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Association between lichen sclerosus and thyroid diseases: A systematic review and meta-analysis
Corresponding author: Dr. Ching-Chi Chi, Department of Dermatology, Chang Gung Memorial Hospital, Linkou Main Branch, Guishan Dist, Taoyuan, Taiwan. chingchi@cgmh.org.tw
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Received: ,
Accepted: ,
How to cite this article: Wu PC, Huang IH, Tai CC, Chi CC. Association between lichen sclerosus and thyroid diseases: A systematic review and meta-analysis. Indian J Dermatol Venereol Leprol. doi: 10.25259/IJDVL_54_2025
Abstract
Background
Lichen sclerosus (LS) is a chronic inflammatory dermatosis characterised by ivory-white patches to plaques. Evidence suggests an autoimmune aetiology for LS, given its association with various autoimmune conditions, such as autoimmune thyroiditis, alopecia areata (AA), and vitiligo. However, the association between LS and thyroid diseases remained controversial.
Aim
We aimed to investigate the association between LS and thyroid diseases.
Methods
We performed a systematic review of studies on the association between LS and thyroid diseases. We searched CENTRAL, MEDLINE, and Embase from inception to May 28, 2024. Studies were included if they were case-control designs with LS patients and controls, reported thyroid disease outcomes, and provided effect estimates; two authors screened titles and abstracts to exclude studies without LS or thyroid data, lacking controls, reviews, case reports, or grey literature, with disagreements resolved by the corresponding author. Odds ratio (OR) of various thyroid conditions in relation to LS was calculated using a random-effects model meta-analysis. When adjusted estimates were available, the pooled adjusted OR (aOR) was calculated. The risk of bias in the selected studies was assessed using the Newcastle–Ottawa Scale for case-control studies.
Results
We included nine studies involving 1,77,488 LS patients and 2,21,77,269 controls. Most patients, primarily middle-aged females, were recruited from the USA, and more were recruited from Poland, Sweden, the UK, Finland, and Serbia. All the studies scored 7 or higher for quality in selection, comparability, and exposure. Significant associations were identified between LS and various thyroid conditions, including thyroid diseases (OR 2.48; 95% confidence interval (CI) 2.01–3.05, from two studies, 1,055 LS patients and 2,040 controls), thyroiditis (OR 2.07; 95% CI 1.18–3.63, from two studies, 1,202 LS patients and 2,252 controls), autoimmune thyroid disease (OR 4.07; 95% CI 3.78–4.38, from one study, 10,004 LS patients and 21,672,016 controls), autoimmune thyroiditis/Hashimoto thyroiditis (OR 2.97; 95% CI 1.92–4.59, from three studies, 21,461 LS patients and 21,707,152 controls), and Graves’ disease (OR 2.34; 95% CI 2.02–2.71, from 1 study, 10,004 LS patients and 21,672,016 controls) based on crude estimates. The adjusted estimates revealed significantly increased odds of family history of thyroid disease (aOR 9.10; 95% CI 2.30–36.00), hypothyroidism (aOR 1.91; 95% CI 1.24–2.95), thyroiditis (aOR 2.00; 95% CI 1.22–3.29), and autoimmune thyroiditis/Hashimoto thyroiditis (aOR 2.88; 95% CI 1.95–4.25) among LS patients.
Limitations
Limitations such as a small number of included studies, lack of subgroup data, reliance on a few studies for analysis, absence of long-term cohort data, potential influence of systemic treatments, and variability in thyroid disease terminology highlight the need for future research with more diverse populations, standardised definitions, and comprehensive data. Significant association exists between LS and thyroid diseases, particularly thyroiditis and autoimmune thyroiditis/Hashimoto thyroiditis. The physicians should look for thyroid related symptoms, such as, palpitation, heat intolerance, and body weight changes in LS patients, and early endocrinology consult should be sought to diagnose and manage thyroid diseases.
Conclusion
We found significant associations between LS and thyroid diseases, particularly thyroiditis and autoimmune thyroiditis, as well as Hashimoto thyroiditis.
