CAMPISI, Giuseppina

COMPILATO, Domenico

DI FEDE, Olga

GULOTTA, Gaspare

PADERNI, Carlo

Archivio istituzionale della ricerca - Università di Palermo

OOOOE12 Letters to the Editor January 20117. Pitak-Arnnop P, Schouman T, Bertrand JC, Hervé C. Commentéviter la non-conformité de la recherche biomédicale? Recom-mandations aux chirurgiens. J Chir (Paris) 2008;145:534-41.8. Altman DG, Bland JM. Absence of evidence is not evidence ofabsence. BMJ 1995;311:485.9. Rehman KU, Parmar S, Williams R, Dover S, Lalani El-N.Research training for oral and maxillofacial surgery. Br J OralMaxillofac Surg 2008;46:343.10. Trikalinos NA, Evangelou E, Ioannidis JP. Falsified papers inhigh-impact journals were slow to retract and indistinguishablefrom nonfraudulent papers. J Clin Epidemiol 2008;61:464-70.11. Wager E, Fiack S, Graf C, Robinson A, Rowlands I. Sciencejournal editors’ views on publication ethics: Results of an inter-national survey. J Med Ethics 2009;35:348-53.12. Nath SB, Marcus SC, Druss BG. Retractions in the researchliterature: misconduct or mistakes? Med J Aust 2006;185:152-4.13. Atlas MC. Emerging ethical issues in instructions to authors ofhigh-impact biomedical journals. J Med Libr Assoc 2003;91:442-9.14. Sorinola O, Olufowobi O, Coomarasamy A, Khan KS. Instruc-tions to authors for case reporting are limited: a review of a corejournal list. BMC Med Educ 2004;4:4.15. Rohrich RJ. Ethical approval of clinical studies, informed consent,and the declaration of Helsinki: what you need to know. PlastReconstr Surg 2007;119:2307-9.16. Gilbert FJ, Denison AR. Research misconduct. Clin Radiol2003;58:499-504.17. Benninger MS, Jackler RK, Johns MM, Johnson JT, KennedyDW, Ruben RJ, et al. Consortium of otolaryngology—head andneck surgery journals to collaborate in maintenance of highethical standards. Arch Otolaryngol Head Neck Surg 2005;131:381-2.18. Johnson JT, Niparko JK, Levine PA, Kennedy DW, Weber PC,Weber RS, et al. Standards for ethical publication. Arch Otolar-yngol Head Neck Surg 2007;133:7-8.19. Pitak-Arnnop P, Hemprich A, Dhanuthai K, Pausch NC. Ethicalconduct of human research: some controversies. OtolaryngolHead Neck Surg 2010;143:469-70.doi:10.1016/j.tripleo.2010.10.001Association of oral lichen planuswith thyroid disease in a Finnishpopulation: A retrospective case-control study: “A different findingfrom a Mediterranean area”To the Editor:Siponen et al.1 report an association of oral lichenplanus/oral lichenoid lesions (OLP/OLL) with thyroiddisease in the Finnish population. As they point out,OLP has been associated with a number of systemicdisorders, generally of autoimmune origin (myastheniagravis, Sjögren’s syndrome, ulcerative colitis, psoria-sis, celiac disease, some liver diseases, thymoma, andlupus erythematosus); however, only in a few condi-tions has this link been confirmed.2-6 For example, thecorrelation between chronic hepatitis C virus (HCV)infection and OLP would be one of these, even if manycontrasting results have been published,7-14 and thepartial dependency on geographic factors as well asgenetic differences has been focused.15,16 Furthermore,autoimmune conditions, such as systemic lupus ery-thematosus, rheumatoid arthritis, and celiac diseasehave also been simply found to be associated withautoimmune thyroid diseases,17 but without great anddefinitive evidence.Hence, the association between OLP/OLL and thy-roid diseases/thyroid medication, in particular hypothy-roidism, have been reported in some studies18-20 up tothe recent study by Siponen et al.,1 who analyzedretrospectively 222 OLP/OLL patients and 222 con-trols, with a marginal significant association (95% con-fidence interval [CI]  1.03 to 4.90) between OLP/OLL and hypothyroidism (10% versus 5% in controls).Finally, the authors suggested that the association ofOLP and hypothyroidism could be linked to a similar,but still unknown, immune-mediated mechanism, war-ranting further studies in a different population.With this regard, we would like to share our findingsfrom a cross-sectional study