Lichen planus has been reported in association with liver diseases. Clinical signs such as jaundice may not be reliable indicator of ongoing inflammation or the presence of an ongoing liver disease. Liver function test in spite of its variability may serve as amore reliable indicator of liver disease. The objective of this study is to assess the discriminant power of liver enzymes with lichen planus and control. Sixty Nigerians with lichen planus (LP group) and 30 patients with other dermatoses control group A) and 30 apparently normal individual (control group B) had their liver enzymes assayed using the automated Hitachi 70 auto-analyzer There was no a statistically significant difference in the level of liver enzymes between the LP group and controls Liver enzymes in Nigerian with lichen planus are generally within normal limits and are comparable to individuals without lichen planus.
 Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp.64-6

Abbiyesuku, FA

Daramola, OOM

Otegbayo, J A

English

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64Nigerian Journal of Clinical PracticeMarch 2008 Vol 11(1):64-67LIVER ENZYMES IN NIGERIANS WITH LICHEN PLANUS* O.O M Daramola, **F A Abbiyesuku, ***J A OtegbayoABSTRACTIntroduction:Methods:Result:Conclusion:Key Words:Departments of *Medicine, **Chemical Pathology, Medicine *University Of Ilorin, Ilorin,**University College Hospital, Ibadan Nigeria.Accepted 1 February 2007Lichen planus has been reported in association with liver diseases. Clinical signs such asjaundice may not be reliable indicator of ongoing inflammation or the presence of an ongoing liver disease.Liver function test in spite of its variability may serve as a more reliable indicator of liver disease. The objectiveof this study is to assess the discriminant power of liver enzymes with lichen planus and control.Sixty Nigerians with lichen planus (LP group) and 30 patients with other dermatoses control groupA) and 30 apparently normal individual (control group B) had their liver enzymes assayed using the automatedHitachi 70 auto-analyzerThere was no a statistically significant difference in the level of liver enzymes between the LP groupand controlsLiver enzymes in Nigerian with lichen planus are generally within normal limits and arecomparable to individuals without lichen planus.Lichen planus, Liver enzymes, Nigerian ( )(INTRODUCTIONThe search for the aetiopathogenesis of lichenplanus (LP) and research into the extra hepaticmanifestations of the hepatrophic viruses hasindicated a relationship between liver diseases andlichen planus . Cross reactivity or molecularmimicry between the hepatocytes and keratinocytesmay be the link between the skin and the liver .Liver diseases that have been reported in associationwith lichen planus include autoimmune chronicactive hepatitis, primary biliary cirrhosis, andprimary sclerosing cholangitis. Others are Wilson'sdisease and haemochromatosis .The presence of jaundice as an indicator of anongoing inflammation in the liver has been found tobe very unreliable . For example only 10% who aresuffering from hepatitis develop jaundice. Eventhough a sub-clinical inflammation of the liver maygo unnoticed in majority of individuals, the ultimatesequele might be fatal and often irreversible. Liverfunction test is a relatively available, affordablenone invasive procedure in Nigeria. Lichen planuson the other hand is a common dermatosis withunique undisputable clinical features. We thereforeassessed the discriminant power of liver enzymesb e t w e e n l i c h e n p l a n u s a n d c o n t r o l s .1214Correspondence: Dr O O DaramolaE-mail addresses: nikem95@yahoo.comMATERIALSAND METHODSSixty patients with cutaneous lichen planus werestudied. Thirty patients with hepatitis