Lichen planus and hepatitis c virus (HCV) - Is there an association? A serological study of 65 cases

Smitha Prabhu, K Pavithran, G Sobhanadevi

 Department of Dermatology and Venereology, Medical College Hospital, Calicut-673 008, India

Correspondence Address:
K Pavithran
Department of Dermatology and Venereology, Medical College Hospital, Calicut-673 008
India

Introduction

Lichen planus is a relatively common dermatological disease, with a frequency of prevalence of 1.4% in the world and 0.76% in India. Many agents have been implicated in its etiology, but none could be proved. It was found to be more frequent in patients with hepatic dysfunction. With the discovery of hepatitis C virus, a single stranded RNA virus in 1989, and with the availability of tests for anti HCV antibodies in 1991, an increased prevalence of lichen planus (LP), especially oral and erosive LP was found in people with HCV infection. Various studies conducted in different parts of the world have proved or disproved a causative role for HCV in LP 1-8,10

Subjects and Methods

At the Department of Dermato Venereo-Leprology, Calicut Medical College, 65 patients with lichen planus, clinically or histologically proven, were tested for anti HCV antibodies. There were 48 females (75.4%), 15 males (52.3%) and 2 children below the age of 12 years (one male and one female). 34 cases (52.3%) were in the third and fourth decades. 43 (66.15%) had oral lesions. Mean age was 39.52 years. Mean duration of the disease was 19.91 months, 50 cases (76.92%) being in the range of 0-12 months.

The morphology of the lesions, sites involved, and associated disease, if any were noted down. Routine laboratory tests on blood including liver function tests and urinalysis were done in all cases. All patients were undergoing treatment with topical or intralesional steroids.

The kit used was Hepatitis C Virus Encoded Antigen (Recombinant c22-3, c200 and NS5) ORTHO HCV 3.0 ELISA Test System with Enhanced SAVe. This is a second generation ELISA containing Hepatitis C Virus Encoded Antigen (Recombinant c22-3, c200 and NS5).

Result

Of all 65 patients, none were HCV positive.

Discussion

HCV infection is wide spread, with an estimated 3% of the world population being infected and it has been implicated as an etiological factor for the occurrence of lichen planus. It is a single stranded RNA virus mainly transmitted via transfusion of blood or blood products. The proposed mechanisms for the causation of lichen planus are:1) HCV is capable of cytopathic replication in cell types outside the liver.[6] 2) It may trigger an auto-immune process that is directed against antigens expressed on extra-hepatic cells.[9] 3) Persistent infection can lead to immune complex formation with antibodies, followed by deposition on small blood vessels. 4) The trigger of immunological processes leading to dermatological manifestations are the activated CD8 T cells, cytokines and expansion of certain B cell clones.[9],[12]

The first case was reported from France in 1991. So far, many case control studies have been undertaken implicating or refuting HCV association in LP Most of the positive studies are from Japan, Spain and Italy.[2],[3],[4],[10] Northern UK studies have persistently failed to depict an association between Hepatitis C infection and lichen planus.[13],[14]

In India, studies conducted in New Delhi have failed to demonstrate statistically significant association between HCV and LP, whereas studies conducted in Hyderabad and Bangalore have shown a significant association.

We have not found any association between lichen planus (oral and non-oral) and HCV infection in our patients. Probably regional variation in HCV prevalence accounts for the positive correlation between HCV infection and lichen planus, especially oral and erosive varieties, in most series. Routine liver function tests and further screening on the basis of abnormal values will be a fair enough protocol to follow, especially in areas where the prevalence of HCV infection is low.

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