The Relationship Between Lichen Planus and Thyroid Autoimmunity
Published October 12 2015
People with an autoimmune thyroid condition such as Graves’ Disease and Hashimoto’s Thyroiditis are more likely to develop other autoimmune conditions. One of these conditions is known as lichen planus. This is an autoimmune condition that affects the skin, oral mucosa, genital mucosa, scalp, and nails (1). While it can be challenging to deal with any autoimmune condition, when lichen planus is present on mucous membranes it can be very difficult to treat, and unfortunately this is commonly the case.
Some of the more common symptoms of lichen planus include tenderness or pain, it can cause itchiness, can lead to a dry mouth, hair loss, a metallic taste in the mouth, and even nail abnormalities (2). Lichen planus lesions are described using the following six P’s (3):
Lichen planus affects the oral mucosa most frequently, although it may also involve other mucosa and the skin (4). The conventional medical treatment usually involves topical steroids, although systemic steroids may be used in severe cases. Laser therapy can be an effective treatment option (5) (6), and it comes with no known side effects. This doesn’t do anything to address the autoimmune component, but it might be an option to consider for those with painful lesions. There is a small risk of oral lichen planus transforming into squamous cell carcinoma (7) (8).
Lichen Planus and Thyroid Health
Numerous studies have shown a correlation between lichen planus and autoimmune thyroid conditions. One small study identified different dermatologic conditions associated with thyroid disease, and showed that lichen planus was the second most common condition, right after alopecia areata (9). Another study involving 105 patients with oral lichen planus showed that 14.3% had Hashimoto’s Thyroiditis (10). A case-control study showed an association of oral lichen planus with thyroid disease (11).
Can People With Lichen Planus Benefit From A Natural Treatment Approach?
Most, if not all autoimmune conditions can benefit from natural treatment methods. This isn’t meant to suggest that everyone with an autoimmune condition can get into a state of remission by following a natural treatment protocol. But by improving the health of their immune system one usually will notice a significant improvement.
But how can one improve the health of their immune system? Autoimmune conditions such as lichen planus involve cytokines. Some natural healthcare professionals use herbs and nutrients to balance the Th1 and Th2 pathways. However, the problem with this is that not all autoimmune conditions are predominantly Th1 or Th2 dominant, and this is the case with lichen planus. While some studies have shown that this condition involves Th1 cytokines (12), other studies have shown a state of Th2 dominance with lichen planus (13).
Remove the Trigger and Reduce Cytokines
Since inflammatory cytokines such as IL-1, 2, 4, 5, 6, 8, 10, 12, 17, 18, TGF-β, IFN-γ and TNF-α have been associated with lichen planus (14), then it makes sense to do things to decrease these cytokines. I discussed this more in a past blog post I wrote entitled “The Role of Cytokines In Autoimmune Thyroid Conditions“. One of the herbs I discussed in this post which can help to reduce proinflammatory cytokines is turmeric, and there is evidence that turmeric can help with lichen planus (15). But there are other nutrients and herbs which can decrease these cytokines, including vitamin D3, fish oils, and resveratrol.
But while doing things to decrease proinflammatory cytokines is important, just as is the case with any autoimmune condition it is important to remove the trigger. And here are some of the common factors which can trigger the autoimmune response:
Gluten. Although there is no evidence of gluten directly causing this condition, there is a correlation between lichen planus and Celiac disease (16) (17). And so at the very least it probably would be a good idea for people with lichen planus to consider a gluten free trial, and to also consider ordering a Celiac panel.
Stress. Of course stress can cause many different health conditions, and there is evidence that it can play a role in the development of lichen planus. One case-control study involving 46 patients with lichen planus showed that stressful situations may have a role in the onset of lichen planus lesions (18). However, another study showed significantly higher depression, anxiety, and stress scores in those with oral lichen planus (19). As a result, doing things to reduce stress levels and improve one’s stress handling skills can greatly help some people with this condition.
Infections. Certain infections can play a role in triggering an autoimmune response. With regards to lichen planus, there is evidence of a significant association between hepatitis C virus and lichen planus (20) (21). Other viruses such as epstein barr and human papilloma virus can also play a role in the development of this condition (22) (23) (24). There also might be a correlation between lichen planus and candida (25). However, there doesn’t seem to be a relationship between H. Pylori and oral lichen planus (26) (27).
Mercury. There is evidence that mercury amalgams can play a role in the pathogenesis of oral lichen planus (28) (29). As a result, if you have oral lichen planus and mercury amalgams then it probably would be a good idea to visit a biological dentist to get these removed.
Blood sugar imbalances. There is also evidence of a higher prevalence of glucose metabolism disturbances in those with lichen planus. A small study involving 30 patients with lichen planus showed that approximately half had such an imbalance (30).
In summary, lichen planus is an autoimmune condition that primarily affects the skin and mucous membranes. It is more common in people with Graves’ Disease and Hashimoto’s Thyroiditis. Laser therapy can be an effective procedure, although it doesn’t do anything for the underlying cause of the problem. Just as is the case with any autoimmune condition, the goal should be to find and then remove the autoimmune trigger and at the same time do things to reduce proinflammatory cytokines.