unrelateddermatoses (control group A) and another 30apparently healthy individuals (control group B)were recruited into the study as 2 separate controlgroups. None of the subject had symptoms of ongoinghepatitis. Based on the extent of their lesions, patientswith lichen planus were categorised into 3 subgroups(Generalised, localised to the extremities andlocalised)Clinical examination was carried out in all subjects todetermine the presence of hepatomegaly. . Patientswith peripheral stigmata of chronic liver disease werealso excluded.Ten millimetres of venous blood was collected fromall subjects and controls by antecubital venepuncture.Sera were collected by centrifugation at 400 rpm andstored at 20 degree centigrade till seroanalysis.Seroanalysis was done using the Hitachi 70autoanalyzer to determine the levels alkalinephosphatase, alanine aminotransaminase andaspartate aminotransaminase, serum proteins [Totaland Albumin]. Values of liver enzymes werecompared within the subgroup of lichen planussubjects and between lichen planus subjects an thecontrol groupsEthical approval for this study was obtained from the65joint University College Hospital and University ofIbadan Ethical Committee.. The mean age of patients with lichen planuswas 37.13 12.8 years with the range of 10 68 yearswhile the mean age of control group A was 35.3313.67 years with ages ranging from 13-64 years. Incontrol group B, the mean age was 34.41 11.69years with ages ranging from 12 to 57 years. Of the60 patients with lichen planus 25 were males and 35female. No patients had hepatomegaly on clincalexamination The summary of theresults of liver function test in all subjects (lichenplanus and control groups) is shown in Table 1. Themean values of these parameters in subjects werewithin normal limits. The differences observedbetween the groups were not statistically significant(P >0.05). The liver function tests of patients withlichen planus is shown Table2. The mean valueswere within normal limits and also the differencesobserved between subgroups were not statisticallysignificant (P>0.05).RESULTSBiodataLiver enzymes.+++Alkaline phosphataseAspartate amin transaminases. Among patients with lichenplanus, 7 had elevated alkaline phosphates aboveupper limits of normal with values ranging from 252622 IU/L. The highest value of 622IU/L wasobtained in 50-year-old woman with lichen planus.Three patients in control group A had elevatedalkaline phosphates values ranging from 262393IU/L. In control group B, the 3 subjects withelevated alkaline phosphates were 16 years and lessin age.Values of AST wereelevated in 3 patients with lichen planus above theupper limit of normal, these were 50 IU/L, 64 IU/Land 100 IU/L with a mean of 71.3 IU/L. Values ofAST in subjects in control group A were all withinnormal limit except for a value of 43 IU/L obtained inone. The value of AST in control group B were allwithin normal limit but for a value of 77IU/Lobtained in one control.The reference values of the liver function testsparameters are as follow: Alkaline Phosphatase 0-250IU\L;AST 0-40IU\L;ALT 0-40IU\L; Total protein 5-8g\dl;Albumin 3-5g\dl.Nigerian Journal of Clinical Practice March et.al. 2008, Vol.11(1) Liver Enzymes in Nigerians DaramolaTable 1:Test Statistics LP GPA GPB F value Pvaluen=60 n=30 n=30Mean 181.68 168.03 169.97ALK PH S. D. 110.18 74.2 112.44 0.23 0.8Range 73- 622 60 -393 69 -566Mean 26.83 27.17 28.90AST S. D. 14.99 10.21 12.94 0.24 0.79Range 11 100 7 65 15 - 71Mean 6.8 13.83 15.13ALT S. D. 13.78 7.82 9.4 1 0.70 0.5Range 4 90 3 40 6 51Mean 7.74 7.66 7.39T Protein S. D. 0.6 1.13 1.11 1.52 0.22Range 5.8 9 3.1- 8.8 4.1 - 8.3Mean 4.75 4.63 4.97Albumin S. D. 0.4 0.85 0.85 2.08 0.13Range 3.6 - 5.6 1.6 - 5...5 3- 6.1ALK PH(alkaline phosphatase)AST(aspartate amin