Non-erosive Oral Lichen Planus Research Articles

Association between the clinical severity of oral lichen planus and anti-TPO level in thyroid patients.

This study considered a possible relationship between the severity of oral lichen planus (OLP), serum anti-TPO autoantibodies (TPOAb) titer and thyroid disease in OLP patients. Forty-six OLP patients with positive TPOAb results (> 35 IU/ml) who had also been diagnosed with thyroid disease were included in the study group. The control group consisted of 46OLP patients with no thyroid disease. The study and control groups (92) were divided to two subgroups of erosive OLP (EOLP) and non-erosive OLP (NEOLP). Serum TPOAb levels and IL-8 (to measure OLP severity) were evaluated using the independent t-test, chi-square and conditional logistic regression analysis (α = 0.05). A significant positive correlation was found between serum IL-8 and TPOAb levels in the study group (r = 0.783; p = 0.001). The positive blood levels of TPOAb were significantly associated with an increased risk of EOLP (OR = 4.02 at 95%CI; 1.21-13.4; p = 0.023). It is possible to used positive serum TPOAb levels in patients with OLP as in indicator of possible undetected thyroid disorders in those patients. Because erosive OLP has been associated with TPOAb in thyroid patients, it may be useful to determine TPOAb levels of such patients to diagnose a possible undetected thyroid disorders and follow-up for malignancy.

Immunohistochemical Evaluation of Ki-67 Expression in Erosive andNon-Erosive Oral Lichen Planus

Background: Oral lichen planus (OLP) is a relatively common, chronic inflammatory condition, which is considered a precancerous lesion. The Ki-67 antigen is expressed in all the phases of the cellular cycle in proliferative cells. Different studies have suggested the relationship between incidences of malignancy in precancerous lesions and the occurrence of this protein. Objectives: This study aimed to evaluate Ki-67 expression in erosive and non-erosive oral lichen planus. Materials and Methods: Specimens (formalin-fixed and paraffin-embedded) of 30 lesions of erosive OLP and 30 lesions of nonerosive OLP were referred for immunehistochemistry (IHC) analysis of Ki-67. Results of immunohistochemistry were statistically evaluated by means of the chi-square test and independent t-test. The level of statistical significance was established at P < 0.05. Results: The mean expression of Ki-67 in patients with erosive OLP was higher than people in the control group. These differences were statistically significant (P = 0.041). Conclusions: Since Ki-67 is extensively accepted as an important biomarker in diagnosis, prognosis and treatment of cancerous and precancerous lesions, a high degree of presence of this biomarker in chronic precancerous lesions, such as erosive OLP, can be of great use in prognosis and suggested treatments.

Phenotypic variability and therapeutic implications of Candida species in patients with oral lichen planus

We investigated the prevalence and phenotypic variation of Candida species in oral lichen planus (OLP) and the therapeutic implications of our findings. Eighty patients with clinically and histopathologically confirmed cases of OLP (64 non-erosive, 16 erosive) and a control group of 80 healthy individuals with no predisposing factors for oral candidiasis were examined for evidence of Candida infection. Oral swabs and smears were obtained for cytology and culture. Identification, speciation and antifungal susceptibility tests of Candida isolates were performed using an automated microbial identification system. Fifty percent of erosive OLP cases, 28% of non-erosive cases and none of the controls showed evidence of Candida. Candida albicans was found predominantly in non-erosive OLP, while other Candida species were predominate in erosive OLP. Non-Candida albicans isolates (C. glabrata, C. krusei) were resistant to the commonly used antifungals, clotrimazole and fluconazole. Candida infection is common in cases of OLP. We recommend antifungal sensitivity testing prior to antifungal therapy for the erosive form of OLP.

Different Expression of MicroRNA-146a in Peripheral Blood CD4(+) T Cells and Lesions of Oral Lichen Planus.