Keywords
Lichen sclerosus
meta-analysis
systematic review
thyroid diseases
thyroiditis
Introduction
Lichen sclerosus (LS) is a chronic inflammatory dermatosis characterised by ivory-white glistening patches to plaques.1 It primarily affects the anogenital areas, potentially leading to skin atrophy, genital scarring, and sexual and urinary dysfunction.2 LS is more common in females than males, with an estimated prevalence of 1 in 300 to 1 in 1000 in the general population.3 Although the exact pathogenesis of LS remains unclear, autoimmunity, genetic predisposition, infection, and hormones have been implicated in the literature.3,4 Evidence suggests an autoimmune aetiology for LS, given its association with various autoimmune conditions, such as autoimmune thyroiditis, alopecia areata (AA), vitiligo, and pernicious anaemia.3,5 Among them, autoimmune thyroid disease is particularly discussed due to its abnormal activity of T-lymphocytes similar to LS.4-6
The association between thyroid diseases and skin autoimmunity has been extensively investigated. Strong evidence has indicated the association with thyroid diseases and vitiligo, dermatitis herpetiformis, chronic urticaria, AA, and psoriasis.7 Shared genetic susceptibility, expression of melanocyte-specific or thyroid-specific antigens, and thyroid hormone alterations are proposed mechanisms underlying the progression of these autoimmune skin diseases.8-10 However, the association between LS and thyroid diseases remained controversial. The reported prevalences of thyroid diseases in LS patients varied widely among studies, ranging from 6% to 33%.4-6,11-14 Furthermore, different thyroid conditions, such as hyperthyroidism, hypothyroidism, thyroiditis, or autoimmune thyroid disease, showed varied associations with LS. Therefore, we performed this systematic review and meta-analysis to explore the association between LS and thyroid diseases with an emphasis on different types of thyroid diseases.
Methods
We registered our protocol with the International Prospective Register of Systematic Reviews (CRD42022361332) and followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines.15 The types of eligible studies included comparative observational studies. Two experienced reviewers (P.W. and I.H.) independently performed the literature search, data extraction, and quality assessment.16,17 Any disagreement was resolved by consensus among the reviewers or referred to a third reviewer (C.C.).18,19
Data search and selection
The eligibility criteria for study inclusion were defined using the Population, Exposure, Comparator, and Outcome (PECO) framework as follows: (1) Population (P): individuals; (2) Exposure (E): presence of LS; (3) Comparison (C): individuals without LS, serving as controls; and (4) Outcome (O): the primary outcome was thyroid disease in individuals with LS relative to non-LS controls. Secondary outcomes included family history of thyroid disease, hyperthyroidism, hypothyroidism, thyroiditis, autoimmune thyroid disease, autoimmune thyroiditis (including Hashimoto thyroiditis), and Graves’ disease. Studies were eligible for inclusion if they: (1) were case-control studies including both LS patients and non-LS controls; (2) reported thyroid disease outcomes; and (3) provided effect estimates such as odds ratio (OR) with corresponding 95% confidence interval (CI) for the association between LS and thyroid conditions.
Based on the aforementioned criteria, relevant terms, including ‘lichen sclerosus’, ‘thyroid disease’, ‘hypothyroidism’, ‘hyperthyroidism’, and ‘thyroiditis’ were used in the literature search conducted in free text, medical subject headings, and abbreviations. The search strategy employed was adapted from our previous Cochrane review.20 The keywords were combined using appropriate Boolean operators, and a primary search strategy was developed without limitations regarding language and published status. The primary search strategy involved a CENTRAL (Cochrane Library) search, which was adapted to MEDLINE and Embase [Supplementary Table 1]. Handsearch of the bibliographies of included studies was also performed. The final search of all databases was completed on May 28, 2024.
Study selection
After potential studies were identified, two authors excluded irrelevant studies by screening the title and abstract in accordance with the following exclusion criteria: (1) studies recruiting non-LS patients or patients who did not report thyroid diseases, (2) studies without a control group, (3) review articles or case reports and (5) grey literature not providing patient data. Disagreements between the two authors were resolved by the corresponding author.
