Ann Dermatol.  2019 Apr;31(2):146-153. 10.5021/ad.2019.31.2.146.

Serotonin Expression in Lichen Planus Lesions and Its Relationship with Depression/Anxiety

• KurmuÅŸ GI
• Gönül M
• Canpolat F
• Yılmazer
• Cankurtaran ES

• KMID: 2439060
• DOI: http://doi.org/10.5021/ad.2019.31.2.146

Abstract

BACKGROUND
Psychological factors such as stress, depression, and anxiety have been documented to contribute to the development of lesions in lichen planus (LP).
OBJECTIVE
To evaluate the relationship between serotonin expression in LP lesions and depression/anxiety.
METHODS
Forty patients (22 females, 18 males) with LP and 20 healthy control subjects were included in this study. The severity of LP was assessed with the palmar method (using the measurement of affected body surface area [BSA]). The depression and anxiety scores were measured with Beck's depression inventory (BDI) and Beck's anxiety inventory (BAI). The expression of serotonin was determined via immunohistochemistry in LP lesions and in the control group skin using a monoclonal antibody to serotonin.
RESULTS
The skin biopsies of the LP patients had significantly higher levels of serotonin than those of the control subjects (p < 0.001). In the LP patients, and there was a positive correlation between serotonin expression and LP severity (p=0.022). Based on the results from the BDI and BAI, there was a significant relationship between the severity of depression/anxiety and intensity of serotonin expression (p < 0.001).
CONCLUSION
Data from this study suggest that serotonin may have a possible role in the pathogenesis of LP. Further, the relationship between serotonin expression in acute cutaneous lesions and the depression/anxiety scores indicates that serotonin may be a mediator for the association of LP and depression/anxiety simultaneously. There is a need for more specific studies showing the expression of serotonin in the lichen planus to demonstrate the cause or effect.

Keyword

Anxiety; Depression; Lichen planus; Serotonin

MeSH Terms

Anxiety
Biopsy
Body Surface Area
Depression
Female
Humans
Immunohistochemistry
Lichen Planus*
Lichens*
Methods
Psychology
Serotonin*
Skin
Serotonin

Figure

• 

  Fig. 1 (A) BDI values, (B) BAI values. BDI: Beck's depression inventory, BAI: Beck's anxiety inventory, LP: lichen planus.

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  Fig. 2 Serotonin expression in the eccrine glands of lichen planus lesions (serotonin mouse monoclonal antibody, 10×20). (A) Grade 0, no staining (−); (B) Grade 1, mild staining (+); (C) Grade 2, moderate staining (++); (D) Grade 3, strong staining (+++).

• 

  Fig. 3 Immunohistochemical staining of lichen planus lesions for serotonin. (A) Grade 2, moderate staining (++). (B) Grade 3, strong staining (+++).

Reference

1. Boyd AS, Neldner KH. Lichen planus. J Am Acad Dermatol. 1991; 25:593–619.

2. Lehman JS, Tollefson MM, Gibson LE. Lichen planus. Int J Dermatol. 2009; 48:682–694.

3. Marshman G. Lichen planus. Australas J Dermatol. 1998; 39:1–11.

4. Shiohara T, Kano Y. Lichen planus and lichenoid dermatoses. In : Bolognia J, Jorizzo JL, Schaffer JV, editors. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders;2012.

5. Daoud MS, Pittelkow MR. Lichen planus. In : Freedberg IM, Eisen AZ, Wolf K, Austen KF, Goldsmith LA, Katz SI, editors. Fitzpatrick's dermatology in general medicine. 7th ed. New York: McGraw-Hill;1999. p. 561–577.

6. Gorouhi F, Davari P, Fazel N. Cutaneous and mucosal lichen planus: a comprehensive review of clinical subtypes, risk factors, diagnosis, and prognosis. ScientificWorldJournal. 2014; 2014:742826.

7. James WD, Berger TG, Elston DM. Lichen planus and related condition. In : James WD, Elston DM, Berger TG, Andrews GC, editors. Andrews' diseases of the skin: clinical dermatology. 11th ed. Philadelphia, PA: Elsevier Saunders;2011.

8. Roopashree MR, Gondhalekar RV, Shashikanth MC, George J, Thippeswamy SH, Shukla A. Pathogenesis of oral lichen planus--a review. J Oral Pathol Med. 2010; 39:729–734.

9. Öztürk MO, Uluşahin NA. Ruh Sağlığı ve Bozuklukları. Ankara: Hekimler Yayğn Birliği;1994.

10. Tamam L, Zeren T. Depresyonda serotonerjik düzenekler. Klinik Psikiyatri Dergisi. 2002; 5:11–18.

11. Müller N. Immunology of major depression. Neuroimmunomodulation. 2014; 21:123–130.

12. Leonard BE. The HPA and immune axes in stress: the involvement of the serotonergic system. Eur Psychiatry. 2005; 20:Suppl 3. S302–S306.

