Clinical Significance of Hematological Parameters and Inflammatory Indices in Patients with Lichen Planus
Abstract
Aim: Lichen planus (LP) is a chronic, T-cell–mediated inflammatory dermatosis that affects the skin and mucous membranes. However, the relationship between LP and systemic inflammatory biomarkers remains controversial. This study aimed to evaluate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Systemic Immune-Inflammation Index (SII), and Systemic Inflammatory Response Index (SIRI) in patients with LP, compare these parameters with healthy controls, and investigate their diagnostic discriminative value.
Methods: In this retrospective study, 150 patients diagnosed with LP who presented to Sivas Numune Hospital between 1 August 2022 and 1 October 2025 were screened; after applying exclusion criteria, 52 LP patients and age- and sex-matched 52 healthy controls were included in the analysis. Demographic data and hemogram parameters were recorded for all participants, and NLR, PLR, SII, and SIRI were calculated using standard formulas. Diagnostic performance was assessed using a receiver operating characteristic (ROC) curve analysis.
Results: The LP and control groups were similar in terms of age and sex distributions. The hemoglobin, NLR, PLR, SII, and SIRI levels did not differ significantly between the groups (p>0.05). None of the indices demonstrated significant diagnostic discrimination in the ROC analysis (AUC <0.60 for all parameters). A subgroup analysis of 15 patients with oral mucosal involvement also revealed no significant differences in systemic inflammatory indices.
Conclusion: The findings indicate that LP does not substantially elevate the systemic inflammatory response, and hematological indices such as NLR, PLR, SII, and SIRI have limited value in diagnosing LP or distinguishing clinical variants such as oral involvement. These results support the view that LP is predominantly a localized immune-mediated inflammatory condition. Prospective studies with larger cohorts integrating molecular- and cytokine-based biomarkers are needed to better elucidate the systemic inflammatory profile of LP.
References
- 1. Ghotra R, Bhatia A. Oral lichen planus etiology, pathogenesis, clinical presentation and treatment. Journal of Advanced Medical and Dental Sciences Research. 2024;12(6):28-31.
- 2. Akbari E, Epstein JB, Samim F. The Importance of Recognition and Management of Oral Lichen Planus: Navigating Epidemiology, Pathogenesis, Cancer Risk, and Advances in Management. Head & Neck. 2025.
- 3. Joshi TP, Zhu H, Naqvi Z, Holla S, Duruewuru A, Ren V. Prevalence of lichen planopilaris in the United States: a cross-sectional study of the All of Us research program. JAAD international. 2022;8:69-70.
- 4. Boch K, Langan EA, Kridin K, Zillikens D, Ludwig RJ, Bieber K. Lichen planus. Frontiers in medicine. 2021;8:737813.
- 5. Zhang X, Lei L, Jiang L, Fu C, Huang J, Hu Y, et al. Characteristics and pathogenesis of Koebner phenomenon. Experimental dermatology. 2023;32(4):310-23.
- 6. Ioannides D, Vakirlis E, Kemeny L, Marinovic B, Massone C, Murphy R, et al. European S1 guidelines on the management of lichen planus: a cooperation of the European Dermatology Forum with the European Academy of Dermatology and Venereology. Journal of the European Academy of Dermatology and Venereology. 2020;34(7):1403-14.
- 7. Tampa M, Nicolae I, Ene CD, Mitran CI, Mitran MI, Matei C, et al. The interplay between nitrosative stress, inflammation, and antioxidant defense in patients with lichen planus. Antioxidants. 2024;13(6):670.
- 8. Wang J, Yang J, Wang C, Zhao Z, Fan Y. Systematic Review and Meta‐Analysis of Oxidative Stress and Antioxidant Markers in Oral Lichen Planus. Oxidative Medicine and Cellular Longevity. 2021;2021(1):9914652.
- 9. Georgescu SR, Mitran CI, Mitran MI, Nicolae I, Matei C, Ene CD, et al. Oxidative stress in cutaneous lichen planus—a narrative review. Journal of Clinical Medicine. 2021;10(12):2692.
- 10. Ma R, Cui L, Cai J, Yang N, Wang Y, Chen Q, et al. Association between systemic immune inflammation index, systemic inflammation response index and adult psoriasis: evidence from NHANES. Frontiers in immunology. 2024;15:1323174.
- 11. Liu Z, Perry L, Morgan V. The association between platelet indices and presence and severity of psoriasis: a systematic review and meta-analysis. Clinical and experimental medicine. 2023;23(2):333-46.
