Serological and psychological assessment of patients with oral lichen planus using serum cortisol levels and HADS questionnaire A case control study

Main Article Content

Nallan CSK Chaitanya
Danam Reshmapriyanka
Kandi Pallavi
Shaik Ameer
Amurtha Appala
Avanthi Chowdhary
Tirupathi Prabhath
Marikanti Pota Ratna
Bodakunta Sai Sowmya
Chintireddy Vaishnavi
Parinita Bontala

Keywords

Oral lichen planus, serum cortisol, depression, anxiety, T cell mediated, autoimmune disorder

Abstract

Oral lichen planus (OLP) is a T cell-mediated chronic autoimmune disorder directed against antigens secreted by the basal cell layer, with an incidence of 0.02–0.22% in Indian population and showing female predilection. Stress is considered one of the etiological factors in the causation, progression, and recurrence of this disease.


To evaluate the levels of serum cortisol, anxiety, and depression in patients with symptomatic OLP and to correlate the levels of serum cortisol with anxiety and depression.


Sixty subjects were categorized into two groups. Group A: 30 adults with no history of OLP and no psychological history of anxiety and depression. Group B: 30 patients with clinically and histopatholog-ically diagnosed symptomatic OLP. The subjects in both groups were evaluated for anxiety and depres-sion levels using the Hospital Anxiety and Depression Scale (HADS) questionnaire and serum cortisol levels (8–9 am sample) using the chemiluminiscence method.


Higher depression and anxiety levels were significantly associated with group B with significant P values (P < 0.0001 and <0.0002 respectively) when compared with group A; higher mean serum corti-sol levels were seen in group B compared with group A, with P < 0.0001. In group A, a positive cor-relation was found between depression, anxiety, and serum cortisol levels with non-significant P-value. In group B, a positive correlation was found between depression, anxiety, and serum cortisol levels with a significant P value (P < 0.0001).


Increased levels of depression and anxiety with increased serum cortisol levels were observed in subjects with OLP.

