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ORIGINAL CONTRIBUTIONS
Year : 1990  |  Volume : 56  |  Issue : 6  |  Page : 430-433

Liver function and immunoglobulins in skin lichen palnus




Correspondence Address:
P K Sharma


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  Abstract 

Fifty-two patients of skin lichen planus conforming to the clinical and histopathological description were subjected to the different liver function tests. Age and sex matched clinically normal equal number of persons were taken as controls to exclude liver disorders.] Seven (13.46%) of the patients used to consume mild to moderate amount of alcohol. Nine (17.30%) cases gave the history of jaundice in the past and all of them had hepatomegaly. Otherwise hepatomegaly was observed in 37 (71.15%) cases. None of the healthy controls had hepatomegaly. Aspartase iminotransferase (AST) alanine aminotransferase (ALT) and alkaline phosphatase was raised in 11 (21.15%), 4 (7.69%) and 10 (19.23%) cases respectively. HBsAg was not detected in any of the 52 patients.The most contradictory finding was the revelation of raised immunoglo bulin of G, A or M either singly or in different combinations. IgG and IgA were raised in 32 (61.53%) cases while IgM in 26 (50.0%).


Keywords: Lichen planus, Liver function, Immunoglobulins


How to cite this article:
Sharma P K, Gautam R K, Kalra N S, Sharma A K. Liver function and immunoglobulins in skin lichen palnus. Indian J Dermatol Venereol Leprol 1990;56:430-3

How to cite this URL:
Sharma P K, Gautam R K, Kalra N S, Sharma A K. Liver function and immunoglobulins in skin lichen palnus. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2019 Dec 13];56:430-3. Available from: http://www.ijdvl.com/text.asp?1990/56/6/430/3594


A variety of skin manifestations may occur in disturbances of liver function.[1] Lichen planus lesions were reported in patients of graft versus host reaction and in cases of bone marrow transplants besides other causes like viral infections, inborn error of metabolism and continuous minute damage of unknown origin to the cells in the basal layer of epidermis[2],[3],[4],[5],[6],[7] Recently primary biliary cirrhosis and chronic active hepatitis are reported to' be associated with oral lichen plan us.[8],[9],[10],[11],[12] A retrospective and a prospective study in non erosive[12] and erosive oral lichen plan us[13] on its association with liver disease and liver function has been done but no prospective study is available for skin lichen planus. Uptill now low levels of immunoglobulins were reported.[14],[15],[16]

This study was undertaken to assess by the biochemical tests the liver function and immunoglobulins level in skin lichen planus.


  Materials and Methods Top


Fifty two cases of lichen planus conforming to the clinical and histopathological description were subjected to the different liver function tests after their due consent. Thirty males twenty two females with an average age of 29 years of constituted the study. The youngest patient was a three year old boy and the oldest was 64 years old male. Four different types of skin lichen planus were studied namely classical 36 (69.32%), hypertrophicus 8 (15.3%), actinicus 6 (11.54%) and generalised lichen planus 2 (3.85%). Cases of lichenoid eruption were not included.

Thorough general physical and systemic examination was accomplished in each patient. The following blood chemical studies were undertaken by standard methods - bilirubin concentration, alanine aminotransferase (ALT) activity aspartase aminotransferase (AST), alkaline phosphatase activity, total and differential serum protein concentration and one stage prothrombin time. Bromsulphalein (BSP) retention and liver biopsy were not done. Concentration of serum immunoglobulins G, A and M were measured on Tri-Partigen plates by radial immunodiffusion technique. Hepatitis B surface antigen (HBsAg) was tested by counter immune electrophoresis. Stool was examined for cysts of E. histolytica and Giardia lamblia ovas. Proper age and sex matched equal number of normal persons were taken as controls for liver disease exclusion of immunoglobulin levels.


  Results Top


Seven (13.48%) of the patients consumed low or moderate amount of alcohol. Nine (17.30%) cases gave the history of jaundice in the past and all of them had hepatomegaly but were non alcoholic. The liver was found to be clinically enlarged in 37(71.15%) cases, ranging from one to four centimeter with an average of 2.06 cm. and was soft, smooth and non tender. None of the controls showed hepatomegaly. No patient was clinically jaundiced. The cysts of E. histolytica were isolated in 7(13.46%) cases. Five of the controls showed positive stool test for E. histolytica.

LFT revealed inconsistent results. Total, direct and indirect serum bilirubin was normal in all the cases. AST, ALT and alkaline phosphatase were mildly raised in 11 (21.15%), 4(7.69%) and 10(19.23%) cases respectively. Total serum protein levels were normal in all the patients but albumin was raised in 1 (1.92%) and globulin in 5 (9.16%). All patients showed raised levels of immunoglobulins G, A and M either singly or in different combinations. IgG was raised. in 32(61.63%) cases while IgA and IgM were raised in 32(61.63%) and 26(50.0%) respectively. All the patients were HBsAg negative. [Table - 1]


  Comments Top


This study was done on lichen planus involving skin only as compared to previous studies done on oral lichen planus.[8],[9] No relationship could be established between the four types of lichen planus studied and liver function abnormalities.

