ABSTRACT
Background:
A chronic inflammatory illness known as oral lichen planus (OLP) affects approximately 1–2% of adults, with middle-aged women having a higher prevalence than men. One clinical endocrine condition that primary care doctors frequently see is hypothyroidism.
Aim:
To compare the prevalence of OLP among individuals with a previous diagnosis of hypothyroidism against those without hypothyroidism.
Methods and Materials:
A total of 1200 patients were included in this study. As per their medical reports, 600 patients included were found to have hypothyroidism. The rest 600 patients did not have hypothyroidism. All the patients underwent clinical examination and cases of OLP were identified according to the criteria of diagnosis of OLP.
Results:
Twenty (3.45%) study participants with hypothyroidism were found to have OLP. Eight (1.34%) study participants without hypothyroidism were found to have OLP of 2.37 (confidence interval: 0.91–6.23) and showed that the frequency of lichen planus in study participants with hypothyroidism was 2.37 times greater than that without hypothyroidism.
Conclusion:
Prevalence of lichen planus in persons with hypothyroidism was greater than that without hypothyroidism.
KEYWORDS: Endocrine condition, hypothyroidism, oral lichen planus
INTRODUCTION
The mouth serves as a watchdog or early detection system, reflecting both health and illness. Because many systemic disorders occur in the mouth, the oral cavity is often referred to as a window into the body.[1,2,3] A chronic inflammatory illness known as oral lichen planus (OLP) affects approximately 1–2% of adults, with middle-aged women having a higher prevalence than men. Most cutaneous manifestations of lichen planus (LP) are reversible and produce itching, whereas oral lesions are chronic, presumably premalignant, seldom undergo spontaneous healing, and are a common cause of morbidity.[4,5,6] The exact cause of the condition is still unknown; however, in people who are predisposed to it, it may be a cell-mediated immune response to an antigenic shift that has been generated in the skin or mucosa.[7,8,9]
Even though high-potency topical corticosteroids are still the best treatment for OLP, the condition is typically managed empirically, with no suitable control groups or altered study designs.[2,3,4] Significant correlations have been observed between LP and dyslipidemia. Moreover, LP is more strongly connected with obesity, socioeconomic level, diabetes, hypertension, hypothyroidism, age, sex, and smoking.[5,6,7]
As it is thought to be a global health concern, hypothyroidism is prevalent in India. One clinical endocrine condition that primary care doctors frequently see is hypothyroidism. In the United States, autoimmune thyroid disease is the most prevalent cause of hypothyroidism.[4,5,6] It can be the consequence of primary gland failure or a thyroid hormone shortage. It could also be caused by decreased tissue-level thyroid hormone activity or inadequate pituitary or hypothalamic activation of the thyroid gland.[7,8]
Because thyroid hormone is needed by all cells that are metabolically active, a deficiency in the hormone can have a variety of repercussions.[3,4,5,6,7] If left untreated, hypothyroidism can cause neuromuscular dysfunction, dyslipidemia, hypertension, infertility, and cognitive decline.[5,6,7,8] To compare the prevalence of OLP among individuals with a previous diagnosis of hypothyroidism against those without, this study was conducted.
MATERIALS AND METHODS
This case–control study was conducted to study the difference in the prevalence of LP in individuals with hypothyroidism and without hypothyroidism. A total of 1200 patients visiting the Department of Oral Medicine and Radiology were included in this study. As per their medical reports, 600 patients included were found to have hypothyroidism. They were considered as case group. The rest 600 patients did not have hypothyroidism as per medical reports. They were considered as control group (IEC-NHDC&RI/2023/FAC/OMDR.21/SS-10-ECC).
Inclusion standards for cases
Individuals between the ages of 20 and 45, regardless of gender.
Individuals who have hypothyroidism.
Exclusion standards for cases
Individuals who are menstruating, pregnant, taking oral contraceptives, and have other systemic disorders.
Individuals with any systemic illness, except for hypothyroidism.
People with unilateral lesions of the LP.
Individuals not providing their consent
Inclusion standards for controls
Individuals between the ages of 20 and 45, regardless of gender.
Exclusion standards for controls
Individuals who are menstruating, pregnant, taking oral contraceptives, and have other systemic disorders.
Individuals with any systemic illness.
Individuals not providing their consent.
All the patients underwent clinical examination, and cases of oral LP were identified according to the following criteria for diagnosis of OLP.[1]
OLPs are a combination of red and white lesions that typically have several foci.
It features a design that is bilaterally symmetrical and features a network of tiny white lines called Wickham’s striae that resembles lace.
The most common area affected is the buccal mucosa, though it can occasionally affect the gingiva, tongue, and lower lip as well.
The red lesion may seem atrophic, erosive, or bullous, whereas the white lesion has a reticular, papule-like, plaque-like look.
The doctor who initially diagnosed patients with hypothyroidism was contacted to obtain the patient’s medical records to validate the diagnosis of OLP. In addition, the histological findings supported the clinical diagnosis of OLP.
Statistical analysis
The data was put in an MS Excel sheet and then subjected to statistical analysis using the SPSS software version 2021. The data was represented in the form of percentages. Chi-square test was used for statistical analysis. There was also a calculation of odds ratio (OR; confidence interval [CI]). A P value of ≤0.05 was considered statistically significant.
RESULTS
Twenty (3.45%) study participants with hypothyroidism were found to have OLP. Eight (1.34%) study participants without hypothyroidism were found to have OLP. OR of 2.37 (CI: 0.91–6.23) showed that the frequency of LP in study participants with hypothyroidism was 2.37 times greater than that without hypothyroidism [Table 1].
Table 1.
Data showing the frequency of LP in study participants with and without hypothyroidism
| Lichen planus present | Lichen planus absent | |||
|---|---|---|---|---|
|
|
|
|||
| No | Percentage | No | Percentage | |
| Hypothyroidism present (cases) (600) | 20 | 3.45 | 580 | 96.55 |
| Hypothyroidism absent (control) (600) | 8 | 1.34 | 592 | 98.67 |
| OR (CI) | OR of 2.37 (CI: 0.91–6.23) | |||
| P | 0.07 | |||
DISCUSSION
To compare the prevalence of OLP among individuals with a previous diagnosis of hypothyroidism against those without, this study was conducted. It was found that 20 (3.45%) study participants with hypothyroidism were found to have OLP. Eight (1.34%) study participants without hypothyroidism were found to have OLP. OR of 2.37 (CI: 0.91–6.23) showed that the frequency of LP in study participants with hypothyroidism was 2.37 times greater than that without hypothyroidism.
Some studies also found an increased prevalence of OLP in hypothyroidism patients as compared to normal controls. However, some studies did not find any significant difference in the prevalence of OLP in people with hypothyroidism as compared to people without hypothyroidism.[2,3,4,5,6,7,8,9]
There are notable associations between dyslipidemia and LP. Furthermore, it has been discovered that LP has a stronger correlation with age, sex, smoking, diabetes, hypertension, obesity, socioeconomic status, and hypertension. India has a high prevalence of hypothyroidism, which is considered a global health concern.[4,5,6,7] Hypothyroidism is one clinical endocrine disease that primary care physicians often treat. The most common cause of hypothyroidism in the United States is autoimmune thyroid disease. It may result from a deficiency of thyroid hormone or from primary gland failure. It might also result from insufficient pituitary or hypothalamus activation of the thyroid gland or a decline in tissue-level thyroid hormone activity.[6,7,8,9]
CONCLUSION
Prevalence of LP in persons with hypothyroidism was greater than that without hypothyroidism.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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