transaminases)ALT (aminotransaminase)Liver Function Test InAll SubjectsSUBJECT GROUPS166DISCUSSIONThe association of liver diseases with lichen planushave been documented in literature. Theseassociations may not be as widely reported as therelationship of lichen planus with Hepatitis B and Cviruses , no doubt they underscore the importanceof assessing the status of the liver in patients withlichen planus. Since this may reveal a clinicallyconcealed disease in the liver. The relationshipbetween an apparently benign cutaneous diseasesuch as lichen planus and an ultimately fatal diseaseof a vital organ such as the liver are thought to be dueto altered keratinocytes antigenicity, which mightinduce a reaction that damages the keratinocytes andalso the hepatocytes . Other postulation adduced forthis that has been supported by some report is thatthe keratinocytes may share certain epitopes withantigens like HBV which can induce immunologicdamage of the liver. To an African patient andhealthcare worker the above scientific postulationmay not be as important as the possible relationshipbetween the lichen planus and the liver, sincediseases of the skin in this instance lichen planusmay serve as first line screening tools for patientswho may be suffering from presymptomatic liverdisease. In the absence of signs of an apparent liverdisease such as jaundice and massive hepatomegaly,convincing Nigeria patients of the need to undergodetailed evaluation of the liver with ultrasonographyand radioimaging is very difficult let a lone a request4-82for a liver biopsy. Reasons for this are the cost ofinvestigations and fear of undergoing any invasiveprocedure particularly if the reason is not veryobvious . Liver function test a relatively noneinvasive procedure and a more reliable indicator of anon going inflammation can be easily done.In thisstudy, there was no statistically significant differencein values of liver enzymes between patients withlichen planus and the controls. However, we found7(11.6%) of the patients with lichen planus withelevated alkaline phosphatase and 3(0.05%) hadmildly elevated aspartate transaminases. Mildlyelevated levels of AST has been reported in patientstaking erythromycin and this cannot be ruled out inour patients because of easy access to controlleddrugs . The elevations in the level of alkalinephosphates were minimal and cannot be said toindicate an ongoing liver disease since slightlyelevated levels has been reported as a commonfinding. The highest value of 622IU/L a 2-foldincrease of the upper limit of the normal value in thiscentre was in a 50-year-old woman; this value is notunusual in menopausal women where serum alkalinephosphatase may be derived from the bones .Measuring the fractionated levels of alkalinephosphatase, which is not available in this centre,would have helped in differentiating an extra hepaticsources .The findings in this study is consistent with that byKatz and Pisanti, who in their study of the9101112Table 2:Laboratory Statistics Gen LE L F value PvalueTest n=25 n=25 n=10Mean 173.68 194.64 169.3ALK PH S. D. 33 147.90 52.78 0.3 0.74Range 80 - 403 73 - 622 103 - 272Mean 26.5 24.4 33.5AST S. D. 9.7 10.4 29.4 2.12 0.13Range 13- 50 14- 64 11- 100Mean 7.92 12.96 23.6ALT S. D. 13.29 5.64 24.35 2.38 0.10Range 4 - 56 5- 29 4- 90Mean 7.64 7.78 7.86T Protein S. D. 0.67 0.55 0.51 0.56 0.58Range 5.8- 9 6.6 - 8.8 7.3- 8.9Mean 4.68 4.79 4.83Albumin S. D. 0.45 0.36 0.36 0.68 0.57Range 3.6 -5.6 4.0 -5.4 4.1- 5.4KeyGen (Generalized) LE (Localized to extremities) L(Localized)ALK PH (alkaline phosphatase) AST(aspartate amintransaminases) ALT (aminotransaminase)Comparison Of LiverFunction TestAnd The Extent Of Lesion In Lichen Planus PatientsSUBJECT GROUPS81.1Nigerian Journal of Clinical Practice