Data extraction and risk of bias assessment
The following data were extracted from the included studies: reference (author name and year of publication), study design, country, database, or facilities that recruit patient data, study period, type of LS, number of LS patients and controls, patient age and sex, and reported outcomes. When essential data were unavailable or unclear, the corresponding studies were excluded from quantitative synthesis to maintain the integrity and reliability of the analysis. The risk of bias in the selected studies was assessed using the Newcastle-Ottawa Scale for case-control studies, which consisted of three sections, including selection, comparability, and exposure, with a maximum score of 9 points.
Data synthesis and analysis
We conducted a meta-analysis in a random-effects model for quantitative synthesis. Dichotomous analysis was performed for crude estimates using OR with 95% CI. When adjusted estimates were available, the pooled adjusted OR (aOR) was calculated. To assess the quality of the pooling results, this study evaluated the heterogeneity and small study effect; I2 and the P value of Cochran’s Q were used to assess heterogeneity. Substantial heterogeneity was defined as an I2 value of > 50%.19 If the number of the study was greater than or equal to 10, a small study effect was illustrated using the funnel plot and assessed using Egger’s test to guarantee a good performance.21 The pooled results seemed to be affected by a small study effect when the P value of Egger’s test was <0.05. All statistical analyses were performed using Review Manager (RevMan) version 5.4.
Results
The flow diagram for evidence selection has been displayed in Figure 1. In total, 254 studies were identified from the three important biomedical databases and a hand search. Manual screening further showed that 44 studies were duplicates. Of the remaining 210 studies, 154 were excluded after the title, abstract, and article type were screened because they did not include LS patients (n=104) or they were not reporting data on thyroid diseases (n=50). Full-text article assessment was performed for the remaining 56 studies, which further excluded 15 review articles, one conference abstract, 18 non-comparative studies, and 13 case reports. Finally, the data sources of the eligible studies were obtained from nine studies. All studies were included in this study for qualitative analysis and quantitative synthesis.
- PRISMA flowchart of the selection of studies.
Characteristics and quality of the included studies
Table 1 presents the characteristics of the included studies. The nine studies involved 1,77,488 LS patients and 2,21,77,269 controls. Most patients were recruited from the USA,4,6,14 while the other patients were from Poland, Sweden,23 the UK,5 Finland,12 and Serbia.13 Most patients and controls were middle-aged females. All the included studies exhibited high quality in selection, comparability, and exposure sections with a score of 7 or higher [Supplementary Table 2].
| First author, publication year | Design | Country | Database (coding) | Study period | LS type | Group | n | Age* | Sex (M/F) | Reported outcomes |
|---|---|---|---|---|---|---|---|---|---|---|
| Dulska et al. 202422 | Case-control | Poland | Patient data from the gynaecological clinic Centrum Zdrowia Kobiety in Katowice, Poland (diagnosis in children based on medical history and physical examination) | 2020-2021 | Genital | LS | 20 | 10.8 | 0/20 | Anti-thyroid antibodies, Family history of thyroid autoimmune disease (Hashimoto thyroiditis) |
| control | 35 | 10.8 | 0/35 | |||||||
| Gulin et al. 202423 | Case-control | Sweden | The National Patient Register database (ICD-10-CM) | 2001-2021 | NR | LS | 154,424 | NR | 44,973/1,09,451 | Thyroiditis, hyperthyroidism |