Oral lichen planus (OLP) is a common T cell-mediated chronic inflammatory disease of unknown etiology. Recent increasing evidence indicates that microRNA-146a (miR-146a) plays a vital role in inflammatory diseases and T cell regulation. This study aimed to investigate the expression of miRNA-146a in peripheral blood CD4(+) T cells and local OLP lesions and to evaluate its relationship with clinical forms of OLP. Sixteen patients with OLP were divided into two groups: erosive OLP and nonerosive OLP. The expression of miR-146a was examined by quantitative real-time polymerase chain reaction. The expression of miR-146a in peripheral blood CD4(+) T cells showed no significant difference between OLP group and control group (P > 0.05), and among erosive OLP, nonerosive OLP, and control groups (P > 0.05 for all). The expression in local lesions of the OLP group was significantly higher than that of the control group (P = 0.003), and it was significantly higher in the erosive OLP group than in the non-erosive OLP (P = 0.010) and control groups (P = 0.007). However, miR-146a expression in the nonerosive OLP group did not significantly differ from that in the control group (P > 0.05). These data indicate that miR-146a might be more involved in the local immune disorder of OLP. MiR-146a might be utilized as a candidate biomarker to estimate the severity of OLP.

Altered Autophagy-Associated Genes Expression in T Cells of Oral Lichen Planus Correlated with Clinical Features

Oral lichen planus (OLP) is a T cell-mediated inflammatory autoimmune disease. Autophagy has emerged as a fundamental trafficking event in mediating T cell response, which plays crucial roles in innate and adaptive immunity. The present study mainly investigated the mRNA expression of autophagy-associated genes in peripheral blood T cells of OLP patients and evaluated correlations between their expression and the clinical features of OLP. Five differentially expressed autophagy-associated genes were identified by autophagy array. Quantitative real-time RT-PCR results confirmed that IGF1 expression in the peripheral blood T cells of OLP patients was significantly higher than that in controls, especially in female and middle-aged (30–50 years old) OLP patients. In addition, ATG9B mRNA levels were significantly lower in nonerosive OLP patients. However, no significant differences were found in the expression of HGS, ESR1, and SNCA between OLP patients and controls. Taken together, dysregulation of T cell autophagy may be involved in immune response of OLP and may be correlated with clinical patterns.

Expression of cdk4 and p16 in Oral Lichen Planus.

ABSTRACTObjectivesThe purpose of this study was to evaluate the expression of cdk4 and p16, the proteins implicated in hyperproliferation and arrest in oral lichen planus and to compare their expression in erosive and non-erosive oral lichen planus and with normal mucosa and oral squamous cell carcinoma.Material and MethodsAnalysis of cdk4 and p16 expression was done in 43 erosive oral lichen planus (EOLP) and 17 non-erosive oral lichen planus (NOLP) cases, 10 normal mucosa and 10 oral squamous cell carcinoma (OSCC) cases with immunohistochemistry.ResultsThis study demonstrated a significantly increased expression of cytoplasmic cdk4 (80% cases, cells stained - 19.6%), and cytoplasmic p16 (68.3% cases, cells stained - 16.4%) in oral lichen planus (OLP) compared to normal mucosa. cdk4 was much higher in OSCC in both cytoplasm and nuclei compared to normal mucosa. Also, while comparing OLP with positive control, significant difference was noted for cdk4 and p16, with expression being more in OSCC. While comparing EOLP with NOLP; significant differences were seen for cdk4 cytoplasmic staining only, for number of cases with positive staining as well as number of cells stained.ConclusionsOverexpression of cytoplasmic cdk4 and p16 was registered in oral lichen planus, however considerably lower than in squamous cell carcinoma. Erosive oral lichen planus demonstrated overexpression of cytoplasmic cdk4 and premalignant nature compared to non-erosive lesion. Therefore there is an obvious possibility for cytoplasmic expression of cdk4 and p16 to predict malignant potential of oral lichen planus lesions.