March et.al. 2008, Vol.11(1) Liver Enzymes in Nigerians Daramola676.Oral lichen planus and HCV infection: aclinical evaluation of 263 cases. Int JDermatol1998; 37(8): 575-5787.Hepatitis C Virus And Lichen Planus InNigerian's: Any Relationship? Int. J. Dermatol(In press).8Lichen planus following hepatitis B vaccinationin anAfrican girl. Trop Doct. 2002; 32(2):117-8.9. Elevatedalphafetoprotein in an hepatitis B seropositiveAfrican woman with hypertrophic zosteriformlichen planus. Trop Doct. 2003; 33(4):249-50..10. Serumglutamic oxaloacetic transaminase. Falsee leva t ions dur ing adminis t ra t ion oferythromycin. N Engl J Med 1968; 279:113711. Referencelimits of bone and liver alkaline phosphataseisoenzymes in the serum of healthy subjectsaccording to age and sex as determined bywheat germ lectin affinity electrophoresis. ClinChim Acta 1988; 173:273.12 Urea as a selectiveinhibitor of human tissue alkalinephosphatases. Clin ChimActa 1967; 17:367.13. Oral erosive lichen planusand chronic active hepatitis. J Am. AcadDermatol 1985; 12 71914.Prevalence of hepatitis Cvirus antibodies and evaluation of hepatitis Cvirus genotype in patients with lichen planus.Dermatology 1997; 195(1): 1-5.15. Liverabnormalities in patients with lichen planus. J.Am.Acad. Dermatol 1984; 11:609-615.M i g n o g n a MD , Mu zi o L L , F a v iaG, Mignogna RE, Carbone R ,Bucci EDaramola OOM, George AO, Ogunbiyi AO.Daramola OOM, Ogunbiyi AO, George AO.Daramola OO, Otegbayo JA.Sabath LD, Gerstein DA, Finland M.Kuwana T, Sugita O, Yakata M.Bahr M, Wilkinson JH.Katz M, Pisanti S.Imhof M, Popal H, Lee JH, Zeuzem S,Milbradt R .Korkij W, Chung T and Soltani K.etal.et alrelationship between oral erosive lichen planus andchronic active hepatitis did not find any abnormalityin the liver function test of their patients . Imhof andcolleagues in their study of patients with lichenplanus could not demonstrate any abnormalities intheir liver function test. Mignogna and Dupin intheir separate studies were among other workers whodid not find any in LFT of patients with lichen planuswhen compared to controls . Korkij and colleaguehowever reported abnormal liver functions in 52% oftheir patients while 36% of controls had abnormalliver function . However, the presence of elevatedliver enzymes may help in identifying the cohort thatrequires close monitoring to pick early those whomay be incubating an ominous disease of the liver.Levels of liver enzymes in Nigerians with lichenplanus are generally within normal limits and arecomparable to individuals without lichen planus.However elevated level of alkaline phoshatase foundin few patients though may be a usual finding mayserve as indictor of selecting those that require closemonitoring and follow up.1 Hepatitis virus and lichen planus.Arch Dermatol 1994; 130 1328-1329.2. Lichen planus and the liver. Int. J.Dermatol 1992; 31: 392-395.3.Clinical andvirological course of chronic hepatitis B virusinfection with hepatitis C and D virus markers.Am J Gastroenterol 1998; 93:354.4.Chronic hepatitis C and skin diseases: areview. Mayo Clinic Proceedings; 1995: 70(6):559-564.5.Lichen planusand hepatitis C virus-related chronic activehepatitis. Arch. Dermatol 1994; 130: 73-76.131415ConclusionREFERENCESRebora A.Rebora A.Liaw YF, Tsai SL, Sheen, IS, Chao M, YehCT, Hsieh SY, Chu CM et al.Daoud MS, Gibson LE, Daoud S, el-AzharyRA.Jubert C, Pawlostky JM, Pouget F,Andre C,Deforges L, Bretagne S, Mavier JP, Duval J,Revuz J, Dhumeaux D .et alNigerian Journal of Clinical Practice March et.al. 2008, Vol.11(1) Liver Enzymes in Nigerians Daramola

Liver enzymes in Nigerians with lichen planus

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Liver enzymes in Nigerians with lichen planus

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