Oral lichen planus and hepatitis C virus infection; a symbiotic relationship or a mere co-incidence?

Malik Adeel Anwar, Sahar Iqrar, Zain Akram, Muhammad Arslan Tayyab, Nadeem Afzal


Background: Lichen planus (LP) is a common idiopathic chronic inflammatory immune mediated mucocutanous disease that effects stratified squamous epithelia and appendices. Hepatitis C virus (HCV) infection is quite common across the world. A couple of reports have suggested positive association of HCV infection and oral lichen planus (OLP) and most of the studies are usually confined to Mediterranean and south European countries. Due to high incidence and suspected alliance between these two diseases in Pakistan, the following study was conducted with the view that it may help clinicians to set guidelines for HCV testing of lichen planus patients.

Methods: Approximately 11500 patients from general population coming to dental diagnostics department of Fatima Memorial Hospital, Lahore (from March 2015-February 2016) were screened clinically for OLP and by ELISA for HCV infection. Out of these 11500 patients 103 were selected one of them incidental and the other pre-diagnosed or both incidental and both pre-diagnosed. These patients were unaware but had either one or both OLP and HCV infection which was confirmed clinically and by ELISA respectively.

Results: Majority of patients presenting for other dental complaints were unaware of these diseases process going on in them and was mostly an incidental finding by the clinician. Either one or both OLP and HCV infection were more conjoint in females comprising 77.7% of the total subjects. OLP alone was most common finding comprising 66.67% of the cases. HCV infection alone was present in 15.53% whereas 16.50% subjects showed presence of both OLP and HCV infection.

Conclusions: The current study could not detect statistically significant relationship between OLP and HCV infection in Pakistani population which could be due to genetic variation or may be geographic relationship.


Association, Hepatitis C viral infection, Oral lichen planus

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Boorghani M, Gholizadeh N, Taghavi Zenouz A, Vatankhah M, Mehdipour M. Oral lichen planus: clinical features, etiology, treatment and management; a review of literature. J Dent Res Dent Clin Dent Prospects. 2010;4(1):3-9.

Carrozzo M, Thorpe R. Oral lichen planus: a review. Minerva Stomatol. 2009;58(10):519-37.

Edwards PC, Kelsch R. Oral lichen planus: Clinical presentation and management. J Can Dent Assoc. 2002;68:494-9.

Shafer WG, Hine MK, Levy BM. Shafer's textbook of oral pathology. 6th ed. Noida, India: Elsevier publications; 2009:800.

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(1):86-122.

Gupta S, Jawanda MK. Oral Lichen Planus: An Update on Etiology, Pathogenesis, Clinical Presentation, Diagnosis and Management. Indian J Dermatol. 2015;60(3):222-9.

Carrozzo M, Uboldi de Capei M, Dametto E, Fasano ME, Arduino P, Broccoletti R, et al. Tumor necrosis factor-alpha and interferon-gamma polymorphisms contribute to susceptibility to oral lichen planus. J Invest Dermatol. 2004;122(1):87-94.

Patil S, Khandelwal S, Rahman F, Kaswan S, Tipu S. Epidemiological relationship of oral lichen planus to hepatitis C virus in an Indian population. Oral Health Dent Manag. 2012;11(4):199-205.

Pol S, Vallet-Pichard A, Corouge M, Mallet VO. Hepatitis C: epidemiology, diagnosis, natural history and therapy. Contrib Nephrol. 2012;176:1-9.

Lodi G, Porter SR, Scully C. Hepatitis C virus infection: Review and implications for the dentist. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;86(1):8-22.

Catanese MT, Uryu K, Kopp M, Edwards TJ, Andrus L, Rice WJ, et al. Ultrastructural analysis of hepatitis C virus particles. Proc Natl Acad Sci USA. 2013;110(23):9505-10.

El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 2012;142(6):1264-73.

