Lichen planus and hepatitis c virus (HCV) there

　　　　 作者：Adarsh Lata Singh， Sanjeev Chaudhary， A.D. Salodkar， Dr. S.R. Joharapurkar

【摘要】 　　
［ABSTRACT］Fifty patients (28 males and 22 females) with lichen planus were tested for anti HCV antibodies. None of them gave positive result in our case control study. There were various studies conducted in different parts of the world that proved or disproved a causative role for HCV in LP.

【关键词】 Lichen planus， hepatitis c virus

　　INTRODUCTION
　　
　　Lichen planus (LP) is a relatively common benign dermatological disease with unknown etiology， its frequency of prevalence is 1.4% in the world and 0.76% in India.［1，2］ Histologically it is characterized by a dense subepidermal lymphocytic infiltrate， hypergranulosis， civatte bodies［4］. Hepatitis C Virus (HCV) a flavivirus is mainly transmitted via transfusion of blood or blood products. It is estimated that 3% of the world population is being infected with HCV and it has been also implicated as an etiological factor for the occurrence of lichen planus. ［1，3，4］

　　MATERIAL AND METHODS
　　
　　This present study was conducted in the Department of Dermatology， Venereology and Leprosy， Jawaharlal Nehru Medical University and associated AVBRH， Sawangi (meghe) Wardha. A total fifty clinically and histopathologically proven cases of lichen planus included in the study. All patients were tested for anti HCV antibodies (Hepatitis C Virus Encoded Antigen (CORE， NS3， NS4， and NS5) Biomed Industries 4TH Generation HCV TriDot Rapid Visual Test for the detection of Hepatitis C in Human serum/plasma). The results were analyzed and compared with those of 50 HIVseronegative volunteer controls (not suffering from LP) selected from the outpatient department willing to participate in the study. Patients were matched for age and sex both in study and control group (Table 1). The morphology of the lesions， types， sites involved， distribution of lesions and associated disease all examined. Routine laboratory tests on blood including liver function tests， kidney function test and ultrasonography of abdomen was performed in all cases of LP as well as in control group. All patients were treated with topical or intralesional steroids and symptomatic drugs as per indications.

　　RESUITS
　　
　　There were 28 males (56%) and 22 females (44%) in study group. The majority of the patients were in the 4150 years age group both in study (34%) and control group (26%) respectively. None of the patients， either in study or control group showed reactivity to HCV. Clinically 70% of the patients had both oral and cutaneous lichen planus， 20% had only oral lichen planus and 10% had only cutaneous lichen planus. The duration of LP lesions ranges between 4 months to 2 years.Table 1 Demographic profile of study and control population（略）

　　HCV is a flavivirus with a positive sense singlestrand RNA (ssRNA); the ends of the RNA are conserved. The polyprotein encoded is cleaved by host and viral proteases to yield at least nine polypeptide proteins， core peptides and viral envelope proteins E1 and E2， which encode six nonstructural (NS) proteins termed， NS2， NS3， NS4a， NS4b， NS5a， and NS5b include RNA polymerase， cyclase， and those proteins necessary for viral replication. HCV particles are found in immune lymphocytes， macrophages， and dendritic cells， as well as in epithelial cells and cells of blood vessels. There were various studies conducted in different parts of the world and have proved or disproved a causative role for HCV in LP， ［3，16］ Like superantigen theory of immune stimulation in LP， HCV replicates in epithelial cells of lesional and nonlesional skin in OLP (oral lichen planus).［3］ Another study suggest HCV exerts an indirect effect， mediated possibly by the induction of cytokines and lymphokines.［5］ In one more study， there is detection of HCV viral sequences and HCVspecific CD4+ and/or CD8+ T lymphocytes in oral samples of LP patients suggests that HCV might be involved in the development of oral lesions via an immunological pathway， characterized by an excessive production of Th1 cytokines following an ineffective antiviral immunoresponse.［6］ There is one more factor HLADR6 that could be responsible for the peculiar geographic heterogeneity of the association between HCV and OLP like in Italian patient .［5，7，9］ There is one review study which focuses on the dilemma in evaluating the potential role of LP in diagnosing HCV infection as one of the first overt markers of potentially fatal chronic liver disease with elevated SGOT/SGPT levels.［4，1012］ The above conclusions that LP， mainly (OLP) may be significantly associated with HCV infections is made， as in Italy， Spain， Japan and USA that favors， whereas controversial data are coming from France ，Germany ， Holland， UK and in India.［8，9，13］ The association between hepatitis C virus (HCV) infection and lichen planus (LP) is a subject of controversy， because prevalence studies of HCV infection in LP patients in various countries reveal perse results.［5］
　　
　　In our study we have not found any association between lichen planus (oral and nonoral) and HCV infection. Although association between HCV infection and lichen planus has been described， the association between the two diseases could not been established may be due to geographical origin of patients was an important factor in HCV prevalence in patients with LP.［2］