- 12. Aiholli S, Adya KA, Inamadar AC. Role of hematological indices as predictors of systemic inflammation in dermatology. Indian Dermatology Online Journal. 2024;15(2):188-95.
- 13. Holgersen N, Nielsen VW, Rosenø NAL, Thyssen JP, Egeberg A, Nielsen SH, et al. Biomarkers of systemic inflammation are associated with disease severity and metabolic syndrome in patients with hidradenitis suppurativa. JAAD international. 2024;15:170-8.
- 14. López-Jornet P, Parra-Perez F, Pelaez P, Pons-Fuster E. Retrospective Analysis of Blood Inflammatory Biomarkers in Patients with Oral Lichen Planus: Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio. Journal of Clinical Medicine. 2024;13(23):7490.
- 15. Ataş H, Cemil BÇ, Kurmuş GI, Gönül M. Assessment of systemic inflammation with neutrophil-lymphocyte ratio in lichen planus. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2016;33(3):188-92.
- 16. Çelik MS, Aktaş H. Comparison of hematological inflammatory markers and comorbid conditions in patients with psoriasis vulgaris and lichen planus. Cutaneous and Ocular Toxicology. 2025:1-5.
- 17. Menyhart O, Fekete JT, Győrffy B. Inflammation and colorectal cancer: a meta-analysis of the prognostic significance of the systemic immune–inflammation index (SII) and the systemic inflammation response index (SIRI). International Journal of Molecular Sciences. 2024;25(15):8441.
- 18. Lu R, Zhang J, Sun W, Du G, Zhou G. Inflammation‐related cytokines in oral lichen planus: an overview. Journal of Oral Pathology & Medicine. 2015;44(1):1-14.
- 19. Humberto JSM, Pavanin JV, Rocha MJAd, Motta ACF. Cytokines, cortisol, and nitric oxide as salivary biomarkers in oral lichen planus: a systematic review. Brazilian oral research. 2018;32:e82.
- 20. Louisy A, Humbert E, Samimi M. Oral lichen planus: an update on diagnosis and management. American journal of clinical dermatology. 2024;25(1):35-53.
- 21. Popa C, Sciuca AM, Onofrei B-A, Toader S, Condurache Hritcu OM, Boțoc Colac C, et al. Integrative approaches for the diagnosis and management of erosive oral lichen planus. Diagnostics. 2024;14(7):692.
- 22. Ye JH, Zhang Y, Naidoo K, Ye S. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in psoriasis: a systematic review and meta-analysis. Archives of dermatological research. 2024;316(3):85.
- 23. An I, Ucmak D, Ozturk M. Evaluation of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and mean platelet volume in patients with lichen planus. 2019.
- 24. Xie Y, Liu F, Wu Y, Zhu Y, Jiang Y, Wu Q, et al. Inflammation in cancer: therapeutic opportunities from new insights. Molecular Cancer. 2025;24(1):51.
- 25. Aydin AA, Kayikcioglu E, Unlu A, Acun M, Guzel HG, Yavuz R, Ozgul H, Onder AH, Ozturk B, Yildiz M, ÖNDER H. Pan-immune-inflammation value as a novel prognostic biomarker for advanced pancreatic cancer. Cureus. 2024 Oct 11;16(10).
- 26. Mangoni AA, Zinellu A. The diagnostic role of the systemic inflammation index in patients with immunological diseases: a systematic review and meta-analysis. Clinical and Experimental Medicine. 2024;24(1):27.
- 27. Islam MM, Satici MO, Eroglu SE. Unraveling the clinical significance and prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and delta neutrophil index: An extensive literature review. Turkish journal of emergency medicine. 2024;24(1):8-19.
- 28. Keim-del Pino C, Ramos-García P, González-Moles MÁ. A molecular hypothesis on malignant transformation of oral lichen planus: a systematic review and meta-analysis of cancer hallmarks expression in this oral potentially malignant disorder. Cancers. 2024;16(15):2614.
Abstract
Amaç: Liken planus (LP), deri ve mukozaları etkileyen kronik, T hücre aracılı bir inflamatuvar dermatozdur. Hastalığın sistemik inflamatuvar belirteçlerle ilişkisi literatürde tartışmalıdır. Bu çalışma, LP hastalarında nötrofil/lenfosit oranı (NLR), trombosit/lenfosit oranı (PLR), Sistemik İmmün-İnflamasyon İndeksi (SII) ve Sistemik İnflamatuar Yanıt İndeksi (SIRI) düzeylerini değerlendirmeyi, sağlıklı kontrollerle karşılaştırmayı ve bu parametrelerin tanısal ayırt ediciliğini incelemeyi amaçlamıştır.