Significant association of deficiencies of hemoglobin, iron, folic acid, and vitamin B12 and high homocysteine level with oral lichen planus

A portion of patients with oral lichen planus (OLP) may have nutritional deficiency. This study evaluated whether there was an intimate association of the deficiencies of hemoglobin (Hb), iron, vitamin B12, and folic acid and high blood homocysteine level with OLP. The blood Hb, iron, vitamin B12, folic acid, and homocysteine concentrations in 352 OLP patients were measured and compared with the corresponding levels in 352 age- and sex-matched healthy control participants. We found that 77 (21.9%) OLP patients, 48 (13.6%) OLP patients, 25 (7.1%) OLP patients, and one (0.3%) OLP patient had deficiencies of Hb (men < 13g/dL, women < 12g/dL), iron (< 60μg/dL), vitamin B12 (< 200pg/mL), and folic acid (< 4ng/mL), respectively. Moreover, 52 (14.8%) OLP patients had abnormally high blood homocysteine level. OLP patients had a significantly higher frequency of Hb, iron, or vitamin B12 deficiency and of abnormally elevated blood homocysteine level than healthy control participants (all p<0.001). Upon further dividing OLP patients into those with major erosive OLP (MjEOLP; n=67), minor erosive OLP (n=202), and nonerosive OLP (NEOLP; n=83), we found that MjEOLP patients had a significantly higher mean homocysteine level than NEOLP patients (p=0.035). We conclude that there is a significant association of deficiencies of Hb, iron, folic acid, and vitamin B12 and abnormally high blood homocysteine level with OLP. There may be a close relation of high blood homocysteine level to severity of OLP.

Evaluation of the Relationship between Serum Lipid Profile andOral Lichen Planus.

Background and aims. Oral lichen planus (OLP) is an immunologic disorder. A large number of studies have reported that lipid rafts have a key role in receptor signaling of lymphocytes. Here, we explore the potential of lipid rafts as targets for the development of a new class of agents to down-modulate immune responses and treat autoimmune diseases.Materials and methods. The present cross-sectional study evaluated 88 patients referring to the Department of Oral Medicine in 3 groups (Group 1: erosive OLP; Group 2: non-erosive OLP; Group 3: healthy). A total of 3 mL of blood sample was taken from each subject and the serum levels of cholesterol, triglycerides, HDL and LDL were determined. The mean outcomes of each group were compared with each other and analyzed two by two.Results. The results of statistical analyses showed no significant differences in mean HDL and LDL serum levels between the three groups. The results of post hoc LSD test showed that mean serum levels of subjects with erosive and non-erosive lichen planus were higher than those in healthy subjects. In relation to triglyceride serum levels, the mean serum levels of triglycerides were higher in erosive and non-erosive OLP patients compared to healthy subjects.Conclusion. Triglyceride and cholesterol can be considered to have a critical role in the incidence of lichen planus and in its manifestations as predisposing factors.

Expression of miRNA-155 and miRNA-146a in peripheral blood mononuclear cells and plasma of oral lichen planus patients

To investigate the expression and clinical significance of miRNA-155 and miRNA-146a in peripheral blood mononuclear cells (PBMC) and plasma of oral lichen planus (OLP) patients. Twenty-five female and seven male OLP patients (OLP group) aged 25 to 54 years were selected from January 2012 to May 2013. The diagnosis was confirmed by pathology and the lesions were divided into two non-erosive OLP group (18 cases) and erosive OLP group (14 cases). Twenty healthy sex and age matched volunteers served as control. miRNA-155 and miRNA-146a expressions in PBMC and plasma were examined by real-time PCR. The difference between OLP group and control group was statistically analyzed. The expressions of PBMC and plasma miRNA-155 were higher in OLP patients than those in the healthy control (median, 0.07 vs 0.03, P < 0.05; 5.84 vs 1.32, P < 0.01). The median expression level of miRNA-146a in PBMC and plasma of OLP patients and healthy controls were (1.26 vs 0.58, P < 0.05) and (412.60 vs 238.42, P < 0.01). The plasma miRNA-155 and miRNA-146a expressions were significantly higher in erosive OLP group than those in non-erosive OLP group. There were no significant differences in the expression of PBMC miRNA-155 and miRNA-146a between the two groups. The expressions of PBMC and plasma miRNA-155 and miRNA-146a are higher in OLP patients. The expressions of plasma miRNA-155 and miRNA-146a are associated with OLP severity. The over expression of miRNA-155 and miRNA-146a in OLP may play a role in the pathogenesis of OLP.

