Clinic And Pathologic Analysis Of Patients With Lichen Planus And Primary Study On The Immunopathogenesis

Objective:(1)To study the clinical feature and pathologic character of lichen planus.(2) To investigate the role of proinflammation cytokine (TNF-αand ICAM-1), apoptosis related protein (Caspase-3 and Bax), Cyclin D1, and Th1-type cytokine (IL-12) in the pathogenesis of lichen planus.Methods:(1) 83 lichen planus patients from Union hospital of Huazhong University of Science Technology which had been diagnosed by clinical character and skin biopsy between Jan 2005 and Dec 2007 were reviewed;(2) Immunohistochemical technique was employed to observe the expression of TNF-α, ICMA-1, Caspase-3, Bax and Cyclin D1 in the lesional skin from 29 patients with lichen planus. Normal skin from 10 healthy persons was used as control;(3) The expressions of IL-12p35 and IL-12p40 mRNA were semi-quantitatively analyzed with reverse transcriptase-polymerase chain reaction (RT-PCR) in the lesional skin from 29 patients with lichen planus and 10 healthy persons.(4) PBMC was obtained from 29 patients with LP and 10 normal controls. IL-12 in the culture supernatants were measured quantitatively by ELISA.Results:(1) According to our information, the onset of LP generally occurred in the middle-aged especially 30-39 years old (mean age 42.84±15.97), with the ratio of male to female 1.08:1;(2) The lesions always involved more than one part of body. The clinical character is diversifying, and prunosus papular and patch were the most clinical manifestations. Many patients were asymptomatic or symptomatic in low degree;(3) The histopathology of LP is the subepithelial band-like inflammatory cell infiltrate predominated by lymphocytes, and destruction of the epithelial basal cell layer. In some cases, there is Civatte bodies and change in epidermal skin;(4) Only depend on clinical character, the dermatologist can not diagnosis lichen planus correctly;(5) Positive TNF-αexpressions rate in lichen planus were significantly higher than those in normal skins (χ~2=19.40,P<0.05);(6) Positive ICAM-1 expressions rate in lichen planus were significantly higher than those in normal skins (χ~2=26.90,P<0.05);(7) Positive Caspase-3 expressions rate in lichen planus were significantly higher than those in normal skins (χ~2=14.15,P<0.05);(8) Positive Bax expressions rate in lichen planus were significantly higher than those in normal skins (χ~2=17.60,P<0.05);(9) Positive Cyclin D1 expressions rate in lichen planus were significantly higher than those in normal skins (χ~2=8.57,P<0.05);(10) The lever of IL-12p40mRNA in lichen planus were significantly higher than those in normal skins (F=9.03,P<0.05);(11) There is no difference in the lever of IL-12p35mRNA of lichen planus and normal skins (F=3.71,P>0.05);(12) IL-12 in the culture supernatants of PBMC from patients with lichen planus were significantly higher than those from normal controls (F=5.75,P<0.05).Conclusions:(1) According to our information, the onset of LP generally occurred in the middle-aged especially 30-39 years old (mean age 42.84±15.97), with the ratio of male to female 1.08:1; (2) The lesions always involved more than one part of body. The clinical character is diversifying, and prunosus papular and patch were the most clinical manifestations. Many patients were asymptomatic or symptomatic in low degree;(3) The histopathology of LP is the subepithelial band-like inflammatory cell infiltrate predominated by lymphocytes, and destruction of the epithelial basal cell layer. In some cases, there is Civatte bodies and change in epidermal skin;(4) In order to diagnosis lichen planus correctly, the dermatologist must master the clinical and pathologic character of LP;(5) The expression of TNF-αand ICAM-1 might play an important role in the chronic inflammation of lichen planus;(6) The expression of Caspase-3 and Bax might play an important role in the keratinocyte apoptosis of lichen planus;(7) The expression of Cyclin D1 might play an important role in the proliferation of keratinocyte in lichen planus;(8) The overexpression of IL-12p40mRNA in lesional skin and IL-12 in the culture supernatants of PBMC might play an important role in the Th1-type autoimmunologic reaction of LP.