The Serum Evaluation of Sex Hormones Including DHEAs, DHT, Testosterone in Oral Lichen Planus Patients

The Serum Evaluation of Sex Hormones Including DHEAs, DHT, Testosterone in Oral Lichen Planus Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Serum Evaluation of Sex Hormones Including DHEAs, DHT, Testosterone in Oral Lichen Planus Patients Fahimeh Rezazadeh, Fatemeh Lavaee, Saba Dezhkameh, Aylar Afshari This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6083473/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 May, 2025 Read the published version in Scientific Reports → Version 1 posted 8 You are reading this latest preprint version Abstract Background: Lichen planus (LP), an inflammatory and chronic disorder, is immune-mediated and influences nails, skin, hair, and mucosal tissues. Autoimmune diseases affect females more commonly, and it is reported that there is an association between certain sex hormones and autoimmune diseases. Methods: This study aims to evaluate the serum levels of DHT, Dehydroepiandrosterone (DHEAs), and testosterone (T) in patients who have oral lichen planus (OLP) compared to healthy people. Forty female patients diagnosed with OLP were selected. They were considered to have the same mean age as 40 patients in the control group. The enzyme-linked immunosorbent assay investigated Androgens' serum levels (Monobomal kit, Sherkat Azmayeshgah Bartar). Results: The age mean 51.90 ±11.52 for the patient group and 49.10 ± 11.63 for the control group. Erosive LP was the most common subtype of LP, 72.5% of LP lesions. The differences between DHEAs (p-value=0.126), DHT (p-value =0.710), and T’s serum level (p-value =0.376) groups were not significant. There was no difference between hormonal levels during menopause and the non-menopause group. Conclusions: There was no correlation between OLP and androgens. DHEAs, DHT, and T levels were not different between case and control groups; therefore, the results did not support any neuroendocrine etiology for OLP. Also, there was no change in these androgens’ serum levels during the transition from pre-menopause to post-menopause. Trial registration: The study adhered to the ethical principles of the Helsinki Declaration (2002 version) and received approval from the ethics committee of Shiraz University of Medical Sciences, Shiraz, Iran (IR.SUMS.REC.1397.709). Biological sciences/Cancer/Cancer screening Biological sciences/Cancer/Head and neck cancer Health sciences/Diseases Lichen Planus Gonadal Steroid Hormones Dehydroepiandrosterone Testosterone Figures Figure 1 Figure 2 Figure 3 Background Oral lichen planus (OLP) is a persistent disease affecting the mucous membranes frequently observed in dental clinics. The main cause of OLP is still unknown, but an abnormal immune response plays a key role in its pathogenesis. Auto-reactive T-lymphocytes are considered to be the most important cause of OLP. It presents in several forms within the oral cavity, with the reticular type being the most prevalent. The erosive and atrophic types are less frequently seen ( 1 ). The prevalence of lichen planus ranges from 0.1–4% depending upon the population studied; in the Indian subcontinent, a high prevalence rate has been noted. LP primarily influences the middle-aged population, with a higher incidence in females. It is rare in children. Histologically, OLP is characterized by hydropic degeneration of basal epithelial cells (keratinocytes), a dense subepithelial lymphocytic infiltration of mononuclear cells, and epithelial invasion ( 2 ). OLP is managed using topical or systemic corticosteroids to regulate the immune system of patients. The best treatment of choice for mild to moderate symptomatic lesions is topical corticosteroids ( 1 ). Female’s immune reactivity is greater than male based on experimental studies made on both humans and animals. There is a greater preponderance of numerous studies that indicated that the significant impact of sex hormones underlies sex-related vulnerability. Women experience hormonal fluctuations during various life stages such as puberty, menstruation, pregnancy, and menopause. Sex hormones play a role in influencing the development and severity of immune-related disorders by affecting lymphocytes from prenatal stages through adulthood. There are several studies about the relation of sex hormones in flare induction, treatment, or even incidence of autoimmune