Modulation of serum smooth muscle antibody levels by levamisole treatment in patients with oral lichen planus

Serum autoantibodies have been found in patients with oral lichen planus (OLP). This study evaluated whether OLP patients had significantly higher frequencies of serum smooth muscle antibody (SMA) than healthy control individuals, and assessed whether levamisole treatment could modulate the serum SMA levels in OLP patients. This study used an indirect immunofluorescence technique to measure the baseline serum SMA levels in a group of 647 OLP patients and 53 controls. Ninety-five SMA-positive OLP patients were treated with levamisole under a regular follow-up schedule, and their serum SMA levels were measured after treatment. The frequencies of serum SMA in patients with OLP (21.9%), erosive OLP (EOLP, 21.6%), major EOLP (17.9%), minor EOLP (24.2%), and nonerosive OLP (24.4%) were all significantly higher than that (0%) in healthy controls (all p<0.001). Of 142 SMA-positive OLP patients, 95 were treated with levamisole under a regular follow-up schedule. Treatment with levamisole for a period of 2-29 months (mean, 9.4±6.0 months) effectively reduced the high mean serum SMA titer (71.0±7.2) at baseline to an undetectable level (0) in all SMA-positive OLP patients, regardless of different initial serum SMA titers. There was a significantly higher frequency of serum SMA (21.9%) in OLP patients than in healthy controls. Treatment with levamisole for 2-29 months significantly reduced the high serum SMA to an undetectable level, and significantly improved the signs and symptoms in all treated OLP patients.

Serum Level of Interleukin 17 in Patients with Erosive and Non erosive Oral Lichen Planus.

Background and aims Oral lichen planus is a relatively common chronic oral mucosal disease of unknown etiology. Regarding numerous studies on the immunologic factors involved in the etiology of lichen planus, the present study evaluated the serum interleukin-17 (IL-17) level in patients with erosive and non-erosive oral lichen planus. Materials and methods This descriptive analytical study included 24 patients with erosive oral lichen planus (EOLP), 24 patients with non-erosive oral lichen planus (NEOLP) and 24 healthy volunteered as control. Blood samples of the subjects underwent ELISA, using special kits, to determine serum interleukin-17 levels. Data was analyzed using with descriptive statistic, chi-square test, and one-way ANOVA and Tukey post-hoc test with SPSS 16 software. Results EOLP patients showed a high level of serum IL-17 compared with NEOLP patents and control groups (EOLP=184.16 ± 12.41 pg/mL, NEOLP=106.09±10.78 pg/mL, control=15.50 ± 4.34 pg/mL, P - 0.001). Conclusion High level of serum IL-17 in erosive oral lichen planus patients compared to the non-erosive type and healthy individuals may be the reason for higher inflammation and atrophy in the erosive type.

New Clinical Approach for Use of Er:YAG Laser in the Surgical Treatment of Oral Lichen Planus: A Report of Two Cases

The aim of this clinical report is to demonstrate the efficiency of Er:YAG laser in reducing symptoms and lymphoplasmocytic infiltrate in case of oral lichen planus (OLP). In addition to medical therapy and conventional surgery, laser has been proposed for the treatment of this disease, but currently, use of Er:YAG laser (2940 nm) has not been reported. Two clinical cases of female patients who came to our clinic with lesions in the internal portion of the cheek and in the hard palate mucosa close to the upper right molars, surgically treated by Er:YAG laser, are described. The parameters used were as follows: energy, 80-120 mJ; frequency, 6-15 Hz; non-contact hand piece; spot size diameter, 0.9 mm; pulse duration, 100 μsec (VSP) to 300 μsec (SP) ; fluences, 12.6-18.9 J/cm(2); and air/water spray (ratio: 6/5). In the two patients, the peeling of the lesions was completed with much less discomfort (<25% in visual analogue scale). A very small recurrence was observed in one case (cheeks) after 15 months, and the same protocol was applied successfully. The use of this wavelength offers several advantages including, a good and fast healing process, a very low level of discomfort during and after intervention, and a rapid disappearance of symptoms. Even if this methodology seems to be an interesting new surgical approach in the management of non-erosive OLP, this clinical report has to be considered as a preliminary one because of the limited number of cases. As a consequence, further studies and long-term follow-up will be necessary.