Yöntem: Retrospektif olarak planlanan çalışmada 1 Ağustos 2022–1 Ekim 2025 tarihleri arasında Sivas Numune Hastanesi’ne başvuran 150 LP hastası taranmış; dışlama kriterleri sonrası 52 LP hastası ve yaş-cinsiyet eşleşmeli 52 sağlıklı kontrol analize dâhil edilmiştir. Tüm katılımcıların demografik özellikleri ve hemogram parametreleri kaydedilmiş, NLR, PLR, SII ve SIRI standart formüllerle hesaplanmıştır. Tanısal performans ROC eğrileriyle değerlendirilmiştir.
Bulgular: LP ve kontrol grupları yaş ve cinsiyet açısından benzerdi. Hemoglobin, NLR, PLR, SII ve SIRI değerleri iki grup arasında anlamlı fark göstermedi (p>0,05). ROC analizinde hiçbir indeks anlamlı tanısal ayırt edicilik sunmadı (AUC tüm parametrelerde <0,60). Oral mukoza tutulumu olan 15 hasta alt grup analizinde de hematolojik inflamasyon indekslerinin hiçbirinde anlamlı değişiklik izlenmedi.
Sonuç: Bulgular, LP’nin sistemik inflamatuvar yanıtı belirgin düzeyde artırmadığını ve NLR, PLR, SII ve SIRI gibi hematolojik indekslerin LP’nin tanısında veya oral tutulum gibi klinik varyantların ayrımında sınırlı değer taşıdığını göstermektedir. LP’nin temel olarak deri ve mukozaya lokalize immun aracılı inflamatuvar bir hastalık olduğu düşünülmektedir. Daha geniş örneklemlerle yapılacak prospektif çalışmaların moleküler ve sitokin temelli biyobelirteçlerle birlikte değerlendirilmesi, LP’nin sistemik inflamasyon profiline yönelik daha kapsamlı sonuçlar sağlayacaktır.
References
- 1. Ghotra R, Bhatia A. Oral lichen planus etiology, pathogenesis, clinical presentation and treatment. Journal of Advanced Medical and Dental Sciences Research. 2024;12(6):28-31.
- 2. Akbari E, Epstein JB, Samim F. The Importance of Recognition and Management of Oral Lichen Planus: Navigating Epidemiology, Pathogenesis, Cancer Risk, and Advances in Management. Head & Neck. 2025.
- 3. Joshi TP, Zhu H, Naqvi Z, Holla S, Duruewuru A, Ren V. Prevalence of lichen planopilaris in the United States: a cross-sectional study of the All of Us research program. JAAD international. 2022;8:69-70.
- 4. Boch K, Langan EA, Kridin K, Zillikens D, Ludwig RJ, Bieber K. Lichen planus. Frontiers in medicine. 2021;8:737813.
- 5. Zhang X, Lei L, Jiang L, Fu C, Huang J, Hu Y, et al. Characteristics and pathogenesis of Koebner phenomenon. Experimental dermatology. 2023;32(4):310-23.
- 6. Ioannides D, Vakirlis E, Kemeny L, Marinovic B, Massone C, Murphy R, et al. European S1 guidelines on the management of lichen planus: a cooperation of the European Dermatology Forum with the European Academy of Dermatology and Venereology. Journal of the European Academy of Dermatology and Venereology. 2020;34(7):1403-14.
- 7. Tampa M, Nicolae I, Ene CD, Mitran CI, Mitran MI, Matei C, et al. The interplay between nitrosative stress, inflammation, and antioxidant defense in patients with lichen planus. Antioxidants. 2024;13(6):670.
- 8. Wang J, Yang J, Wang C, Zhao Z, Fan Y. Systematic Review and Meta‐Analysis of Oxidative Stress and Antioxidant Markers in Oral Lichen Planus. Oxidative Medicine and Cellular Longevity. 2021;2021(1):9914652.
- 9. Georgescu SR, Mitran CI, Mitran MI, Nicolae I, Matei C, Ene CD, et al. Oxidative stress in cutaneous lichen planus—a narrative review. Journal of Clinical Medicine. 2021;10(12):2692.
- 10. Ma R, Cui L, Cai J, Yang N, Wang Y, Chen Q, et al. Association between systemic immune inflammation index, systemic inflammation response index and adult psoriasis: evidence from NHANES. Frontiers in immunology. 2024;15:1323174.