| control | 463,273 | NR | 1,34,919/3,28,354 | |||||||
| Halonen et al. 202424 | Case-control | Finland | Patient data from the Care Register for Health Care, the Population Information System, and census data at Statistics Finland (ICD-19-CM) | 1998-2016 | NR | LS | 10,692 | 60.8 | 0/10,692 | Autoimmune thyroiditis/Hashimoto thyroiditis, Basedow disease/Graves’ disease/hyperthyroidism, hypothyroidism |
| control | 32,076 | 60.8 | 0/32,076 | |||||||
| Fan et al. 20226 | Case-control | USA | Electronic health record database (ICD-10-CM and/or SNOMED code) | 2018-2022 | NR | LS | 765 | 66.2 ± 12.5 | 0/765 | Thyroid cancer, thyroiditis, autoimmune thyroiditis, hypothyroidism, hyperthyroidism |
| control | 3,060 | 66.2 ± 12.5 | 0/3,060 | |||||||
| Bieber et al. 202114 | Case-control | USA | IBM MarketScan Databases (ICD-10-CM) | 2015-2017 | NR | LS | 10,004 | 50.8 | 0/10,004 | Hashimoto disease/chronic lymphocytic thyroiditis/autoimmune thyroiditis, Graves’ disease/thyrotoxicosis, all autoimmune thyroid disease |
| control | 21,672,016 | 50.8 | 0/2,16,72,016 | |||||||
| Hieta et al. 202112 | Case-control | Finland | Hospital patient data from Turku University Hospital in Southwest Finland (ICD-10-CM) | 2004-2012 | NR | LS | 455 | 64.4 | 0/455 | Hypothyroidism |
| control | 4,550 | 64.4 | 0/4,550 | |||||||
| Hu et al. 20214 | Case-control | USA | Patient data from University of Michigan Center (criteria including symptoms, physical examination, and vulvar biopsy) | 1996-2019 | Genital | LS | 865 | 54.4 ± 15.7 | 0/865 | Thyroid disease (including hyperthyroidism and hypothyroidism) |
| control | 1,118 | 42.9 ± 16.0 | 0/1,118 | |||||||
| Bjekic´ et al. 201113 | Case-control | Serbia | Patient data from the City Dispensary for Skin and Venereal Diseases in Belgrade (diagnoses made by history and physical examination) | 2007-2008 | NR | LS | 73 | NR | 73/0 | Family history of thyroid disease (Graves’ disease, Hashimoto thyroiditis, hyperthyroidism, and thyroid cancer) |
| control | 219 | NR | 219/0 | |||||||
| Cooper et al. 20085 | Case-control | the UK | Patient data from vulval clinics in Oxfordshire, England (typical features of adult-onset LS) | NR | Genital | LS | 190 | 63 | 0/190 | Thyroid disease |
| control | 922 | 62 | 0/922 |
Analysis of the association between LS and thyroid diseases using crude estimates
The meta-analysis of crude estimates is presented in Figure 2. Significant increases in thyroid diseases (OR 2.48; 95% CI 2.01–3.05), thyroiditis (OR 2.07; 95% CI 1.18–3.63), autoimmune thyroid disease (OR 4.07; 95% CI 3.78–4.38), autoimmune thyroiditis/Hashimoto thyroiditis (OR 2.97; 95% CI 1.92–4.59), and Graves’ disease (OR 2.34; 95% CI 2.02–2.71) were found among LS patients compared to non-LS controls.
- Meta-analysis of crude estimates for prevalent thyroid diseases in patients with lichen sclerosus (LS) compared with non-LS controls.
Analysis of the association between LS and thyroid diseases using adjusted estimates
The meta-analysis of adjusted estimates is presented in Figure 3. Significant increased odds of family history of thyroid disease (aOR 9.10; 95% CI 2.30–36.00), hypothyroidism (aOR 1.91; 95% CI 1.24–2.95), thyroiditis (aOR 2.00; 95% CI 1.22-3.29), and autoimmune thyroiditis/Hashimoto thyroiditis (aOR 2.88; 95% CI 1.95-4.25) among LS patients were found relative to non-LS controls.
- Meta-analysis of adjusted estimates for prevalent thyroid diseases in the lichen sclerosus (LS) patients compared with non-LS controls.Hashimoto thyroiditis. The physicians should look for thyroid related symptoms, such as, palpitation, heat intolerance, and body weight changes in LS patients, and early endocrinology consult should be sought to diagnose and manage thyroid diseases.