Selimovic D, El-Khattouti A, Ghozlan H, Haikel Y, Abdelkader O, Hassan M. Hepatitis C virus-related hepatocellular carcinoma: An insight into molecular mechanisms and therapeutic strategies. World J Hepatol. 2012;4(12):342-55.

Schamberg NJ, and Lake-Bakaar GV. Hepatitis C Virus-related Mixed Cryoglobulinemia. Pathogenesis, Clinica Manifestations, and New Therapies. Gastroenterol Hepatol. 2007;3(9):695-703.

Cacoub P, Poynard T, Ghillani P, Charlotte F, Olivi M, Piette JC, et al. Extrahepatic manifestations of chronic hepatitis C. MULTIVIRC Group. Multidepartment Virus C. Arthritis Rheum. 1999;42(10):2204-12.

Rebora A, Patri P, Rampini E, Crovato F, Ciravegna G. Erosive lichen planus and cirrhotic hepatitis. Italian General Review of Dermatology. 1978;15:123-31.

Bagán JV, Aguirre JM, del Olmo JA, Milián A, Peñarrocha M, Rodrigo JM, et al. Oral lichen planus and chronic liver disease: a clinical and morphometric study of the oral lesions in relation to transaminase elevation. Oral Surg Oral Med Oral Pathol. 1994;78:337-42.

Baccaglini L, Thongprasom K, Carrozzo M, Bigby M. Urban legends series: lichen planus. Oral Dis. 2013;19(2):128-43.

Carrozzo M, Brancatello F, Dametto E, Arduino P, Pentenero M, Rendine S, et al. Hepatitis C virus-associated oral lichen planus: is the geographical heterogeneity related to HLA-DR6? J Oral Pathol Med. 2005;34(4):204-8.

Muzaffar F, Hussain I, Haroon TS. Hepatitis C: the dermatologic profile. JPAD. 2008;18:171-81.

Ingafou M, Porter SR, Scully C, Teo CG. No evidence of HCV infection or liver disease in British patients with oral lichen planus. Int J Oral Maxillofac Surg. 1998;27(1):65-66.

Azfar NA, Zaman T, Rashid T, Jahangir M. Cutaneous manifestations in patients of hepatitis C. JPAD. 2008;18:138-43.

El-Rifaei A, Fathalla S, Al-Sheikh I, Tinguria MB, Qadry YA. The prevalence of indices of hepatitis C and B infection, and elevated aminotransferase enzymes in patients with oral lichen planus (OLP) in eastern Saudi Arabia. J Family Community Med. 1998;5(2):39-43.

Ghodsi SZ, Daneshpazhooh M, Shahi M, Nikfarjam A. Lichen planus and hepatitis C: a case-control study. BMC Dermatol. 2004;4:6.

Denli YG, Durdu M, Karakas M. Diabetes and hepatitis frequency in 140 lichen planus cases in Cukurova region. J Dermatol. 2004;31:293-8.

Kindt TJ, Goldsby RA, Osborne BA. Kuby immunology. 6th Ed. New York: WH Freeman and Company. 2007:408-11.

Jubert C, Pawlotsky JM, Pouget F, Andre C, DeForges L, Bretagne S, et al. Lichen planus and hepatitis c virus-related chronic active hepatitis. Arch Dermatol. 1994;130(1):73-6.

Carrozzo M, Gandolfo S, Carbone M, Colombatto P, Broccoletti R, Garzino-Demo P, et al. Hepatitis C virus infection in Italian patients with oral lichen planus: a prospective case-control study. J Oral Pathol Med .1996;25(10):527-33.

Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies. Clin. Dermatol. 2010;28(1):100-8.

Meij EH, Waal I. Hepatitis C virus infection and oral lichen planus: a report from the Netherlands. J Oral Pathol Med. 2000;29(6):255-8.

Figueiredo L, Carrilho F, De Andrade H, Migliari D. Oral lichen planus and hepatitis C virus infection. Oral Diseases. 2002;8:42-6.