Oral lichen planus and lichenoid reactions in bronchial asthma patients: a case-control study on prevalence and clinicopathological associations

Authors: Ashwini Deshpande, Krishnan Rajkumar, Parijat Goswami, Amit Byatnal

DOI: 10.18231/j.ijmmtd.12877.1761737217

Keywords: Corticosteroid-Associated Oral Lesions, Drug-Induced Oral Lesions, Lichenoid Drug Reactions, Mucosal Immunopathology, T-Cell Mediated Immunity

Abstract: Background: Chronic inflammatory oral conditions like oral lichen planus (OLP) and oral lichenoid reactions (OLR) have been associated with systemic disorders and pharmacological treatments. Bronchial asthma therapies, especially inhaled corticosteroids and β2-agonists, may affect the occurrence of asymptomatic OLP and OLR, yet their relationship is not well established. Aim: To evaluate the prevalence and clinicopathologic correlation of asymptomatic OLP and OLR in bronchial asthma patients compared to age- and sex-matched non-asthmatic controls. Methodology: This observational case-control study included 140 bronchial asthma patients and 140 matched healthy controls who underwent detailed oral examinations, and suspected lesions were biopsied for histopathological confirmation. Asthma severity was assessed using pulmonary function tests, and medication histories, particularly ICS and β2-agonist use, were documented. Confounding factors like smoking, oral hygiene, and systemic diseases were controlled through strict inclusion and exclusion criteria, with statistical significance set at p < 0.05. Results: Asymptomatic OLP and OLR were more frequently observed in asthma patients than in controls, with buccal mucosa and tongue being the most affected sites (p < 0.05). However, asthma severity did not significantly influence lesion presence (R = -0.064, p = 0.307). Among asthma treatments, inhaled corticosteroids showed the highest occurrence of OLP and OLR, though without statistical significance (p = 0.49). Histopathological evaluation revealed a notable association between lichenoid tissue changes and asthma (p = 0.02), highlighting a possible immunopathological link requiring further investigation through larger-scale studies. Conclusion: Asthma patients show a higher prevalence of asymptomatic OLP and OLR compared to healthy controls, with ICS use emerging as a possible contributing factor, although further studies are needed to establish statistical significance. Regular oral health monitoring is recommended for asthma patients, especially those on long-term ICS therapy.