Autoimmune disorders as predictive factors for oral lichen planus and malignancy risk: real-world data analysis

Oral lichen planus (OLP) is a T-cell-mediated mucosal disorder with malignant potential and ∼1% prevalence. Its associations with autoimmune diseases and oral squamous cell carcinoma (OSCC), especially among smokers, remain unclear. This study quantified OLP prevalence across 17 autoimmune disorders and evaluated OSCC risk in these cohorts.

Data from TriNetX research network were analyzed in a retrospective cohort of adults ≥18 years. Patients with one of 17 autoimmune diseases were identified via ICD-10 codes and compared to nonautoimmune controls. OLP prevalence and risk were estimated using 1:1 age- and sex-matched propensity score matching. OSCC risk in autoimmune and OLP patients was assessed via ICD-O/ICD-10 codes, and tobacco impact was evaluated.

In 4,480,330 patients with autoimmune disorders, OLP prevalence was 2.04%, ranging from 1.19% in multiple sclerosis to 4.57% in Sjögren's. OLP risk was significantly elevated in 13 conditions (OR = 1.06-2.44; P < .05), nonsignificant for scleroderma, myasthenia gravis, and Hashimoto, and inversely associated with multiple sclerosis (OR = 0.78; P < .0001). OSCC risk was 1.39%, with ORs of 15.93 overall and 23.6 in smokers with autoimmune disorders and OLP (P < .0001).

Autoimmune interactions in OLP are complex, with robust associations in Sjögren's, vasculitis, Addison's, and intriguing multiple sclerosis protection. The markedly elevated risk of OSCC in patients with autoimmune disease and OLP highlights the need for integrated screening protocols and patient education.