performed in Sicily (WestMediterranean area). We consecutively recruited 125resident patients, of these 74 had Hashimoto’s thyroid-itis or Graves disease (70 female and 4 male; mean age:47  15.2 years; range: 14 to 79 years; of which 58patients had Hashimoto’s thyroiditis and 16 had Gravesdisease) as the test group; these 2 autoimmune pathol-ogies share with OLP a common immune-mediatedpathogenesis, causing hypothyroidism and hyperthy-roidism, respectively. Controls were 51 patients (42female; 9 male; mean age: 54.6 11.5 years; range: 24to 73 years) suffering from goiter, an endemic diseasein Sicily without autoimmune pathogenesis,21 and werefound to be matched for age and gender with the testgroup (P  .2 by Student t).In all samples, thyroid diseases were diagnosedboth serologically and histologically; all patients un-derwent total thyroidectomy and subsequent replace-ment with thyroxin medication. All patients under-went oral examination, independently, by 2 of theauthors (C.D. and C. P.), both experts in oral medi-cine. In our study, all patients who were HCV-positive or with OLL potentially associated withdrugs,22 amalgam fillings, or topical allergens wereexcluded, different from Siponen et al.,1 to reducebiases on the final results.One patient with Hashimoto’s thyroiditis showedoral lesions with a reticular aspect bilaterally on thebuccal mucosa and atrophic/erosive features on themasticatory mucosa, compatible with the diagnosis ofOLP. The patient underwent incisional oral biopsy andthe subsequent histologic examination confirmed thediagnosis of OLP. None of the controls showed clinicalsigns of OLP/OLL.Different from Siponen et al.,1 we did not find anysignificant association between autoimmune thyroidOOOOEVolume 111, Number 1 Letters to the Editor 13diseases and OLP or between thyroxin drug use andOLL, presumptively high because of the endemic statusof thyroid diseases in our population and the conse-quent use of thyroxine-based drugs.In conclusion, with regard to the findings by Siponenet al.,1 we do not think that the data to date showdefinitively an association between OLP/OLL and, atleast, hypothyroidism, especially with the potential forbiases from sample size calculation and consequentlyfrom type I error.Domenico Compilato, DDS, PhDaCarlo Paderni, DDS, PhDaOlga Di Fede, DDS, PhDaGaspare Gulotta, MDbGiuseppina Campisi, DDSaaDepartment of Surgical and Oncological DisciplinesSection of Stomatological SciencesbDepartment of Surgical Oncological DisciplinesSection GENURTOREFERENCES1. Siponen M, Huuskonen L, Laara E, Salo T. Association of orallichen planus with thyroid disease in a Finnish population: aretrospective case-control study. Oral Surg Oral Med Oral PatholOral Radiol Endod 2010;110:319-24.2. Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).Lichen planus and liver diseases: a multicentre case-controlstudy. BMJ 1990;300(6719):227-30.3. Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).Study of lichen planus conducted by the IGESD: results, impli-cations for clinical practice, prospects. G Ital Dermatol Venereol1990;125(12):563-7.4. Gruppo. Italiano Studi Epidemiologici in Dermatologia(GISED). Epidemiological evidence of the association betweenlichen planus and two immune-related diseases. Alopecia areataand ulcerative colitis. Arch Dermatol 1991;127:688-91.5. Scully C, Beyli M, Ferreiro MC, Ficarra G, Gill Y, Griffiths M,et al. Update on oral lichen planus: etiopathogenesis and man-agement. Crit Rev Oral Biol Med 1998;9:86-122.6. Scully C, Porter SR, Eveson JW. Oral lichen planus and coeliacdisease. Lancet 1993;341:1660.7. Bagan JV, Aguirre JM, del Olmo JA, Milian A, Penarrocha M,Rodrigo JM, et al. Oral lichen planus and chronic liver disease:a clinical and morphometric study of the oral lesions in relationto transaminase elevation. Oral Surg Oral Med Oral Pathol1994;78:337-42.8. Campisi G, Di Fede O, Craxi A, Di Stefano R, Margiotta V. Orallichen planus, hepatitis C virus, and HIV: no association in acohort study from an area of high hepatitis