Modulation of Serum Antinuclear Antibody Levels by Levamisole Treatment in Patients With Oral Lichen Planus

Serum autoantibodies, including antinuclear antibodies (ANAs), have been found in patients with oral lichen planus (OLP). This study evaluated whether Taiwanese OLP patients had significantly higher frequencies of serum ANAs than healthy control subjects, and whether levamisole treatment could modulate the antibody levels. This study used an indirect immunofluorescence technique to measure the baseline serum levels of ANA in a group of 583 Taiwanese OLP patients and 53 healthy control subjects. Seventy-nine ANA-positive OLP patients were treated with levamisole under a regular follow-up schedule in our dental clinic, and their serum ANA levels were measured after treatment. We found that the frequencies of serum ANA in patients with OLP (23.2%), erosive OLP (EOLP, 23.8%), major EOLP (31.5%), and minor EOLP (18.1%) were all significantly higher than that (5.7%) in healthy control subjects. In addition, major EOLP patients had a significantly higher serum ANA positive rate than minor EOLP or non-erosive OLP patients. Of 135 ANA-positive OLP patients, 79 were treated with levamisole under a regular follow-up schedule. We found that treatment with levamisole for a period of 2-38 months (mean, 12 ± 9 months) effectively reduced the high mean serum ANA titer (557 ± 98) at baseline to an undetectable level (0) in all ANA-positive OLP patients, regardless of different high initial serum titers of ANA. There was a significantly higher frequency of serum ANA (23.2%) in Taiwanese OLP patients than in healthy control subjects. Treatment with levamisole for 2-38 months reduced the high serum ANA to an undetectable level, and significantly improved the signs and symptoms in all treated OLP patients.

Modulation of Serum Anti-thyroglobulin and Anti-thyroid Microsomal Autoantibody Levels by Levamisole in Patients With Oral Lichen Planus

Several types of serum autoantibodies including anti-thyroglobulin (TGA) and anti-thyroid microsomal autoantibody (TMA) were detected in patients with oral lichen planus (OLP). This study evaluated whether Chinese OLP patients had significantly higher frequencies of serum TGA and TMA than healthy control subjects, and whether levamisole treatment could modulate serum TGA and TMA levels in Chinese OLP patients. This study used a semi-quantitative microtiter particle agglutination test to measure the baseline serum levels of TGA and TMA in a group of 278 Chinese OLP patients and 53 healthy control subjects. Forty-one TGA-positive and 48 TMA-positive OLP patients were treated with levamisole for a complete period of 1 year, and their serum TGA and TMA levels were measured after treatment. We found that the frequencies of serum TGA and TMA in patients with OLP (21.6% and 24.5%, respectively), erosive OLP (21.8% and 24.5%, respectively), or non-erosive OLP (19.0% and 23.8%, respectively) were significantly higher than those (1.9% and 1.9%, respectively) in healthy control subjects. After 1 year of levamisole treatment, the serum TGA and TMA titers decreased partially or became undetectable in 36 (88%) TGA-positive and 46 (96%) TMA-positive OLP patients. At least 9 months or 3 months of levamisole treatment were needed to reduce the mean serum TGA or TMA titer to a significantly lower level in OLP patients, respectively. Significantly higher frequencies of serum TGA and TMA were found in Chinese OLP patients than in healthy control subjects. After 1 year of levamisole treatment, serum TGA and TMA levels were reduced partially or became undetectable in approximately 88% of TGA-positive and 96% of TMA-positive OLP patients.

Scanning Electron Microscopic Study of Surface Epithelial Cells in Erosive and Nonerosive Oral Lichen Planus

Aim of the study is to study the surface epithelial cells of erosive, nonerosive lichen planus by scanning electron microscope (SEM) and to correlate it with that of normal mucosa and oral leukoplakia. Twenty biopsies of lichen planus and five biopsies of normal mucosa were taken. Half piece of each biopsy was processed for H&E stain and another half for SEM study. Surface epithelial cells were showing different features. Definite different features were seen in lichen planus-leukoplakia group than in normal oral mucosa. These changes are due to abnormality in cell maturation and differentiation. SEM study is helpful in early detection of dysplasia. It can lead to early treatment of the lesion and thus prevention of squamous cell carcinoma.

