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12-05-2024 | Lichen Planus | Original Article

Choroidal thickness and retinal vascular changes in patients with lichen planus: an inflammatory disease beyond the skin

Authors: Hala M. El-Sadek, Sahar Saad Eldeen Mohamed Shaban, Ayman Abdelmaksoud, Basma El-sayed Mohammad Risha, Mahmoud A. Rageh

Published in: Irish Journal of Medical Science (1971 -) | Issue 5/2024

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Abstract

Background

Lichen planus (LP) is a common inflammatory condition of unknown etiology that commonly affects the skin and mucous membranes. Optical coherence tomography angiography (OCTA) is a noninvasive technique for identifying early retinal vascular impairment in systemic disease without clinical damage by imaging deep and superficial capillary networks.

Aims

To assess the impacts of LP on the choroid and assess vascular changes in retinal capillary density using OCTA.

Methods

This single-center prospective case-control study included 30 therapeutic-naïve LP patients and 30 age and sex-matched healthy individuals. All study subjects underwent a complete ophthalmological examination, including best-corrected visual acuity (BCVA) measurement using a Snellen chart, slit-lamp biomicroscopy, intraocular pressure (IOP) measurement, and fundus examination. They were then examined using spectral domain OCT and choroidal thickness was measured. The vessel density of the superficial and deep capillary networks was measured and assessed using OCTA.

Results

Patients had significantly thicker choroidal and retinal thickness than controls, with subfoveal, nasal, and temporal areas showing a significant difference. A significantly higher vascular density in the superficial capillary plexus, particularly in the nasal perifoveal area, was found compared to the control group. Significantly, higher vascular density in the deep capillary plexus in the parafoveal area compared to controls was reported. Significant correlations were found between visual acuity and IOP, and age, duration of disease, and severity of disease.