Abstract 123 | PDF Downloads 45 XML Downloads 0 HTML Downloads 6

References

1. Shetty VS, Thomas P, Chatra L, Shenai P, Rao P, Babu S. An association between serum cortisol levels in erosive and nonerosive oral lichen pla-nus  patients.Web Med Central Dent. 2010;1(9): WMC00560.
2. Canto AM, Muller H, Freitas RR, Santos PS. Oral lichen planus (OLP): Clinical and complementary diagnosis. An Bras Dermatol. 2010;85(5): 669–75. https://doi.org/10.1590/S0365-05962010000500010
3. Kini R, Nagaratna D, Saha A. Therapeutic man-agement of oral lichen planus: A review for the clinicians. World J Dent. 2011;2:249–53. https:// doi.org/10.5005/jp-journals-10015-1091
4. Nico MM, Fernandes JD, Lourenço SV. Lichen planus affecting the lips. J Clin Exp Dermatol Res. 2015;06(06):306. https://doi.org/10.4172/2155-9554.10000306
5. Munde A, Karle R, Wankhede P, Shaikh S, Kulkurni M. Demographic and clinical profile of  oral lichen planus: A retrospective study. Contemp Clin Dent. 2013;4(2):181–5. https://doi. org/10.4103/0976-237X.114873
6. Pati A, Khan M, Ramachandra V, Panigrahi R, Kabasi S, Acharya S. Psychiatric morbidity in oral lichen planus: A preliminary study. J Indian Acad Oral Med Radiol. 2014;26:19–23. https:// doi.org/10.4103/0972-1363.141833
7. Boorghani M, Gholizadeh N, Taghavi Zenouz A, Vatankhah M, Mehdipour M. Oral lichen planus: Clinical features, etiology, treatment and manage-ment; a review of literature. J Dent Res Dent Clin Dent Prosp. 2010;4(1):3–9.
8. Glick M. Burket’soral medicine. 12th ed. PMPH USA;2015. People’s Medical Publishing House - USA.
9. Roopashree M, Gondhalekar R, Shashikanth M, George J, Thippeswamy S, Shukla A. Pathogenesis of oral lichen planus – A review. J Oral Pathol Med. 2010;39(10):729–34. https://doi.org/10.1111/ j.1600-0714.2010.00946.x
10. Tawil M EL, Sediki N, Hassan H. Psychobiological aspects of patients with lichen planus. Curr Psychiatry. 2009;16(4):370–80.
11. Albanidou-Farmaki E, Poulopoulos A, Epivatianos A, Farmakis K, Karamouzis M, Antoniades D. Increased anxiety level and high salivary and serum cortisol concentrations in patients with recurrent aphthous stomatitis. Tohoku J Exp Med. 2008;214(4):291–6. https://doi.org/10.1620/ tjem.214.291
12. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
13. Chaitanya N, Garlapati K, Priyanka D, Soma S, Suskandla U, Boinepally N. Assessment of anxi-ety and depression in oral mucositis patients undergoing cancer chemoradiotherapy: A ran-domized cross-sectional study. Indian J Palliat Care. 2016;22(4):446–54. https://doi.org/10.4103/ 0973-1075.191797
14. Chaudhary S. Psychosocial stressors in oral lichen planus. Aust Dent J. 2004;49(4):192–5. https://doi.org/10.1111/j.1834-7819.2004. tb00072.x
15. Ingafou M, Lodi G, Oslen I, Porter SR. Oral lichen planus is not associated with IgG cir-culating antibodies to epithelial antigen. Oral Surg Oral Med Oral Pathol Endodontol. 1997;84(2):175–8. https://doi.org/10.1016/S1079-2104(97)90066-4
16. Manolache L, Seceleanu-Petrescu D, Benea V. Lichen planus patients and stressful events. J  Eur Acad Dermatol Venereol. 2008;22(4): 437–41. https://doi.org/10.1111/j.1468-3083. 2007.02458.x
17. Bansal H, Dua V, Sandhu S, Sandhu J. Oral lichen planus and stress: An appraisal. Contemp Clin Dent. 2014;5(3):352–6. https://doi.org/10.4103/ 0976-237X.137946
18. Shah B, Ashok L, Sujatha G. Evaluation of salivary cortisol and psychological factors in patients with oral lichen planus. Indian J Dent Res. 2009;20(3):288–92. https://doi.org/10.4103/ 0970-9290.57361
19. Tiwari S, Gupta S, Laeeq S, Mahdi AA. Anxiety and depression as risk factor for the development of oral lichen planus and its association with blood antioxidant level. J Immunol Infect Inflam Dis. 2017;2(2):1–5.
20. Soto Araya M, Rojas Alcayaga G, Esguep A. Association between psychological disorders and the presence of oral lichen planus, burning mouth syndrome and recurrent aphthous stomatitis. Med Oral. 2004;9:1–7.
21. Sen S, Sahoo PK, Naphade V, Priyadarshini S. Role of stress in oral lichen planus – A cross- sectional study. Int J Curr Res. 2017;9(2):46278–81.
22. McCartan BE. Psychological factors associated with oral lichen planus. J Oral Pathol Med. 1995;24(6):273–5. https://doi.org/10.1111/j.1600-0714.1995.tb01181.x
23. Vallejo MJ, Huerta G, Cerero R, et al. Anxiety and depression as risk factors for oral lichen pla-nus. Dermatology. 2001;203:303–7. https://doi. org/10.1159/000051777
24. Allen C, Beck F, Rossie K, Kaul T. Relation of stress and anxiety to oral lichen planus. Oral Surg Oral Med Oral Pathol. 1986;61(1):44–6. https:// doi.org/10.1016/0030-4220(86)90201-X
25. Hirota SK, Moreno RA, Dos Santos CH, Seo J, Migliari DA. Psychological profile (anxiety and depression) in patients with oral lichen planus: A controlled study. Minerva Stomatol. 2013;62(3): 51–6.
26. Ivanovski K, Nakova M, Warburton G, et al. Psychological profile in oral lichen planus. J Clin Periodontol. 2005;32(10):1034–40. https://doi. org/10.1111/j.1600-051X.2005.00829.x
27. Alves MG, do Carmo Carvalho BF, Balducci I, Cabral LA, Nicodemo D, Almeida JD. Emotional assessment of patients with oral lichen planus. Int J Dermatol. 2015 Jan;54(1):29–32. https://doi. org/10.1111/ijd.12052