- 11. Liu Z, Perry L, Morgan V. The association between platelet indices and presence and severity of psoriasis: a systematic review and meta-analysis. Clinical and experimental medicine. 2023;23(2):333-46.
- 12. Aiholli S, Adya KA, Inamadar AC. Role of hematological indices as predictors of systemic inflammation in dermatology. Indian Dermatology Online Journal. 2024;15(2):188-95.
- 13. Holgersen N, Nielsen VW, Rosenø NAL, Thyssen JP, Egeberg A, Nielsen SH, et al. Biomarkers of systemic inflammation are associated with disease severity and metabolic syndrome in patients with hidradenitis suppurativa. JAAD international. 2024;15:170-8.
- 14. López-Jornet P, Parra-Perez F, Pelaez P, Pons-Fuster E. Retrospective Analysis of Blood Inflammatory Biomarkers in Patients with Oral Lichen Planus: Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio. Journal of Clinical Medicine. 2024;13(23):7490.
- 15. Ataş H, Cemil BÇ, Kurmuş GI, Gönül M. Assessment of systemic inflammation with neutrophil-lymphocyte ratio in lichen planus. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2016;33(3):188-92.
- 16. Çelik MS, Aktaş H. Comparison of hematological inflammatory markers and comorbid conditions in patients with psoriasis vulgaris and lichen planus. Cutaneous and Ocular Toxicology. 2025:1-5.
- 17. Menyhart O, Fekete JT, Győrffy B. Inflammation and colorectal cancer: a meta-analysis of the prognostic significance of the systemic immune–inflammation index (SII) and the systemic inflammation response index (SIRI). International Journal of Molecular Sciences. 2024;25(15):8441.
- 18. Lu R, Zhang J, Sun W, Du G, Zhou G. Inflammation‐related cytokines in oral lichen planus: an overview. Journal of Oral Pathology & Medicine. 2015;44(1):1-14.
- 19. Humberto JSM, Pavanin JV, Rocha MJAd, Motta ACF. Cytokines, cortisol, and nitric oxide as salivary biomarkers in oral lichen planus: a systematic review. Brazilian oral research. 2018;32:e82.
- 20. Louisy A, Humbert E, Samimi M. Oral lichen planus: an update on diagnosis and management. American journal of clinical dermatology. 2024;25(1):35-53.
- 21. Popa C, Sciuca AM, Onofrei B-A, Toader S, Condurache Hritcu OM, Boțoc Colac C, et al. Integrative approaches for the diagnosis and management of erosive oral lichen planus. Diagnostics. 2024;14(7):692.
- 22. Ye JH, Zhang Y, Naidoo K, Ye S. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in psoriasis: a systematic review and meta-analysis. Archives of dermatological research. 2024;316(3):85.
- 23. An I, Ucmak D, Ozturk M. Evaluation of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and mean platelet volume in patients with lichen planus. 2019.
- 24. Xie Y, Liu F, Wu Y, Zhu Y, Jiang Y, Wu Q, et al. Inflammation in cancer: therapeutic opportunities from new insights. Molecular Cancer. 2025;24(1):51.
- 25. Aydin AA, Kayikcioglu E, Unlu A, Acun M, Guzel HG, Yavuz R, Ozgul H, Onder AH, Ozturk B, Yildiz M, ÖNDER H. Pan-immune-inflammation value as a novel prognostic biomarker for advanced pancreatic cancer. Cureus. 2024 Oct 11;16(10).
- 26. Mangoni AA, Zinellu A. The diagnostic role of the systemic inflammation index in patients with immunological diseases: a systematic review and meta-analysis. Clinical and Experimental Medicine. 2024;24(1):27.
- 27. Islam MM, Satici MO, Eroglu SE. Unraveling the clinical significance and prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and delta neutrophil index: An extensive literature review. Turkish journal of emergency medicine. 2024;24(1):8-19.
- 28. Keim-del Pino C, Ramos-García P, González-Moles MÁ. A molecular hypothesis on malignant transformation of oral lichen planus: a systematic review and meta-analysis of cancer hallmarks expression in this oral potentially malignant disorder. Cancers. 2024;16(15):2614.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Services and Systems (Other) |
| Journal Section | Research Article |
| Authors | |
| Submission Date | November 16, 2025 |
| Acceptance Date | December 16, 2025 |
| Publication Date | December 31, 2025 |
| Published in Issue | Year 2025 Volume: 47 Issue: 4 |