Conclusions

This study is the first to reveal that LP patients exhibit choroidal changes and retinal vascular alterations compared to healthy controls.
Literature
1.
go back to reference Kumar SA, Krishnam Raju PV, Gopal KVT et al (2019) Comorbidities in lichen planus: a case-control study in Indian patients. Indian Dermatol Online J 10(1):34–37CrossRefPubMedPubMedCentral Kumar SA, Krishnam Raju PV, Gopal KVT et al (2019) Comorbidities in lichen planus: a case-control study in Indian patients. Indian Dermatol Online J 10(1):34–37CrossRefPubMedPubMedCentral
2.
go back to reference Ruiz-Lozano RE, Hernández-Camarena JC, Valdez-Garcia JE et al (2021) Ocular involvement and complications of lichen planus, lichen planus pigmentosus, and lichen planopilaris: a comprehensive review. Dermatol Ther 34(6)CrossRefPubMed Ruiz-Lozano RE, Hernández-Camarena JC, Valdez-Garcia JE et al (2021) Ocular involvement and complications of lichen planus, lichen planus pigmentosus, and lichen planopilaris: a comprehensive review. Dermatol Ther 34(6)CrossRefPubMed
3.
go back to reference Ozlu E, Teberik K (2019) Evaluation of ocular findings in patients with lichen planus. Postepy Dermatol Alergol 36(3):267–271CrossRefPubMed Ozlu E, Teberik K (2019) Evaluation of ocular findings in patients with lichen planus. Postepy Dermatol Alergol 36(3):267–271CrossRefPubMed
4.
go back to reference Jamal A, Subramanian PT, Hussain KS (2000) Nail changes in end-stage renal failure patients on hemodialysis. Saudi J Kidney Dis Transpl 11(1):44–47PubMed Jamal A, Subramanian PT, Hussain KS (2000) Nail changes in end-stage renal failure patients on hemodialysis. Saudi J Kidney Dis Transpl 11(1):44–47PubMed
5.
go back to reference Webber NK, Setterfield JF, Lewis FM et al (2012) Lacrimal canalicular duct scarring in patients with lichen planus. Arch Dermatol 148(2):224–227CrossRefPubMed Webber NK, Setterfield JF, Lewis FM et al (2012) Lacrimal canalicular duct scarring in patients with lichen planus. Arch Dermatol 148(2):224–227CrossRefPubMed
6.
go back to reference Reiner A, Fitzgerald MEC, Del Mar N et al (2018) Neural control of choroidal blood flow. Prog Retin Eye Res 64:96–130CrossRefPubMed Reiner A, Fitzgerald MEC, Del Mar N et al (2018) Neural control of choroidal blood flow. Prog Retin Eye Res 64:96–130CrossRefPubMed
7.
go back to reference Gorouhi F, Davari P, Fazel N (2014) Cutaneous and mucosal lichen planus: a comprehensive review of clinical subtypes, risk factors, diagnosis, and prognosis. ScientificWorldJournal 2014CrossRefPubMedPubMedCentral Gorouhi F, Davari P, Fazel N (2014) Cutaneous and mucosal lichen planus: a comprehensive review of clinical subtypes, risk factors, diagnosis, and prognosis. ScientificWorldJournal 2014CrossRefPubMedPubMedCentral
8.
go back to reference Şahin T, Öztekin A, Cevher S (2022) Does rosacea, a localized skin disease, affect the choroidal thickness? J Cosmet Dermatol 21(1):387–391CrossRefPubMed Şahin T, Öztekin A, Cevher S (2022) Does rosacea, a localized skin disease, affect the choroidal thickness? J Cosmet Dermatol 21(1):387–391CrossRefPubMed
9.
10.
go back to reference Kaur H, Nikam BP, Jamale VP et al (2020) Lichen planus severity index: a new, valid scoring system to assess the severity of cutaneous lichen planus. Indian J Dermatol Venereol Leprol 86(2):169–175CrossRefPubMed Kaur H, Nikam BP, Jamale VP et al (2020) Lichen planus severity index: a new, valid scoring system to assess the severity of cutaneous lichen planus. Indian J Dermatol Venereol Leprol 86(2):169–175CrossRefPubMed
11.
go back to reference Kurumoğlu Incekalan T, Celik U, Tolunay O et al (2023) Changes in retinal and choroidal capillary dynamics in patients with multisystem inflammatory syndrome in children. Int Ophthalmol 43(1):3–12CrossRefPubMed Kurumoğlu Incekalan T, Celik U, Tolunay O et al (2023) Changes in retinal and choroidal capillary dynamics in patients with multisystem inflammatory syndrome in children. Int Ophthalmol 43(1):3–12CrossRefPubMed
12.
go back to reference Ozlu E, Karadag AS, Toprak AE et al (2016) Evaluation of cardiovascular risk factors, haematological and biochemical parameters, and serum endocan levels in patients with lichen planus. Dermatology 232(4):438–443CrossRefPubMed Ozlu E, Karadag AS, Toprak AE et al (2016) Evaluation of cardiovascular risk factors, haematological and biochemical parameters, and serum endocan levels in patients with lichen planus. Dermatology 232(4):438–443CrossRefPubMed
13.
go back to reference Ebrahimiadib N, Maleki A, Fadakar K et al (2021) Vascular abnormalities in uveitis. Surv Ophthalmol 66(4):653–667CrossRefPubMed Ebrahimiadib N, Maleki A, Fadakar K et al (2021) Vascular abnormalities in uveitis. Surv Ophthalmol 66(4):653–667CrossRefPubMed
14.