disease ( 3 ). Hormones are substances produced by endocrine glands, circulated in the blood to stimulate specific cells or tissues. Testosterone (T) functions as a hormone in men and potentially in women. DHT is considered one of the primary sex steroid hormones in men, alongside T and estradiol ( 4 ). DHEAs, also known as androstenolone, is an adrenal endogenous precursor steroid hormone. DHEAs are one of the most common steroids that circulate in humankind. In females, the androgen receptor agonists, including T; then, DHEAs synthesize DHTs in peripheral tissues by the activities of 3β- and 17β-hydroxysteroid dehydrogenases (3BHSD, 17BHSD) and 5α-reductases enzymes ( 5 ). Concerning the effect of sex hormones on modulating lymphocytes that may influence immune-mediated pathologic conditions such as OLP, this investigation aimed to assess sex hormone changes in patients with OLP lesions. Methods Study subjects: This cross-sectional case-control study was conducted on females who had OLP lesions and were referred to the Oral and Maxillofacial Disease Department at Shiraz Dental Faculty during 2018–2019. The study adhered to the ethical principles of the Helsinki Declaration (2002 version) and received approval from the ethics committee of Shiraz University of Medical Sciences, Shiraz, Iran (IR.SUMS.REC.1397.709). As there was no study to compare and determine the sample size, the results of research about an autoimmune disease that was mostly similar with an 80% power and a type 1 error of 0.05 utilized. With the consideration of the assessment of the relationship between sex hormones and a correlation coefficient of 0.58, the minimum sample size was estimated to be twenty-one participants. A total of 40 participants were put in each of case and control groups. For the case group, individuals with histopathologically confirmed OLP who received either inpatient or outpatient care were included in this study. The clinical criteria for diagnosis of oral lesions used in this research were as follows: i) papular OLP, characterized by keratotic, pinhead-sized, white, slightly elevated papules, which may present as discrete lesions or exhibit reticular or plaque-like configurations; (ii) atrophic OLP, defined by epithelial thinning resulting in atrophic red areas within white lesions; (iii) erosive (ulcerative) OLP, characterized by well-defined ulceration within the aforementioned lesions; and (iv) bullous OLP, distinguished by the presence or development of bullae within the described lesions. Figures 1 , 2 and 3 demonstrate the intra-oral photos of several included patients with OLP. Exclusion criteria: patients who used any systemic corticosteroids, immunosuppressive peals, or nonsteroidal anti-inflammatory drugs (NSAIDs) in the past four weeks, using topical treatments in the past two weeks, patients who had tobacco usage and excessive alcohol drinking, who were pregnant, lactating, had a trauma or surgery history in 1 the last one month, had a present systemic disorder/disease, such as kidney and liver dysfunction, blood dyscrasias, inflammatory diseases, rheumatoid and other dermatologic disorders which affected the immune system, or any malignancies, individuals who received any treatments which affect androgens levels, including steroidal antiandrogens Cyproterone acetate, Nilutamide, Spironolactone, Bicalutamide, and the nonsteroidal antiandrogens Flutamide, were excluded from the study. Forty volunteered female individuals who were healthy and matched with the study group in consideration of their age were entered in the research. Age, OLP type (erosive or non-erosive), and menopausal condition (post-menopause or not) were registered. After signing the written informed consent form, their sex hormones serum level was assessed. Blood samples (6 ml) were gathered as part of their routine check-up before the start of treatment on the third day of the menstrual cycle and two hours after waking up in the morning. This particular timing for blood sample collection was not required for menopausal individuals. After the blood samples were taken, they were allowed to settle, after 15–20 minutes, they were spun at 3500 rpm for seven minutes. Serum samples that were not planned for immediate testing were frozen. The levels of T, DHEAs, and DHT in the serum were analyzed at the Motahari laboratory. The levels of Serum DHT, DHEAs, and T were measured using the enzyme-linked