Discussion
To our knowledge, this is the first meta-analysis investigating the associations between LS and thyroid diseases. Significantly increased odds of thyroiditis and autoimmune thyroiditis/Hashimoto thyroiditis were found in individuals with LS. These associations were further validated through meta-analysis of adjusted estimates. For adjusted estimates, significantly increased odds of family history of thyroid disease and hypothyroidism were also observed.
We observed a significant association between LS and family history of thyroid disease, with an aOR of 9.10. Additionally, significant increased odds of autoimmune thyroiditis, Hashimoto thyroiditis, and Graves’ disease were found in LS patients. Although the exact pathogenesis of LS is not completely elucidated, genetics is recognised as a pivotal factor.2 A considerable percentage (12%) of LS patients exhibited a positive family history of this condition in a large cohort study, and these patients are more associated to autoimmune diseases.25 Several types of Human leukocyte antigen (HLA), including HLA-DR17 and HLA-DQ7, were found to be more prevalent in LS patients.26-28 Furthermore, certain HLA types have been associated with increased susceptibility to vulvar malignancy in females, such as HLA-A*11, HLA-B*15, HLA-B*35, and HLA-DRB1*12.29 On the other hand, autoimmune thyroiditis, Hashimoto thyroiditis, and Graves’ disease have shown associations with specific HLA types. For example, Hashimoto thyroiditis has been linked with HLA-B8, DR3, DR5, and DQ7, while Graves’ disease has shown significant associations with HLA-DR3, -DRB1, -DQB1.30,31 Genetic factors play a crucial role in both LS and these thyroid diseases, underscoring the importance of awareness among clinicians when patients present with positive family histories of either LS or thyroid diseases.
Emerging evidence suggests a potential association between LS and autoimmune processes.27,32 A cross-sectional study by Goolamali et al. revealed that 40% of female patients were positive for anti-thyroid cytoplasm antibodies, with 80% of them exhibiting subclinical thyroiditis.33 This concept was further supported by Kreuter et al., who found a higher prevalence of anti-thyroid antibodies in female LS patients (11%) compared to controls (9%).3 Moreover, both LS and autoimmune thyroid diseases involve abnormalities in T lymphocytes. In LS patients, autoreactive T-cells against basement membrane proteins have been identified in vulvar tissue and peripheral blood, similar to the T-cell autoreactivity against normal thyroid tissue implicated in autoimmune thyroid diseases.34,35 On the other hand, autoimmune mechanisms targeting thyroid tissue may also contribute to the pathogenesis of inflammatory skin diseases such as AA and psoriasis.36,37 Various skin cell types, including keratinocytes and dermal fibroblasts, have been shown to express functional thyrotropin (TSH) receptors and other thyroid-specific antigens, such as thyroglobulin and thyroid peroxidase.38,39 Alterations of thyroid hormone levels have been reported to impact intraepidermal immunoreactivity, as evidenced by the presence of TSH in normal human epidermis.40 These findings regarding autoimmune origin may offer insights into the observed elevated association between LS and autoimmune thyroid diseases in our study. Further research is warranted to fully understand the potential autoimmune etiology of LS.
The findings of our study primarily focus on female patients with LS, with only two studies on male LS patients.13,23 This gender distribution is likely due to the predominance of LS in females. Female LS patients showed a higher prevalence of anti-thyroid antibodies and anti-nuclear antibodies compared to males.3 Additionally, the proportion of male LS patients positive for anti-nuclear antibodies was lower than that of the general population, suggesting that autoimmunity may not have a significant role in LS aetiology in males as it does in females.41 Our analysis revealed a significant increase in thyroiditis and autoimmune thyroiditis/Hashimoto thyroiditis in female LS patients. Conversely, male LS patients were associated with a significant higher odds of a family history of thyroid disease. However, due to the lack of data on male patients, we were unable to conduct a subgroup analysis based on patient sex. Further studies involving both sexes are required to explore the influence of sex on this issue.