Upper gastrointestinal findings and detection of Helicobacter pylori in patients with oral lichen planus

Lichen planus (LP) is a mucocutaneous disease of unknown aetiology, which may involve the gastrointestinal (GI) mucosa. The association of Helicobacter pylori with LP has been a subject of debate. To investigate upper GI findings and the presence of H. pylori in GI mucosa and oral LP (OLP). Oral biopsies from 20 patients with erosive OLP and 20 with non-erosive OLP were investigated for the presence of H. pylori by histopathological examination and PCR. Upper GI endoscopy and GI mucosal biopsies were examined for LP lesions and/or H. pylori. The endoscopic findings of both groups were oesophagitis, antral gastritis and duodenitis. No LP or LP-like changes were found in the upper GI mucosa. H. pylori was found by histopathological examination in the gastric mucosa of 18 patients (45%), with equal distribution in both the control and study groups. Positive PCR results were obtained from biopsy specimens of oral lesions in all patients with erosive OLP and presence of H. pylori in the stomach (9 patients), but in none of the patients with non-erosive OLP (P = 0.001). We did not find any difference in symptoms, endoscopic findings and histopathological results between patients with erosive and non-erosive OLP. However, the concomitant presence of erosive OLP, of H. pylori nucleic acid in erosive OLP and the H. pylori organisms in gastric mucosa implies a possible pathogenic connection between this bacterium and erosive OLP.

Association of Polymorphisms in the Human IFN-γ and IL-4 Gene with Oral Lichen Planus: A Study in an Ethnic Chinese Cohort

Cytokines have an important role in the pathogenesis and disease progression of oral lichen planus (OLP). The aim of this study was to investigate the impact of gene polymorphisms of T helper cell subtype Th1 and Th2 cytokines, interferon-gamma (IFN-gamma) and interleukin-4 (IL-4), on OLP in an ethnic Chinese cohort. We investigated IFN-gamma gene (IFNG) and IL-4 gene (IL-4) polymorphisms in 151 patients with OLP and 143 healthy controls using the polymerase chain reaction with sequence-specific primers (PCR-SSP) method. Each genotype was also validated by direct DNA sequencing methods to further guarantee the significance of our findings. The data revealed that there were highly significant increases in +874 IFNG2 genotype distributions and allele T frequencies in both the OLP patient group (p = 0.033, 0.003) and the more progressive subtype group (eOLP)(p = 0.013, 0.001) compared with those of normal controls There was no difference between the OLP patient and healthy control groups in frequencies of both the IL-4 allele (p = 0.053) and genotype (p = 0.197), although the frequencies of the IL4-590 C allele (p = 0.001) and the CC genotype (p = 0.024) in patients with nonerosive OLP (neOLP) were significantly greater than the corresponding values in the control group. Our study suggests that IFN-gamma and IL-4 gene polymorphisms seem to have a positive influence on disease susceptibility and progression of OLP in this ethnic Chinese cohort.

Levamisole can reduce the high serum tumour necrosis factor-? level to a normal level in patients with erosive oral lichen planus

In this study, we measured the baseline serum levels of tumour necrosis factor (TNF)-alpha in 158 patients with oral lichen planus (OLP) and in 54 normal control subjects. In total, 60 patients with erosive OLP (EOLP) with relatively high TNF-alpha levels were treated with levamisole and the serum TNF-alpha levels measured after treatment. We found that the mean +/- SD serum level of TNF-alpha in patients with either type of EOLP (12.0 +/- 1.7 pg/mL, P<0.005), major EOLP (15.5 +/- 4.4 pg/mL, P<0.001), minor EOLP (11.1 +/- 1.8 pg/mL, P<0.01), or nonerosive OLP (6.1 +/- 1.7 pg/mL, P<0.05) was significantly higher than that (3.8 +/- 0.2 pg/mL) of normal control subjects. Treatment with levamisole for a period of 0.5-7.5 months significantly reduced the mean serum TNF-alpha level from 22.6 +/- 3.4 pg/mL to 6.2 +/- 0.8 pg/mL (P<0.001) in 60 patients with EOLP. We conclude that levamisole can reduce high serum TNF-alpha levels to normal in patients with EOLP.