immunosorbent assay (Monobomal kit, Sherkat Azmayeshgah Bartar). Regarding statistical analysis, the data were processed using SPSS version 22. A p-value below 0.05 was considered statistically significant. The normality of the data was assessed using the Kolmogorov-Smirnov test. The Mann-Whitney test was employed to compare the average hormone levels between OLP and the healthy control group. Results This study evaluated the sex hormone serum level of 40 females with OLP and 40 age-matched healthy females as the control group. The age mean for the patient group was 51.90 ± 11.52, and 49.10 ± 11.63 for the control group. The mean age of the case and control groups were not different significantly compared to each other age (p-value = 0.283). Therefore, our control patient ages were matched with our participants in case groups. Erosive LP was the most commonly observed type (72.5 percent of LPs) (Table 1 ). The mean levels of T (p-value = 0.376), DHT (p-value = 0.710), and DHEAs (p-value = 0.126) in the case group compared with the control group were not significantly different (Table 2 ). There were no differences between hormonal levels during menopause and the non-menopause group (Table 3 ). Table 1 The age and menopausal status of cases and controls Variables Group P-value control case Age 51.90 ± 11.52 49.10 ± 11.63 0.283 menopause - 19(47.5%) 13(32.5%) 0.171 + 21(52.5%) 27(67.5%) Table 2 The mean serum level and comparison of TESTO, DHT and DHEAs between the case and control groups Sex hormones Group P value control case T (ng/dL) 0.33 0.38 0.376 DHT (ng/dL) 228.90 241.37 0.710 DHEAs (µg/dL) 1.40 1.02 0.126 T = testosterone; DHT = Dihydrotestosterone; DHEAs = dehydroepiandrosterone sulfate Table 3 The mean serum level and comparison of TESTO, DHT and DHEAs between menopause and non-menopause participants of case and control groups hormones Non menopause menopause P value case TESTO (ng/dL) 0.28 ± 0.244 0.35 ± 0.242 0.418 DHT (ng/dL) 262.13 ± 218.230 212.90 ± 179.048 0.453 DHEAs (µg/dL) 1.48 ± 0.718 1.36 ± 1.260 0.749 control TESTO (ng/dL) 0.41 ± 0.248 0.33 ± 0.188 0.255 DHT (ng/dL) 263.18 ± 72.865 217.26 ± 101.443 0.106 DHEAs (µg/dL) 1.18 ± 0.708 0.85 ± 1.325 0.313 A significantly higher number of patients had normal T levels in the control group compared to the study group (p = 0.05). However, the number of patients with normal DHT and DHEAs levels were not significantly different in the case compared with the control group (p-value = 0.361 and p-value = 1.000) (Table 4 ). Table 4 The number of patients with LP in the hormonal normal range compared to the abnormal range in the case and control group Sex hormones control case P value TESTO (ng/dL) normal 35 40 0.055 abnormal 5 0 DHT (ng/dL) normal 26 22 0.361 abnormal 14 18 DHEAs (µg/dL) normal 37 37 1.000 abnormal 3 3 No significant differences were observed in concern with the mean serum levels of T, DHT, and DHEAs between erosive and non-erosive patients (p-value = 0.44, p-value = 0.23, p-value = 0.76) (Table 5 ). Table 5 The mean serum level of sex hormones in the erosive and non-erosive patients Sex hormones Mean P value TESTO (ng/dL) erosive 0.35 ± 0.259 0.445 Non erosive 0.28 ± 0.194 DHT (ng/dL) erosive 247.13 ± 210.189 0.230 Non erosive 180.85 ± 124.183 DHEAs (µg/dL) erosive 1.36 ± 1.159 0.764 Non erosive 1.48 ± 0.994 The hormonal level had no relationship with menopause status, type of LP, or age. Discussion LP is an autoimmune long-lasting disease that can affect both mucosa, skin, or both. This means it has its trace on the mucosal tissue of the mouth (OLP) in addition to the cutaneous tissues, genital mucosal tissues, scalp, and nails. The immune-mediated pathogenesis for the LP was identified in previous studies; although, the exact etiology is still unknown. As immunomodulatory, metabolic, and hormonal pathways have huge influences on LP development, and this disease is more prevalent in women ( 6 )( 9 ), the researchers of this study were encouraged to assess the effect of sex hormones in women on the pathogenesis of this disorder. In this study, the relationship between the mean serum level of sex hormones (T, DHT, and DHEAs) and OLP was analyzed, and was not significantly different between the two groups. Which indicated that LP is not affected by sex hormones. So far as we know, there has not been any similar research evaluating the serum level of these hormones in individuals