Limitations
This study has several limitations. First, all the included studies recruited patients from European countries. To enhance the generalisation aspect of our findings, further studies encompassing more diverse ethnic populations are required. Second, a rather small number of studies were included in the quantitative synthesis, and the analyses reflected results mainly from one or two studies. However, the total patient number was large. Third, we could not perform subgroup analyses according to age, race, severity, and type of LS, which was limited by a lack of information from included studies. Cohort studies with long-term follow-ups are warranted to explore the association. Fourth, the influence of concurrent systemic steroids or immunosuppressants should also be considered in future studies. Lastly, due to variability and overlap in the terminologies of thyroid disease used by the included studies, the results are presented as currently structured. Future studies employing standardised and unified definitions are warranted.
Conclusion
Our meta-analysis found significant associations between LS and thyroid diseases, particularly thyroiditis and autoimmune thyroiditis/Hashimoto thyroiditis. These results suggest physicians should be alert to thyroid related symptoms, such as, palpitation, heat intolerance, and body weight changes in LS patients, and consult endocrinologists for early recognition and management of thyroid diseases.
References
- EuroGuiderm guideline on lichen sclerosus-introduction into lichen sclerosus. J Eur Acad Dermatol Venereol. 2024;38:1850-73.
- [CrossRef] [PubMed] [Google Scholar]
- Lichen sclerosus: The 2023 update. Front Med (Lausanne). 2023;10:1106318.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Association of autoimmune diseases with lichen sclerosus in 532 male and female patients. Acta Derm Venereol. 2013;93:238-41.
- [CrossRef] [PubMed] [Google Scholar]
- The prevalence of self-reported medical comorbidities in patients with vulvar lichen sclerosus: A single-center retrospective study. Int J Gynaecol Obstet. 2021;153:340-3.
- [CrossRef] [PubMed] [Google Scholar]
- The association of lichen sclerosus and erosive lichen planus of the vulva with autoimmune disease: A case-control study. Arch Dermatol. 2008;144:1432-5.
- [CrossRef] [PubMed] [Google Scholar]
- Thyroid disorders associated with lichen sclerosus: A case–control study in the all of us research program. Br J Dermatol. 2022;187:797-9.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Thyroid diseases and skin autoimmunity. Rev Endocr Metab Disord. 2018;19:311-23.
- [CrossRef] [PubMed] [Google Scholar]
- Hashimoto’s thyroiditis could be secondary to vitiligo: the possibility of antigen crossover and oxidative stress between the two diseases. Arch Dermatol Res. 2016;308:277-81.
- [CrossRef] [PubMed] [Google Scholar]
- Prevalence of thyroid autoimmunity in patients with pemphigus vulgaris. Medicina (B Aires). 2005;65:307-10.
- [PubMed] [Google Scholar]
- High prevalence of thyroid disease in patients with lichen sclerosus. J Reprod Med. 2007;52:28-30.
- [PubMed] [Google Scholar]
- Comorbidity of dermal and cardiovascular disorders with lichen sclerosus: A case-control study. Acta Derm Venereol. 2021;101:adv00594.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Risk factors for genital lichen sclerosus in men. Br J Dermatol. 2011;164:325-9.
- [CrossRef] [PubMed] [Google Scholar]
- Autoimmune and dermatologic conditions associated with lichen sclerosus. J Am Acad Dermatol. 2021;85:228-9.
- [CrossRef] [PubMed] [Google Scholar]
- Meta-analysis of observational studies in epidemiology: A proposal for reporting. JAMA. 2000;283:2008-12.
- [CrossRef] [PubMed] [Google Scholar]
- Association between bullous pemphigoid and psychiatric disorders: A systematic review and meta-analysis. J Dtsch Dermatol Ges. 2022;20:1305-12.
- [Google Scholar]
- Dupilumab in the treatment of genodermatosis: A systematic review. J Deutsche Derma Gesell. 2023;21:7-17.
- [CrossRef] [Google Scholar]
- Ten essential steps for performing a systematic review. A quick tutorial. Dermatol Sin. 2022;40:204-6.
