Mucosal erosive lichen planus is associated with hepatitis C virus: analysis of 104 patients with lichen planus in two decades

Mucosal erosive lichen planus is associated with hepatitis C virus: analysis of 104 patients with lichen planus in two decades Lichen planus (LP) affects the skin and mucous membranes, with incidence in 0.9–1.2% of the world’s population. The etiology of LP remains unknown, but it has been associated with viral infections, including hepatitis C virus (HCV), which has been associated with LP since 1991. The prevalence of serum anti-HCV antibodies in LP patients is nearly 60% in Japan and 10.5–47% in Spain. The present study evaluates a group of patients with LP in the last two decades and compares the frequency of demographic, clinical, and laboratory data in patients with positive and negative anti-HCV serology. In this retrospective cross-sectional study, we reviewed the chart records of 229 patients diagnosed with LP between 1995 and 2015. Clinical and histopathological features helped to confirm LP diagnosis in 134 (58.5%) patients. Cases of LP attributed to drugs were excluded. Gender, age, LP clinical subtype, cutaneous and/or mucosal involvement, response to LP treatment, anti-HCV serology and C virus genotyping, and anti-HBV and HIV serology were analyzed. Statistical analysis to compare the frequency of variables in the two study groups (patients with positive and negative anti-HCV serology) was performed by Fisher’s exact test (PrismGraph 7.0 software). A P-value <0.05 was considered significant. This study was approved by the local Ethics Committee (# 1.807.902). Using ELISA, 104 out of 134 (77.61%) patients were tested for anti-HCV antibodies; 10/104 (9.62%) patients presented positive anti-HCV serology, and RT-PCR confirmed HCV infection in 5/10 (50%) patients with positive anti-HCV serology (one 1a, three 1b, and one 3a genotypes). In the seropositive HCV group, 80% of the patients were aged 59.5 years on average (50–69 years old). In the seronegative HCV group, 48.94% of the patients were aged 45 years on average (40–59 years old). The age was similar in both groups (P = 0.7252). Regarding the efficacy of LP treatment and HBV or HIV association, there were no significant differences (P = 0.2984 and P = 1.0, respectively) (Table 1). The erosive oral clinical form of LP was diagnosed in 3/10 patients in the seropositive anti-HCV group as compared to 6/ 94 (6.38%) patients in the negative anti-HCV group (P = 0.04) (Table 1). LP treatment response was not associated with the clinical forms of LP in both groups (Table 2). The frequencies of LP and LP association with HCV infection depend on the prevalence of HCV diagnosis in each country, and the oral mucosal form of LP has been emphasized. In our study, 9.62% of the patients diagnosed with LP had positive anti-HCV serology. This association was higher (P = 0.0106) when we considered the prevalence of HCV infection (2.5%) estimated by the WHO in Brazil. The HCV genotype 1b was most commonly found, which was consistent with the Brazilian prevalence. Patients with LP are usually aged between 50 and 70 years. In our study, patients were aged between 50 and 59 years in both groups. Females were more affected than Table 1 Clinical and laboratory data of patients with LP associated with positive or negative anti-HCV serology