with OLP. However, Akanksha et al. assessed prolactin in OLP and their result was in accordance with our data ( 7 ); however, they reported prolactin was related to the activity of OLP. In defiance of what has been seen, it has been told that the level of prolactin has a direct relationship with the occurrence of some autoimmune disorders like systemic rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren’s syndrome, multiple sclerosis, and Hashimoto’s thyroiditis ( 8 ). Corroborating the findings of the present study, Carla et al. could not see any significant differences between LP patients and the control group concerning morning levels or night levels of salivary DHEAs ( 9 ). However, Suzuki et al. admitted that nearly all of the patients with SLE who were examined had very low levels of serum DHEAs ( 10 ). This result was supported by a comparable study on Sjogren syndrome ( 11 ), and Rheumatoid arthritis ( 12 ) which insufficiency of DHEAs could be seen in these participants. Therefore, these differences may be related to diseases. SLE, Sjogren syndrome, and RA have different etiopathogenesis compared with LP. According to this study, age, menopause status, and type of LP do not have any relationship with androgen hormone levels. Thus, the level of these hormones in LP is not affected by menopause status. In women before menopause, the production rate of DHEAs is about 6–8 mg per day. The adrenal glands produce around 50% of this daily amount, the ovaries contribute about 1–2 mg, and peripheral tissues generate the rest ( 13 ). Despite the fact that T production in premenopausal women is about 0.2 to 0.25 mg per day ( 14 ), several postmenopausal women’s ovaries still make some T, but no DHEA ( 15 ). Although age can affect the serum concentration of DHEA (S), in our investigations, it was not significantly different between menopause and non-menopause women in the two groups. Aging affects the serum level of this hormone rather than menopause. A study indicated that the highest levels of circulating DHEA and DHEAS are reached between the ages of twenty and thirty years. Then, as women get older, the body reduces these hormones’ levels ( 16 ). These findings are different from the result of our study: the level of DHEAs was not affected by age or menopause status. The outcome of this study was mainly due to the limited age range of our study’s participants. However, there is significant variability among individuals throughout adulthood, resulting in a very wide normal range of serum DHEA (S) levels for each decade of life. Women in their mid-70s produce about 77% less DHEA(S) compared to women aged 20 to 30, indicating that age solely accounts for approximately 30% of the variation in DHEA (S) levels ( 17 ). In accordance with our study, Henry et al. also found that the total serum levels of T were unchanged across the menopausal transition. T was also independent of age and BMI ( 18 ). However, there are some controversies about changes in serum levels of T across the menopausal transition. Bancroft and Cawood reported that the total mean T level in the group of postmenopausal patients is lower (significantly) compared with their cycling group of subjects ( 19 ). Our report showed that there was no significant relationship between T and females with LP. Assad et al. determined that adjusting estrogen levels in females (both pre-menopausal and post-menopausal) and T levels in males could be an effective treatment for stress-related immune imbalances that lead to autoimmune diseases in both genders ( 20 ). During menopause, androgen levels did not change, and there was no significant relationship with LP. Since menopause is associated with a decline in estrogen levels, we suggest that the level of estrogen and progesterone be analyzed in OLP in later studies. In this study, the number of individuals with abnormal hormone levels was analyzed, and only T abnormality was different in the case and control groups and, which higher in the control group. The biggest limit in this investigation was the amount of sample size and the fact that only females were studied. A second limitation was that only T, DHT, and DHEAs were considered. Other sex hormones in LP patients may be assessed in both females and males as well, with a bigger sample size. Conclusions There was no correlation between OLP and androgens. No difference was observed in DHEAs, DHT, and T