13. Rödström PO, Jontell M, Hakeberg M, Berggren U, Lindstedt G. Erosive oral lichen planus and salivary cortisol. J Oral Pathol Med. 2001; 30:257–263.

14. Huang J, Li G, Xiang J, Yin D, Chi R. Immunohistochemical study of serotonin in lesions of psoriasis. Int J Dermatol. 2004; 43:408–411.

15. Huang J, Li G, Xiang J, Yin D, Chi R. Immunohistochemical study of serotonin in lesions of chronic eczema. Int J Dermatol. 2004; 43:723–726.

16. Akay A, Pekcanlar A, Bozdag KE, Altintas L, Karaman A. Assessment of depression in subjects with psoriasis vulgaris and lichen planus. J Eur Acad Dermatol Venereol. 2002; 16:347–352.

17. Allen CM, Beck FM, Rossie KM, Kaul TJ. Relation of stress and anxiety to oral lichen planus. Oral Surg Oral Med Oral Pathol. 1986; 61:44–46.

18. Bergdahl J, Ostman PO, Anneroth G, Perris H, Skoglund A. Psychologic aspects of patients with oral lichenoid reactions. Acta Odontol Scand. 1995; 53:236–241.

19. Chaudhary S. Psychosocial stressors in oral lichen planus. Aust Dent J. 2004; 49:192–195.

20. Ivanovski K, Nakova M, Warburton G, Pesevska S, Filipovska A, Nares S, et al. Psychological profile in oral lichen planus. J Clin Periodontol. 2005; 32:1034–1040.

21. Koray M, Dülger O, Ak G, Horasanli S, Uçok A, Tanyeri H, et al. The evaluation of anxiety and salivary cortisol levels in patients with oral lichen planus. Oral Dis. 2003; 9:298–301.

22. Lundqvist EN, Wahlin YB, Bergdahl M, Bergdahl J. Psychological health in patients with genital and oral erosive lichen planus. J Eur Acad Dermatol Venereol. 2006; 20:661–666.

23. Rojo-Moreno JL, Bagán JV, Rojo-Moreno J, Donat JS, Milián MA, Jiménez Y. Psychologic factors and oral lichen planus. A psychometric evaluation of 100 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 86:687–691.

24. Soto Araya M, Rojas Alcayaga G, Esguep A. Association between psychological disorders and the presence of Oral lichen planus, Burning mouth syndrome and Recurrent aphthous stomatitis. Med Oral. 2004; 9:1–7.

25. Vallejo MJ, Huerta G, Cerero R, Seoane JM. Anxiety and depression as risk factors for oral lichen planus. Dermatology. 2001; 203:303–307.

26. El-Nour H, Lundeberg L, Abdel-Magid N, Lonne-Rahm SB, Azmitia EC, Nordlind K. Serotonergic mechanisms in human allergic contact dermatitis. Acta Derm Venereol. 2007; 87:390–396.

27. Lonne-Rahm SB, Rickberg H, El-Nour H, Mårin P, Azmitia EC, Nordlind K. Neuroimmune mechanisms in patients with atopic dermatitis during chronic stress. J Eur Acad Dermatol Venereol. 2008; 22:11–18.

28. Nordlind K, Thorslund K, Lonne-Rahm S, Mohabbati S, Berki T, Morales M, et al. Expression of serotonergic receptors in psoriatic skin. Arch Dermatol Res. 2006; 298:99–106.

29. Thorslund K, Amatya B, Dufva AE, Nordlind K. The expression of serotonin transporter protein correlates with the severity of psoriasis and chronic stress. Arch Dermatol Res. 2013; 305:99–104.

30. Thorslund K, El-Nour H, Nordlind K. The serotonin transporter protein is expressed in psoriasis, where it may play a role in regulating apoptosis. Arch Dermatol Res. 2009; 301:449–457.

31. Kushnir-Sukhov NM, Brown JM, Wu Y, Kirshenbaum A, Metcalfe DD. Human mast cells are capable of serotonin synthesis and release. J Allergy Clin Immunol. 2007; 119:498–499.

32. Mössner R, Lesch KP. Role of serotonin in the immune system and in neuroimmune interactions. Brain Behav Immun. 1998; 12:249–271.

33. Sperner-Unterweger B, Kohl C, Fuchs D. Immune changes and neurotransmitters: possible interactions in depression? Prog Neuropsychopharmacol Biol Psychiatry. 2014; 48:268–276.

34. Ahern GP. 5-HT and the immune system. Curr Opin Pharmacol. 2011; 11:29–33.

35. Welz-Kubiak K, Reich A. Mediators of pruritus in lichen planus. Autoimmune Dis. 2013; 2013:941431.