go back to reference Steiner M, Esteban-Ortega MDM, Muñoz-Fernández S (2019) Choroidal and retinal thickness in systemic autoimmune and inflammatory diseases: a review. Surv Ophthalmol 64(6):757–769CrossRefPubMed Steiner M, Esteban-Ortega MDM, Muñoz-Fernández S (2019) Choroidal and retinal thickness in systemic autoimmune and inflammatory diseases: a review. Surv Ophthalmol 64(6):757–769CrossRefPubMed
15.
go back to reference Dai Y, Zhou H, Chu Z et al (2020) Microvascular changes in the choriocapillaris of diabetic patients without retinopathy investigated by swept-source OCT angiography. Invest Ophthalmol Vis Sci 61(3):50CrossRefPubMedPubMedCentral Dai Y, Zhou H, Chu Z et al (2020) Microvascular changes in the choriocapillaris of diabetic patients without retinopathy investigated by swept-source OCT angiography. Invest Ophthalmol Vis Sci 61(3):50CrossRefPubMedPubMedCentral
16.
go back to reference Kaidonis G, Silva RA, Sanislo SR et al (2016) The superficial and deep retinal capillary plexus in cases of fovea plana imaged by spectral-domain optical coherence tomography angiography. Am J Ophthalmol Case Rep 6:41–44CrossRefPubMedPubMedCentral Kaidonis G, Silva RA, Sanislo SR et al (2016) The superficial and deep retinal capillary plexus in cases of fovea plana imaged by spectral-domain optical coherence tomography angiography. Am J Ophthalmol Case Rep 6:41–44CrossRefPubMedPubMedCentral
17.
go back to reference Thompson IA, Durrani AK, Patel S (2019) Optical coherence tomography angiography characteristics in diabetic patients without clinical diabetic retinopathy. Eye (Lond) 33(4):648–652CrossRefPubMed Thompson IA, Durrani AK, Patel S (2019) Optical coherence tomography angiography characteristics in diabetic patients without clinical diabetic retinopathy. Eye (Lond) 33(4):648–652CrossRefPubMed
18.
go back to reference Boch K, Langan EA, Kridin K et al (2021) Lichen planus Front Med (Lausanne) 8PubMed Boch K, Langan EA, Kridin K et al (2021) Lichen planus Front Med (Lausanne) 8PubMed
19.
go back to reference Akkurt ZM, Gümüş H, Aktürk A et al (2015) Evaluation of orbital arteries with colour Doppler ultrasonography in patients with psoriasis. Clin Exp Dermatol 40(5):507–512CrossRefPubMed Akkurt ZM, Gümüş H, Aktürk A et al (2015) Evaluation of orbital arteries with colour Doppler ultrasonography in patients with psoriasis. Clin Exp Dermatol 40(5):507–512CrossRefPubMed
20.
go back to reference Bek T (1994) Transretinal histopathological changes in capillary-free areas of diabetic retinopathy. Acta Ophthalmol (Copenh) 72(4):409–415CrossRefPubMed Bek T (1994) Transretinal histopathological changes in capillary-free areas of diabetic retinopathy. Acta Ophthalmol (Copenh) 72(4):409–415CrossRefPubMed
21.
go back to reference Dikci S, Genç O, Yılmaz T et al (2016) Bilateral retinal vasculitis in a patient with lichen planus. Arq Bras Oftalmol 79(6):402–403CrossRefPubMed Dikci S, Genç O, Yılmaz T et al (2016) Bilateral retinal vasculitis in a patient with lichen planus. Arq Bras Oftalmol 79(6):402–403CrossRefPubMed
22.
go back to reference Arfeen SA, Bahgat N, Adel N et al (2020) Assessment of superficial and deep retinal vessel density in systemic lupus erythematosus patients using optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 258(6):1261–1268CrossRefPubMed Arfeen SA, Bahgat N, Adel N et al (2020) Assessment of superficial and deep retinal vessel density in systemic lupus erythematosus patients using optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 258(6):1261–1268CrossRefPubMed
23.
go back to reference Mimier-Janczak M, Kaczmarek D, Proc K et al (2022) Evaluation of subclinical retinal disease in patients affected by systemic lupus erythematosus with no evidence of ocular involvement-an optical coherence tomography angiography original study. J Clin Med 11(24):7417CrossRefPubMedPubMedCentral Mimier-Janczak M, Kaczmarek D, Proc K et al (2022) Evaluation of subclinical retinal disease in patients affected by systemic lupus erythematosus with no evidence of ocular involvement-an optical coherence tomography angiography original study. J Clin Med 11(24):7417CrossRefPubMedPubMedCentral
24.
go back to reference Mohebbi M, Mirghorbani M, Banafshe Afshan A et al (2019) Lichen planus in ocular surface: major presentations and treatments. Ocul Immunol Inflamm 27(6):987–994CrossRefPubMed Mohebbi M, Mirghorbani M, Banafshe Afshan A et al (2019) Lichen planus in ocular surface: major presentations and treatments. Ocul Immunol Inflamm 27(6):987–994CrossRefPubMed
Metadata
Title
Choroidal thickness and retinal vascular changes in patients with lichen planus: an inflammatory disease beyond the skin
Authors
Hala M. El-Sadek
Sahar Saad Eldeen Mohamed Shaban
Ayman Abdelmaksoud
Basma El-sayed Mohammad Risha
Mahmoud A. Rageh
Publication date
12-05-2024
Publisher
Springer International Publishing
Published in
Irish Journal of Medical Science (1971 -) / Issue 5/2024
Print ISSN: 0021-1265
Electronic ISSN: 1863-4362
DOI
https://doi.org/10.1007/s11845-024-03699-1

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