　　On above observation we can say that not only association between HCV and LP but percentage of HCV infection itself also geographically differs. There is need of that other factors in the pathogenesis of this dermatosis should be studied because possible role of hepatitis C virus (HCV) has been studied with controversial results.［14］
　　
　　On the basis of above findings we can say that antiHCV antibody testing is not necessarily required in LP patients with no risk factors for HCV infection in this geographic region.［15］Although in many studies the correlation between HCV and LP has been observed， however in present study we could not find any such association between HCV and lichen planus lesions.

参考文献

　　1 Smitha Prabhu， K Pavithran， G Sobhanadevi， Lichen planus and hepatitis c virus (HCV)  Is there an association? A serological study of 65 cases. Indian J Dermatol Venereol Leprol. 2002;68:2734.

　　2 Narayan S， Sharma RC， Sinha BK， Khanna V. Relationship between lichen planus and hepatitis C virus. Indian J Dermatol Venereol Leprol.1998;64:2812 .

　　3 Schwartz RA， Birnkrant AP. Cutaneous Manifestations of Hepatitis C. http://emedicine.medscape.com/article/1134161overview (accessed on 21.09.2009) .

　　4 Chuang TY， Stitle L. Lichen Planus. http://emedicine.medscape.com/article/1123213overview (accessed on 21.09.2009) .

　　5 Femiano F， Scully C. Functions of the cytokines in relation oral lichens planushepatitisC Med Oral Patol Oral Cir Bucal. 2005; 10:E404.

　　6 Giovanni Lodi， Crispian Scully， Marco Carrozzo， Mark Griffiths， Philip B.Sugerman， Kobkan Thongprasom， Waltham， Mass， Current controversies in oral lichen planus: Report of an international consensus meeting. Part 1. Viral infections and etiopathogenesis.Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:4051.

　　7 Carrozzo M， Brancatello F， Dametto E， Arduino P， Pentenero M， Rendine S， Porter SR， Lodi G， Scully C， Gandolfo S. Hepatitis C virusassociated oral lichen planus: is the geographical heterogeneity related to HLADR6?J Oral Pathol Med. 2005; 34(4):2048.

　　8 Tucker S.C， Coulson I.H. Lichen planus is not associated with hepatitis C virus infection in patients from North West England. Acta Derm Venereol. 1999; 79(5):3789.

　　9 Gandolfo S， Carrozzo M. Lichen planus and hepatitis C virus infection. Minerva Gastroenterol Dietol. 2002; 48(2):89.

　　10 Ferri C， A L Zignego， and S A Pileri， Cryoglobulins. J Clin Pathol. 2002; 55(1): 413.

　　11 Maticic M. Lichen planus in hepatitis C virus infection: an early marker that may save lives. Acta Dermatovenerol Alp Panonica Adriat. 2007; 16(1):36.

　　12 Ali AA， Suresh CS. Oral lichen planus in relation to transaminase levels and hepatitis C virus. J Oral Pathol Med. 2007; 36(10):6048.

　　13 Ghaderi R， Makhmalbaf Z，The Relationship between Lichen Planus and Hepatitis C in Birjand， Iran.Shiraz EMedical Journal，Vol. 8， No.2， April 2007.

　　14 LuisMontoya P， CortésFranco R， VegaMemije ME. ［Lichen planus and hepatitis C virus. Is there an association?］Gac Med Mex. 2005; 141(1):235.

　　15 Stojanovic L， Lunder T， Poljak M， Mars T， Mlakar B， Maticic M. Lack of evidence for hepatitis C virus infection in association with lichen planus， Int J Dermatol. 2008; 47(12):12506.

　　16 Lazaro P， Olalquiaga J， Bartolomé J， OrtizMovilla N， RodríguezIigo E， Pardo M， Lecona M， Pico M， Longo I， GarcíaMorrás P， Carreo V. Detection of hepatitis C virus RNA and core protein in keratinocytes from patients with cutaneous lichen planus and chronic hepatitis C. J Invest Dermatol. 2002;119(4):798803.