Serum interleukin-8 level is a more sensitive marker than serum interleukin-6 level in monitoring the disease activity of oral lichen planus

Oral lichen planus (OLP) is a T-cell-mediated inflammatory disease. Interleukin (IL)-8 is a pro-inflammatory cytokine of host response to injury and inflammation. To investigate whether serum IL-8 level was a more sensitive marker than serum IL-6 level in monitoring the disease activity of OLP and to assess whether IL-8 was a useful serum marker in evaluating the therapeutic effects of levamisole on OLP patients. In this study, we used a solid phase, two-site sequential chemiluminescent immunometric assay to determine the baseline serum levels of IL-6 and IL-8 in 158 patients with OLP, nine patients with traumatic ulcers (TU) and 54 normal control subjects. Some OLP patients with the serum IL-6 or IL-8 levels higher than the upper limit of normal serum concentration were treated with levamisole for 0.5-6.0 months and their serum IL-6 and IL-8 levels were measured after treatment. We found that 28% (44 of 158) OLP, 28% (40 of 142) erosive OLP (EOLP), and 25% (four of 16) nonerosive OLP (NEOLP) patients had a serum IL-6 level greater than the upper normal limit of 4.7 pg mL(-1). In contrast, 63% (99 of 158) OLP, 63% (90 of 142) EOLP and 56% (nine of 16) NEOLP patients had a serum IL-8 level greater than the upper normal limit of 8.7 pg mL(-1). In some OLP patients with the serum IL-6 or IL-8 levels higher than the upper limit of normal serum concentration, treatment with levamisole for a period of 0.5-6.0 months could significantly reduce the mean serum IL-6 level from 14.3 +/- 1.9 pg mL(-1) to 3.2 +/- 0.6 pg mL(-1) (P < 0.001) and could significantly reduce the mean serum IL-8 level from 95.8 +/- 17.1 pg mL(-1) to 14.8 +/- 5.8 pg mL(-1) (P < 0.001). Because measurement of the serum IL-8 level can detect more OLP patients with an abnormal serum level than measurement of the serum IL-6 level (63% vs. 28%), we conclude that serum IL-8 level is a more sensitive marker than serum IL-6 level in monitoring the disease activity of OLP. Levamisole can modulate both the serum IL-6 and IL-8 levels in OLP patients. IL-8, like IL-6, is also a useful serum marker in evaluating the therapeutic effects of levamisole on OLP patients.

Hepatitis C virus infection in Italian patients with oral lichen planus: a prospective case-control study.

To assess the aetiology of liver disease associated with lichen planus, we prospectively studied 70 consecutive newly diagnosed patients with oral lichen planus (OLP) living in northwest Italy (Piemonte) and 70 controls matched for age and sex with other oral keratoses coming from the same district. Twenty-two patients with OLP (31.4%) and 9 controls (12.9%) were found to be affected by chronic liver disease (CLD) (P = 0.014). In sixteen of the 22 OLP patients with CLD the liver disease was hepatitis C virus (HCV)-related, whereas 2 of the 9 controls had a HCV-related CLD (P = 0.016). In another OLP case, liver damage was related to a combination of HCV and alcohol abuse. The prevalence of HCV antibodies in the whole OLP group (27.1%) was significantly higher than in controls (4.3%) (P = 0.014), whereas no difference was found between the OLP and control groups regarding hepatitis B virus markers and other common causes of CLD. HCV infection was more frequently found in patients with erosive OLP (58.8%) than in patients with non-erosive OLP (13.2%) (P = 0.004). Serum HCV-RNA was detected by polymerase chain reaction (RT-PCR) in the majority (93.7%) of OLP patients who had HCV antibodies. Excluding OLP and control patients with HCV markers, there was no difference between the two groups regarding frequency of CLD. Our data show that HCV is probably the main pathogenic factor in liver disease of Italian patients with OLP, and suggests that HCV could be involved in the pathogenesis of OLP.