,  psychological  factors,  and bacterial  infections  [4]  And  several  viruses,  including; herpes viruses, immunodeficiency virus, papillomavirus, the hepatitis viruses B and C have also been implicated as  etiological  agents  [5,6].  But  in  general,  etiology  of oral lichen planus is still unknown (1). In addition, an autoimmune mechanism which activated T cells directly against basal keratinocyte cells is described [7]. In  addition  to  feeding  problems  in  the  patients,  the emergence of SCC associated with HCV postulated as a possible etiological factor of oral lichen planus can  also create    problems  specific  to  HCV  infection  in  an individual patient. Chronic hepatitis C is often asymptomatic and is usually discovered  accidentally.  Extrahepatic  involvement includes;  thyroiditis,  delayed  skin  porphyria, cryoglobulinemia,  and  glomerulonephritis,  especially membranoproliferative  glomerulonephritis,  sicca syndrome,  thrombocytopenia,  lichen  planus  [8,9], diabetes mellitus and lymphoproliferative disorders [10]. The  first  association  between  oral  lichen  planus  and hepatitis  C  virus  was  reported  in  1991  [11]  and  since then,  several  articles  about  the  relationship  between hepatitis  C  virus  in  oral  lichen  planus  have  been published [12-17]. Most cases of HCV associated with oral lichen planus have been obtained from studies in the Mediterranean area, whereas in countries like Egypt and Nigeria  that  have  the  highest  prevalence  of  HCV,  a significant  difference  has  not  been  reported  [13,18]. Therefore,  some  researchers  have  suggested  that  there cannot be explained any relationship between oral lichen planus and HCV only based on the increased incidence in the general population [19] and some workers believe that this controversy is  related to different geographical areas [20]. Overall, the relationship between oral lichen planus  with  HCV  infection  still  remains  disputed. Recently, the emphasis on being disputed and the need for  more  studies  based  on  an  accurate  methodology without  selection  bias  and  the  possible  confounding factors  such  as  age  have  risen  [21].This  study  was designed  in  the    West  region  of  Iran  considering  the importance of  relationship between hepatitis C viruses in oral lichen planus .    Methods This  prospective  cross-sectional  study  was conducted  on  all  patients  enrolled  with  a  diagnosis  of mucosal lichen planus within 18 months from the start of the  study  who  were  referred  to  the  department  of dermatology  or  Farshchian  hospital  (Skin  Center  in Hamedan  province).  Five  mililiter  of  blood  clots  were taken from each patient, and was saved at a temperature of minus 70 degrees Celsius after centrifugation till anti-HCV testing (DIA-PRO kit Italy)was done. Study design was such that if the anti-HCV was positive, two mililiter of blood clots would be taken from a patient in sterile conditions  in  a  special  tube  for  HCV-Rt-PCR  test (Sinazhen  kit  Iran).  Controls  were  randomly  selected from  the  general  population,  and  wereage  and  gender matched.  An  inclusion  criterion  was  developing  oral lichen planus, which was diagnosed by a dermatologist and defined according to pathology. Exclusion criteria were lack of consent to participate in the study, and  a previous  history of hepatitis C in the control group. The  data  collection  tool  for  demographic  and  clinical profile of patients was a questionnaire. Finally, the data were analyzed by SPSS software.   Results 30  patients  with  oral  lichen  planus  and  60 healthy  controls  enrolled  in  the  study.  Number  of patients with oral lichen planus in men and women were 13 (43.3%) and 17 (56.7%), and number of healthy men, and  women  were  26  (43.3%)  and  34  (56.7%), respectively. The mean age of patients with oral lichen planus  was  46±13.7  years  (range  22-80  years),  and control  was  46±14  years  (range  22-80  years)  old. Between the two groups in terms of sex and age, there was  no  significant  difference.  Among  the  oral  lesions, 86.7%  cases  had    bilateral  involvement.  Most  patients [29 (96.7%)] had buccal involvement, followed by  lip, so that six patients (20%) had involvement in this area. Palatal  involvement in a patient (3 / 3%) had the lowest rate (Tab. 1).  