Serum Amyloid A as an Inflammation Marker in Lichen Planus

Background: Lichen planus (LP) is a chronic T cell-mediated inflammatory disorder that can affect skin, mucosa, hair, and nails. Serum amyloid A (SAA) is a conserved acute phase protein in response to trauma, infection, malignancy, and severe stress. SAA may have a homeostatic role rather than a pro-inflammatory or anti-inflammatory one. Serum levels of SAA were demonstrated to be raised in several inflammatory systemic and skin diseases as rheumatoid arthritis, systemic lupus erythematosus, and psoriasis. Aim: This study aimed to evaluate serum levels of SAA, and IL 6 in a sample of Egyptian LP patients and to estimate its correlation with disease severity. Patients and methods: We included 21 adult patients with LP and 21 healthy adults as control. The total score of LP severity was measured for all patients through measurement of the affected body surface area in cutaneous LP patients while using a semi-quantitative clinical scoring system for oral LP together with the visual analog scale for pain assessment in OLP. Serum levels of SAA were estimated in all participants using enzyme-linked immunosorbent assay. Results: The expression levels of SAA and IL 6 in peripheral blood of patients in the two groups were detected. Pearson analysis was used in the correlation between SAA and IL 6 and Receiver operating characteristic (ROC) curve was employd to analyze the predictive value of SAA and IL 6 for LP severity. Logistic regression analysis was used to analyze the risk factors of LP patients. The expression levels of SAA and IL 6 of patients in sever form were significantly higher than those in mild form (P<0.05). Pearson analysis showed that SAA was positively correlated with IL 6 expression (P<0.05). ROC curve analysis showed that AUC predicted by SAA and IL 6 for LP severity was 0.789 and 0.762 (P<0.05). Logistic regression analysis showed that SAA and IL 6 were prediction indexes of LP severity. Conclusion: The levels of SAA and IL 6 were significantly increased during LP and effectively predicted the severity of LP and is a risk factor affecting LP patients. Further studies are needed to establish this association then it might be used for the evaluation of therapeutic outcomes. J Clin Investigat Dermatol July 2021 Volume 9, Issue 1 © All rights are reserved by Metwalli M, et al. Avens Publishing Group Inviting Innovations Citation: Metwalli M, Ibraheem AH, Abu bakr H, Fathia MK. Serum Amyloid A as an Inflammation Marker in Lichen Planus. J Clin Investigat Dermatol. 2021;9(1): 3 J Clin Investigat Dermatol 9(1): 3 (2021) Page 02 ISSN: 2373-1044 All the study participants were subjected to detailed history taking, thorough physical examination, and measurement of serum SAA. In addition, LP severity was assessed for all LP patients. Estimation of SAA levels, IL 6 by enzyme-linked immunosorbent assay Serum levels of SAA, IL 6 was estimated based on ELISA Kit for in vitro quantitative measurement according to the producer protocol (SunRedBio, Shanghai, China). Five-milliliter venous blood samples were drawn into a sterile vial from all patients and controls. The clotted blood is then centrifuged at 3,000 rpm for 10 minutes. Then serum was transferred to labeled tubes and stored at -80 until assay. Assessment of disease severity for the involved cases Cutaneous LP: severity assessment was done through calculation of the affected body surface area (BSA) which was measured by using the total palmar surface of the hand, including the five digits, which is approximately 1% of total BSA. Patients were classified on basis of BSA into mild (<3% BSA affected), Moderate (3-10% BSA affected), and severe (>10% BSA affected) categories. This scale is primarily used for the classification of psoriasis and no similar scale was found for LP, it was useful practically and clinically for this study as well [11] Severity assessment of OLP was done using a semiquantitative scoring system based on the site, area, and presence of erosions, known as the clinical scoring system of OLP. It divides the mouth into eight areas with a score of severity between 0 and 2. Grading, based on scores, is divided into grades 0,1,2, and 3. Determination of severity, based on grade, is either mild, moderate, or severe disease [12]. Assessment of LP activity was done by progression surveillance, and it was classified according to the emergence of new lesions or progression of current lesions over the last 6 weeks to 1 year [13].