amounts between the case and control patients; therefore, no differences were found between serum levels of androgens in the OLP group compared to healthy controls during the transition from pre-menopause to post-menopause. Abbreviations Lichen planus (LP) Dehydroepiandrosterone (DHEAs), and testosterone (T) in patients who have oral lichen planus (OLP) 3β- and 17β-hydroxysteroid dehydrogenases (3BHSD, 17BHSD) nonsteroidal anti-inflammatory drugs (NSAIDs) rheumatoid arthritis (RA) systemic lupus erythematosus (SLE) Declarations Ethics approval and consent to participate An informed consent form was taken from patients before the initiation of therapy. The study adhered to the ethical principles of the Helsinki Declaration (2002 version) and received approval from the ethics committee of Shiraz University of Medical Sciences, Shiraz, Iran (IR.SUMS.REC.1397.709). Consent for publication An informed consent form was taken from patients before the initiation of therapy. Availability of data and materials The dataset of the present study is available. Please contact the co-responding author (Aylar Afshari: [email protected] ) to request the data from this study. Competing interests The authors did not have any conflicts of interest. Funding This research was supported by the Vice-Chancellor of Shiraz University of Medical Science with the grant number of 17267. Authors' contributions FR designed the work, analyzed and interpreted the patient data, drafted the work, and revised it. FL interpreted the patient data, drafted the work, and revised it. SD analyzed and interpreted the patient data, and drafted the work. AA drafted the work, and revised it. Acknowledgements The authors thank the Vice-chancellery of Shiraz University of Medical Science for the support of this study with the grant number of 17267. The present study based on Saba Dezhkameh thesis from dental School of Shiraz University of Medical Sciences. The authors thank the Research Consultation Center (RCC) of Shiraz University of Medical Sciences for the assistance in editing this manuscript. References Edwards, P. C. & Kelsch, R. 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Endocrinol. 33 (2), 387–410 (2004). Moreau, K. L., Babcock, M. C. & Hildreth, K. L. Sex differences in vascular aging in response to testosterone. Biol. Sex. Differ. 11 (1), 1–14 (2020). Davis, S. R. Androgens in premenopausal women and women with premature ovarian insufficiency. Climacteric 24 (5), 459–465 (2021). Zhang, C. et al. Incorporation of poly(ethylene glycol) grafted cellulose nanocrystals in poly(lactic acid) electrospun nanocomposite fibers as potential scaffolds for bone tissue engineering. Mater. Sci. Eng. C . 49 , 463–471 (2015). Davison, S. L., Bell, R., Donath, S., Montalto, J. G. & Davis, S. R. Androgen levels in adult females: changes with age, menopause, and oophorectomy. J. Clin. Endocrinol. Metab. 90 (7), 3847–3853 (2005). Statello, L., Guo, C-J., Chen, L-L. & Huarte, M. Gene regulation by long non-coding RNAs and its biological functions. Nat. Rev. Mol. cell. Biol. 22 (2), 96–118 (2021). Ambikairajah, A., Walsh, E., Tabatabaei-Jafari, H. & Cherbuin, N. Fat mass changes during menopause: a metaanalysis. Am. J. Obstet. Gynecol. 221 (5), 393–409 (2019). Assad, S. et al. Role of sex hormone levels and psychological stress in the pathogenesis of autoimmune diseases. Cureus ; 9 (6). (2017). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6083473","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":444456746,"identity":"50e41780-0644-4da0-a088-351c7f101a29","order_by":0,"name":"Fahimeh Rezazadeh","email":"","orcid":"","institution":"Shiraz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fahimeh","middleName":"","lastName":"Rezazadeh","suffix":""},{"id":444456748,"identity":"e0321678-67b9-48ac-9bcb-c0b8f5385860","order_by":1,"name":"Fatemeh Lavaee","email":"","orcid":"","institution":"Shiraz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Lavaee","suffix":""},{"id":444456750,"identity":"23650609-fe6c-40ce-8344-6ed31956a56b","order_by":2,"name":"Saba Dezhkameh","email":"","orcid":"","institution":"Shiraz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Saba","middleName":"","lastName":"Dezhkameh","suffix":""},{"id":444456751,"identity":"42250896-afa4-4294-821c-7128c74e7522","order_by":3,"name":"Aylar