Involvement area  Number  Percentage Buccal  29  96.7 Lip  6  20 Gum  4  13.3 tongue  5  16.7 Palate  1  3.3 Oral floor  4  13.3 Table 1.  Frequency of involvement area in patients with oral lichen planus  In most patients who were enrolled in the study, clinical forms of oral lesions, was erosive ulcerative [18 patients (60%)].  And  the  lowest  form  of  involvement  was plaquelike with one case (3.3%) (Tab. 2).     © Our Dermatol Online 4.2011   183 Clinical form   Number  Percentage Atrophic  3  10 Ulcerative (erosive)  18  60 reticular  13  43.3 plaque-like  1  3.3 Table 2. Frequency of clinical forms of oral lesions in patients with oral lichen planus  Most patients had no clinical symptoms [21 (70%)] and only nine cases (30%) had. Smoking or smoking history existed  only  five  cases  (16.7%).  None  of  the  patients with oral lichen planus were infection hepatitis C. Two patients  (3.3%)  in  the  control  group  had  hepatitis  C infection  that  confirmed  by  HCV-Rt-PCR.  The difference was not significant (Tab. 3).  Study groups anti-HCV (+) N (%) anti-HCV (-) N (%) 2  P.value* Oral lichen planus  0(0)  30(100) Healthy  2(3.3)  58(96.7) Total  2(2.2)  88(97.8) 0.8  P=0.21 * Pearson chi-square test Table 3. Comparison of frequency of HCV infection among patients with oral lichen planus, and healthy individuals  Discussion In  the  present  study, none of the patients was suffering from hepatitis C. This study showed that there is no relation between oral lichen planus and hepatitis C infection  in  the  region  of  Hamadan  (West  of  Iran). Furthermore,  in  the  present  study,  confounding  factors that could affect the outcome of this study such as age [21]  and  sex  also  were  eliminated.  The  lack  of association  has  been  reported  in  several  other  studies [13,18,23,22].  Most cases of oral lichen planus associated with HCV have been reported from studies in Mediterranean area. In  countries  that  have  the  highest  prevalence  of  HCV (such as Egypt and Nigeria), significant difference in oral lichen planus associated with HCV has not been reported in  the case group when compared with the control group [13,18].  Although two patients in the control group were positive for  hepatitis  C which was confirmed by PCR, the two had no clinical manifestations of disease and were found accidentally.  Like  this  study,  it  has  been  reported  in literature that chronic hepatitis C is often asymptomatic and  is  often  discovered  accidentally  [8-10].  Statistical analysis  of  differences  in  hepatitis  C  infection  in  two groups  was  not  significant. Although reports about the association  between  oral  lichen  planus  and  hepatitis  C virus  infection  is  contradictory  and  controversial,  and given that a number of researchers said this association depend on geographical areas [20], this study is of the opinion that in Hamedan province (West of Iran) there is no association between them.     REFERENCES: 1.  Breathnach  SM,  Black  MM:  Lichen  Planus  and Lichenoid Disorders. In:  Burns T, Breathnach S, Cox N, Griffiths C. Rook's Textbook of Dermatology, 7th edition. USA: Blackwell Science Ltd; 2004: 2089-2120. 2. Pittelkow MR, Daoud MS. Lichen planus: In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffel DJ. Fitzpatrick’s Clinical Dermatology in General medicine. 7th edition. New York: McGraw Hill; 2008. p: 244-55 3.  Scully  C,  Beyli  M,  Ferreiro  MC,  Ficarra  G,  Gill  Y, Griffiths  M,  et  al:  Update  on  oral  lichen  planus: etiopathogenesis and management. Crit Rev Oral Biol Med. 1998; 9: 86-122. 4. 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Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 98:171-183.   22. Sulka A, Simon K, Piszko P, Kalecińska E, Dominiak M: Oral mucosa alterations in chronic hepatitis and cirrhosis due to HBV or HCV infection. Bull Group Int Rech Sci Stomatol Odontol. 2006; 47: 6-10.  23. Michele G, Carlo L, Mario MC, Giovanni L, Pasquale M, Alessandra M: Hepatitis C virus chronic infection and oral  lichen  planus:  an  Italian  case-control  study.  Eur  J Gastroenterol Hepatol. 2007; 19: 647-652.                                                         © Our Dermatol Online 4.2011 Copyright Akram Ansar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 

Comparison of seropositivity of HCV between oral lichen planus and healthy control group in Hamedan province (west of Iran)

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