C virus endemicity.J Am Acad Dermatol 2004;51:364-70.9. Campisi G, Fedele S, Lo Russo L, Di Fede O, Arico P, Craxi A,et al. HCV infection and oral lichen planus: a weak associationwhen HCV is endemic. J Viral Hepat 2004;11:465-70.10. Carrozzo M, Gandolfo S, Carbone M, Colombatto P, BroccolettiR, Garzino-Demo P, et al. Hepatitis C virus infection in Italianpatients with oral lichen planus: a prospective case-control study.J Oral Pathol Med 1996;25:527-33.11. Friedrich RE, Heiland M, El-Moawen A, Dogan A, von Schre-nck T, Loning T. Oral lichen planus in patients with chronic liverdiseases. Infection 2003;31:383-6.12. Klanrit P, Thongprasom K, Rojanawatsirivej S, TheamboonlersA, Poovorawan Y. Hepatitis C virus infection in Thai patientswith oral lichen planus. Oral Dis 2003;9:292-7.13. Lodi G, Giuliani M, Majorana A, Sardella A, Bez C, DemarosiF, et al. Lichen planus and hepatitis C virus: a multicentre studyof patients with oral lesions and a systematic review. Br JDermatol 2004;151:1172-81.14. Nagao Y, Sata M, Tanikawa K, Itoh K, Kameyama T. Lichenplanus and hepatitis C virus in the northern Kyushu region ofJapan. Eur J Clin Invest 1995;25:910-4.15. Carrozzo M, Francia Di Celle P, Gandolfo S, Carbone M, Con-rotto D, Fasano ME, et al. Increased frequency of HLA-DR6allele in Italian patients with hepatitis C virus-associated orallichen planus. Br J Dermatol 2001;144:803-8.16. Eisen D, Carrozzo M, Bagan SJV, Thongprasom K, Number V.Oral lichen planus: clinical features and management. Oral Dis2005;11:338-49.17. Lazurova I, Benhatchi K, Rovensky J, Kozakova D, WagnerovaH, Tajtakova M, et al. Autoimmune thyroid disease and autoim-mune rheumatic disorders: a two-sided analysis. Ann N Y AcadSci 2009;1173:211-6.18. Kragelund C, Thomsen CE, Bardow A, Pedersen AM, NauntofteB, Reibel J, et al. Oral lichen planus and intake of drugs metab-olized by polymorphic cytochrome P450 enzymes. Oral Dis2003;9:177-87.19. Dreiher J, Shapiro J, Cohen AD. Lichen planus and dyslipidae-mia: a case-control study. Br J Dermatol 2009;161:626-9.20. Chang JY, Chiang CP, Hsiao CK, Sun A. Significantly higherfrequencies of presence of serum autoantibodies in Chinesepatients with oral lichen planus. J Oral Pathol Med 2009;38:48-54.21. Vigneri R. Studies on the goiter Endemia in Sicily. J EndocrinolInvest 1988;11:831-43.22. Scully C, Bagan JV. Adverse drug reactions in the orofacialregion. Crit Rev Oral Biol Med 2004;15:221-39.doi:10.1016/j.tripleo.2010.09.074Association of oral lichen planuswith thyroid disease in a Finnishpopulation: A retrospective casecontrol study: “A different findingfrom a Mediterranean area”In reply:We thank Dr Compilato et al. for their interest in ourstudy and for sharing their own findings. We also fullyagree with their statement “. . . we do not think the datato date show definitively an association between OLP/OLL and, at least, hypothyroidism” up to this point.Nothing in our article indicates a different conclusion;yet, we are unable to follow their argument to the end.For example, the meaning of “bias from sample sizecalculation” remains obscure to us, such a bias notbeing described in any well-known textbook on epide-miologic methods. Therefore, we would like to elabo-rate some methodological issues that we consider es-sential when evaluating observational evidenceprovided either by any single study, including theirsand ours, or jointly by several independent studies onthe same question.A major problem encountered in any epidemiologicstudy addressing the existence, direction, and strengthof a conceivable association between thyroid diseases

Association of oral lichen planus with thyroid disease in a Finnish population: A retrospective case-control study: "A different finding from a Mediterranean area".

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Association of oral lichen planus with thyroid disease in a Finnish population: A retrospective case-control study: "A different finding from a Mediterranean area".

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