Afshari","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYDAC5gNsQFICyGBuYGCoYIAy8AG2BJgWRqDKMwxQBmEtIABUydgGZeAD/G3szx783GPBwN/O2Pi5cl5tNJDRwPCjYhtOLRLHeMwNe55JMEgcZmyWPLvteO6Mw4wNjD1nbuO25n4PmwTPAaBfgColG7cdy20AMpgZ23BrkT/G/kzyD1CLPNCWn41zjuXOJ6TF4BiDmTTIFoPDjG2SjQ01uRsIaTE8xmMmLXNAgscQqMWy4diB3I1ALQfx+UUO5LA3B+rk5M4fPnyzoaYud975wwcf/KjA430o4IHSh8HkAYLqkUAdKYpHwSgYBaNghAAA9ohYWjtgLoQAAAAASUVORK5CYII=","orcid":"","institution":"Shiraz University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Aylar","middleName":"","lastName":"Afshari","suffix":""}],"badges":[],"createdAt":"2025-02-22 06:08:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6083473/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6083473/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-01750-4","type":"published","date":"2025-05-14T15:58:01+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81010045,"identity":"b66be056-1798-4491-b73f-f995d00947b2","added_by":"auto","created_at":"2025-04-21 08:14:06","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":273898,"visible":true,"origin":"","legend":"\u003cp\u003ePapular \u003cstrong\u003eOLP lesion on the left buccal mucosa\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6083473/v1/bc51e2cc72775549ae3a87bd.jpeg"},{"id":81010049,"identity":"0ca365e9-079b-47db-adcd-98c83f88efdd","added_by":"auto","created_at":"2025-04-21 08:14:06","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":239193,"visible":true,"origin":"","legend":"\u003cp\u003eErosive OLP \u003cstrong\u003elesion on the right buccal mucosa\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6083473/v1/4d585deb505eb292b5b979ba.jpeg"},{"id":81010046,"identity":"8da125fd-c2bd-44d1-a637-eeb4d92a5bc2","added_by":"auto","created_at":"2025-04-21 08:14:06","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":295559,"visible":true,"origin":"","legend":"\u003cp\u003eErosive OLP lesion on the labial gingiva of anterior maxilla\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6083473/v1/8bb3136c9c05c17fa00d50ae.jpeg"},{"id":83067893,"identity":"c1265acb-4a2a-41b2-8260-a6907000dda1","added_by":"auto","created_at":"2025-05-19 16:07:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2197384,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6083473/v1/a6be0d59-2fbd-4bfa-960b-bb89a1212734.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Serum Evaluation of Sex Hormones Including DHEAs, DHT, Testosterone in Oral Lichen Planus Patients","fulltext":[{"header":"Background","content":"\u003cp\u003eOral lichen planus (OLP) is a persistent disease affecting the mucous membranes frequently observed in dental clinics. The main cause of OLP is still unknown, but an abnormal immune response plays a key role in its pathogenesis. Auto-reactive T-lymphocytes are considered to be the most important cause of OLP. It presents in several forms within the oral cavity, with the reticular type being the most prevalent. The erosive and atrophic types are less frequently seen (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of lichen planus ranges from 0.1\u0026ndash;4% depending upon the population studied; in the Indian subcontinent, a high prevalence rate has been noted. LP primarily influences the middle-aged population, with a higher incidence in females. It is rare in children. Histologically, OLP is characterized by hydropic degeneration of basal epithelial cells (keratinocytes), a dense subepithelial lymphocytic infiltration of mononuclear cells, and epithelial invasion (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOLP is managed using topical or systemic corticosteroids to regulate the immune system of patients. The best treatment of choice for mild to moderate symptomatic lesions is topical corticosteroids (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFemale\u0026rsquo;s immune reactivity is greater than male based on experimental studies made on both humans and animals. There is a greater preponderance of numerous studies that indicated that the significant impact of sex hormones underlies sex-related vulnerability. Women experience hormonal fluctuations during various life stages such as puberty, menstruation, pregnancy, and menopause. Sex hormones play a role in influencing the development and severity of immune-related disorders by affecting lymphocytes from prenatal stages through adulthood. There are several studies about the relation of sex hormones in flare induction, treatment, or even incidence of autoimmune disease (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHormones are substances produced by endocrine glands, circulated in the blood to stimulate specific cells or tissues. Testosterone (T) functions as a hormone in men and potentially in women. DHT is considered one of the primary sex steroid hormones in men, alongside T and estradiol (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). DHEAs, also known as androstenolone, is an adrenal endogenous precursor steroid hormone. DHEAs are one of the most common steroids that circulate in humankind. In females, the androgen receptor agonists, including T; then, DHEAs synthesize DHTs in peripheral tissues by the activities of 3β- and 17β-hydroxysteroid dehydrogenases (3BHSD, 17BHSD) and 5α-reductases enzymes (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConcerning the effect of sex hormones on modulating lymphocytes that may influence immune-mediated pathologic conditions such as OLP, this investigation aimed to assess sex hormone changes in patients with OLP lesions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e Study subjects: This cross-sectional case-control study was conducted on females who had OLP lesions and were referred to the Oral and Maxillofacial Disease Department at Shiraz Dental Faculty during 2018\u0026ndash;2019. The study adhered to the ethical principles of the Helsinki Declaration (2002 version) and received approval from the ethics committee of Shiraz University of Medical Sciences, Shiraz, Iran (IR.SUMS.REC.1397.709).\u003c/p\u003e \u003cp\u003eAs there was no study to compare and determine the sample size, the results of research about an autoimmune disease that was mostly similar with an 80% power and a type 1 error of 0.05 utilized. With the consideration of the assessment of the relationship between sex hormones and a correlation coefficient of 0.58, the minimum sample size was estimated to be twenty-one participants. A total of 40 participants were put in each of case and control groups.\u003c/p\u003e \u003cp\u003eFor the case group, individuals with histopathologically confirmed OLP who received either inpatient or outpatient care were included in this study. The clinical criteria for diagnosis of oral lesions used in this research were as follows: i) papular OLP, characterized by keratotic, pinhead-sized, white, slightly elevated papules, which may present as discrete lesions or exhibit reticular or plaque-like configurations; (ii) atrophic OLP, defined by epithelial thinning resulting in atrophic red areas within white lesions; (iii) erosive (ulcerative) OLP, characterized by well-defined ulceration within the aforementioned lesions; and (iv) bullous OLP, distinguished by the presence or development of bullae within the described lesions. Figures\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e,\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e demonstrate the intra-oral photos of several included patients with OLP.\u003c/p\u003e\u003cp\u003eExclusion criteria: patients who used any systemic corticosteroids, immunosuppressive peals, or nonsteroidal anti-inflammatory drugs (NSAIDs) in the past four weeks, using topical treatments in the past two weeks, patients who had tobacco usage and excessive alcohol drinking, who were pregnant, lactating, had a trauma or surgery history in 1 the last one month, had a present systemic disorder/disease, such as kidney and liver dysfunction, blood dyscrasias, inflammatory diseases, rheumatoid and other dermatologic disorders which affected the immune system, or any malignancies, individuals who received any treatments which affect androgens levels, including steroidal antiandrogens Cyproterone acetate, Nilutamide, Spironolactone, Bicalutamide, and the nonsteroidal antiandrogens Flutamide, were excluded from the study.\u003c/p\u003e \u003cp\u003eForty volunteered female individuals who were healthy and matched with the study group in consideration of their age were entered in the research.\u003c/p\u003e \u003cp\u003eAge, OLP type (erosive or non-erosive), and menopausal condition (post-menopause or not) were registered. After signing the written informed consent form, their sex hormones serum level was assessed.