- [CrossRef] [Google Scholar]
- Using grading of recommendations assessment, development, and evaluation (GRADE) to rate the certainty of evidence of study outcomes from systematic reviews: A quick tutorial. Dermatol Sin. 2023;41:3-7.
- [CrossRef] [Google Scholar]
- Topical interventions for genital lichen sclerosus. Cochrane Database Syst Rev. 2015;2015
- [Google Scholar]
- Testing small study effects in multivariate meta-analysis. Biometrics. 2020;76:1240-50.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- The potential coexistence of autoimmune thyroid diseases and pediatric vulvar lichen sclerosus. Children (Basel). 2024;11:255.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Lichen sclerosus-incidence and comorbidity: A nationwide swedish register study. J Clin Med. 2024;13:2761.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Risk factors for lichen sclerosus: A case-control study of 43,000 finnish women. J Low Genit Tract Dis. 2024;28:164-8.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- The high rate of familial lichen sclerosus suggests a genetic contribution: An observational cohort study. Acad Dermatol Venereol. 2010;24:1031-4.
- [CrossRef] [Google Scholar]
- Lichen sclerosus in adult men: A study of HLA associations and susceptibility to autoimmune disease. Br J Dermatol. 1999;140:79-83.
- [CrossRef] [PubMed] [Google Scholar]
- Lichen sclerosus premenarche: Autoimmunity and immunogenetics. Br J Dermatol. 2000;142:481-4.
- [CrossRef] [PubMed] [Google Scholar]
- The immunogenetics of morphea and lichen sclerosus. Adv Exp Med Biol. 2022;1367:155-72.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Associations between HLA-a\B\DRB1 polymorphisms and risks of vulvar lichen sclerosus or squamous cell hyperplasia of the vulva. Genet Mol Res. 2015;14:15962-71.
- [CrossRef] [PubMed] [Google Scholar]
- Actual Associations between HLA haplotype and Graves’ disease development. J Clin Med. 2022;11
- [Google Scholar]
- Hashimoto’s thyroiditis: From genes to the disease. Curr Genomics. 2011;12:576-88.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Lichen Sclerosus: An autoimmunopathogenic and genomic enigma with emerging genetic and immune targets. Int J Biol Sci. 2019;15:1429-3.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Organ-specific antibodies in patients with lichen sclerosus. Br Med J. 1974;4:78-9.
- [CrossRef] [PubMed] [Google Scholar]
- The pathogenesis of thyroid autoimmune diseases: New T lymphocytes - Cytokines circuits beyond the Th1-Th2 paradigm. J Cell Physiol. 2019;234:2204-16.
- [CrossRef] [PubMed] [Google Scholar]
- T cells reactive with the NC16A domain of BP180 are present in vulval lichen sclerosus and lichen planus. J Eur Acad Dermatol Venereol. 2010;24:186-90.
- [CrossRef] [PubMed] [Google Scholar]
- Cover Image: Are melanocyte-associated peptides the elusive autoantigens in alopecia areata? Br J Dermatol. 2017;176:1106.
- [CrossRef] [PubMed] [Google Scholar]
- Prevalence of thyroid autoimmunity in patients with spondyloarthropathies. J Rheumatol. 2011;38:1371-7.
- [CrossRef] [PubMed] [Google Scholar]
- HaCaT keratinocytes express functional receptors for thyroid-stimulating hormone. J Dermatol Sci. 2010;59:52-5.
- [CrossRef] [PubMed] [Google Scholar]
- TSH receptor and thyroid-specific gene expression in human skin. J Invest Dermatol. 2010;130:93-101.
- [CrossRef] [PubMed] [Google Scholar]
- Thyroid-stimulating hormone, a novel, locally produced modulator of human epidermal functions, is regulated by thyrotropin-releasing hormone and thyroid hormones. Endocrinology. 2010;151:1633-42.
- [CrossRef] [PubMed] [Google Scholar]
- Clinical features, complications and autoimmunity in male lichen sclerosus. Acta Derm Venereol. 2017;97:365-9.
- [CrossRef] [PubMed] [Google Scholar]