for the general population and 0.98% among clinical patients.
Globally, oral lichen planus (OLP) appears to be more prevalent in women than men (1.55% vs. 1.11% in population-based studies; 1.69% vs. 1.09% in clinic-based), in those aged 40 years and older (1.90% vs. 0.62% in clinic-based studies), and in non-Asian countries (see graph), Changchang Li, MD, and associates reported in JAMA Dermatology.
Of the 25 countries represented among the 46 included studies, Brazil had the highest OLP prevalence at 6.04% and India had the lowest at 0.02%. “Smokers and patients who abuse alcohol have a higher prevalence of OLP. This factor may explain why the highest prevalence … was found in Brazil, where 18.18% of residents report being smokers and 29.09% report consumption of alcoholic beverages,” wrote Dr. Li of the department of dermatology at Zhejiang University of Traditional Chinese Medicine, Wenzhou, China, and associates.
The difference in OLP prevalence by sex may be related to fluctuating female hormone levels, “especially during menstruation or menopause, and that different social roles may lead to the body being in a state of stress,” the investigators suggested.
The age-related difference in OLP could be the result of “longstanding oral habits” or changes to the oral mucosa over time, such as mucosal thinning, decreased elasticity, less saliva secretion, and greater tissue permeability. The higher prevalence among those aged 40 years and older also may be “associated with metabolic changes during aging or with decreased immunity, nutritional deficiencies, medication use, or denture wear,” they wrote.
The review and meta-analysis involved 15 studies (n = 462,993) that included general population data and 31 (n = 191,963) that used information from clinical patients. Sample sizes for those studies ranged from 308 to 402,669.
Statistically significant publication bias was seen among the clinic-based studies but not those that were population based, Dr. Li and associates wrote, adding that “our findings should be considered with caution because of the high heterogeneity of the included studies.”
The study was funded by the First-Class Discipline Construction Foundation of Guangzhou University of Chinese Medicine, the Young Top Talent Project of Scientific and Technological Innovation in Special Support Plan for Training High-level Talents, and the Youth Research and Cultivation Project of Guangzhou University of Chinese Medicine. The investigators did not report any conflicts of interest.
SOURCE: C Li et al. JAMA Dermatol. 2020 Jan 2. doi: 10.1001/jamadermatol.2019.3797.