The hepatomegaly in 37(71.15%) cases is the most conspicuous finding not reported previously. Hepatic amoebiesis syndrome was not observed in any of the seven cases with positive stool test for E. histolytica. The HBsAg was negative in all the cases including those who gave the history of jaundice in the past. The mildly raised AST, ALT alkaline phosphatase levels in cases of hepatomegaly in our study had also been reported previously in patients without hepatomegaly in non erosive lichen planus.[8],[9]

These impaired enzymatic levels signify liver cell damage which may be of primary nature or secondary to anicteric viral hepatitis or granulomatous infiltration or some other unknown causation factor which needs further evaluation. But an extensive liver damage is primarily ruled out because of normal prothrombin time and normal albumin levels which are exclusively synthesized in liver. The raised immunoglobulins levels of IgG, IgA and IgM described in previous reports[14],[15],[16] are quite contradictory to our findings which revealed raised levels of all of them either alone or in different combinations.

The IgG and IgA level might have been raised either because of a food allergen or exotoxin of some bacteria, virus, protozoa or helminth by persisting in the body for a long time which in turn may cause the lichen planus like lesions, Either withdrawal of these stimuli or the body becoming immune to these stimuli, the resolution and non recurrence of the disease process occurs, The IgG and IgM levels could also be raised because of mitogenic glycoprotein present in P. falciparum malaria and trypanosomiasis after prolonged exposure.[17] The infection with the former being quite common in India. The IgM deposition in early and perilesional area of lichen planus[18] could be due to the reason that its rise is the first following antigenic exposure.

In conclusion, this study implies that lichen planus involving skin is a manifestation of multifactorial causes in which. there is either a primary or secondary mild derangement of liver function and / or there is immunological stimulation by various factors, These two mechanisms may play their role either singularly or simultaneously and the two may be complimentary to each other. So, it becomes a matter of interest that ways and means be found out to recognise the site and the causative organism if any, during and / or before the onset of disease process.

 
  References Top

1.Samitz MH : Dermatologic - Gastro - intestinal Relationship, in : Gastroenterology 3rd ed, vol 4 Editor, Beckus HL : WB Saunders company. Philadelphia London, Toronto, 1976; p426-473.  Back to cited text no. 1    
2.Saurat JH, Gluckman E, Bussel A et al : The lichen planus like eruption after bone marrow transplantation, Brit J Dermatol, 1975; 92 : 675 681.  Back to cited text no. 2    
3.Lerner KG, Kao GF, Sterb R et al : Histopathology of graft versus host reaction human recipients of marrow from HLA matched siblings donors, Transplantation proceedings, 1974; 6 : 367-372.   Back to cited text no. 3    
4.Depaoli M: Experimental Study of phenomenon of isomorphous reaction in psoriasis and lichen planus, Minerva Dermatol, 1953; 28: 197-201.  Back to cited text no. 4    
5.Cotton DWK, Van Don Hurk, Jose MMA and Van Der Staak : Lichen planus : an inborn error of metabolism, Brit J Dermatol, 1972; 87 : 341-344.  Back to cited text no. 5    
6.Marks R, Black MM and Wilson JE: Epidermal cell kinetics in lichen planus, Brit J Dermatol, 1973; 88: 37-41.  Back to cited text no. 6    
7.Presbury DGC and Marks R : The epidermal disorder in lichen planus: an in vitro study, Brit J Dermatol, 1974; 90: 373-375.  Back to cited text no. 7    
8.Monk BE and Pembroke AC : Skin problems in chronic active hepatitis, Lancet, 1981; 2:1045.  Back to cited text no. 8    
9.Powell FC and Rogers RS: Primary biliary cirrhosis, Penicillamine and lichen planus, Lancet, 1981 2:525.  Back to cited text no. 9    
10.Rebera A : Lichen planus and liver, Lancet, 1981; 2:525.  Back to cited text no. 10    
11.Seehafer JR, Rogers RS, Flaming CR et al : Lichen planus like lesions caused by penicillamine in primary biliary cirrhosis, Arch Dermatol, 1981; 117: 140-142.  Back to cited text no. 11    
12.Rebora A and Rengioletti F : Lichen planus and chronic active hepatitis, Acta Dermato-Venerol (Stockholm), 1984; 64: 52-56.  Back to cited text no. 12    
13.Mabacken H, Nilson LA, Olsson R et al: Incidences of liver disease in chronic lichen planus of mouth, Acta Dermato-Venerol (Stockholm). 1984; 64: 7072.  Back to cited text no. 13    
14.Stankler L: Deficiency of circulating IgA and IgM in adult patients with lichen planus , Brit J Dermatol, 1975 ; 93: 25-27.  Back to cited text no. 14    
15.Jacyk WK and Greenwood BM : Serum immunoglobulins in Nigeria patients with lichen planus , Clin and Exp Dermatol, 1978 ; 3:83-84.  Back to cited text no. 15    
16.Nigam PK, Singh G Sharma L and Khurana SK Humoral immunodeficiency in lichen planus, Ind J Dermatol Venereol Leprol, 1988; 54 : 244-246.  Back to cited text no. 16    
17.Turner MW : Immunoglobulins, in : Immunology in medicine a comprehensive guide to clinical immunology, 2nd ed, Editors, Helborow EJ and Reevers WG : Grane and Stratton, London, New York, 1983; p54-55.  Back to cited text no. 17    
18.Abell E, Presbury DGC, Marks R et al: The diagnostic significance of immunoglobulins and fibrin deposition in lichen planus. Brit J Dermatol, 1975; 93: 17-24.  Back to cited text no. 18    


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