\u003c/p\u003e \u003cp\u003eBlood samples (6 ml) were gathered as part of their routine check-up before the start of treatment on the third day of the menstrual cycle and two hours after waking up in the morning. This particular timing for blood sample collection was not required for menopausal individuals. After the blood samples were taken, they were allowed to settle, after 15\u0026ndash;20 minutes, they were spun at 3500 rpm for seven minutes. Serum samples that were not planned for immediate testing were frozen. The levels of T, DHEAs, and DHT in the serum were analyzed at the Motahari laboratory. The levels of Serum DHT, DHEAs, and T were measured using the enzyme-linked immunosorbent assay (Monobomal kit, Sherkat Azmayeshgah Bartar).\u003c/p\u003e \u003cp\u003eRegarding statistical analysis, the data were processed using SPSS version 22. A p-value below 0.05 was considered statistically significant. The normality of the data was assessed using the Kolmogorov-Smirnov test. The Mann-Whitney test was employed to compare the average hormone levels between OLP and the healthy control group.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study evaluated the sex hormone serum level of 40 females with OLP and 40 age-matched healthy females as the control group. The age mean for the patient group was 51.90\u0026thinsp;\u0026plusmn;\u0026thinsp;11.52, and 49.10\u0026thinsp;\u0026plusmn;\u0026thinsp;11.63 for the control group.\u003c/p\u003e \u003cp\u003eThe mean age of the case and control groups were not different significantly compared to each other age (p-value\u0026thinsp;=\u0026thinsp;0.283). Therefore, our control patient ages were matched with our participants in case groups. Erosive LP was the most commonly observed type (72.5 percent of LPs) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe mean levels of T (p-value\u0026thinsp;=\u0026thinsp;0.376), DHT (p-value\u0026thinsp;=\u0026thinsp;0.710), and DHEAs (p-value\u0026thinsp;=\u0026thinsp;0.126) in the case group compared with the control group were not significantly different (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere were no differences between hormonal levels during menopause and the non-menopause group (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe age and menopausal status of cases and controls\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ecase\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.90\u0026thinsp;\u0026plusmn;\u0026thinsp;11.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.10\u0026thinsp;\u0026plusmn;\u0026thinsp;11.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.283\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003emenopause\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(47.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13(32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(52.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27(67.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe mean serum level and comparison of TESTO, DHT and DHEAs between the case and control groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex hormones\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ecase\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eT (ng/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.376\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDHT (ng/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e228.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e241.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.710\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDHEAs (\u0026micro;g/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eT\u0026thinsp;=\u0026thinsp;testosterone; DHT\u0026thinsp;=\u0026thinsp;Dihydrotestosterone; DHEAs\u0026thinsp;=\u0026thinsp;dehydroepiandrosterone sulfate\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe mean serum level and comparison of TESTO, DHT and DHEAs between menopause and non-menopause participants of case and control groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ehormones\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon menopause\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003emenopause\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ecase\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTESTO (ng/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.418\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDHT (ng/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e262.13\u0026thinsp;\u0026plusmn;\u0026thinsp;218.230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e212.90\u0026thinsp;\u0026plusmn;\u0026thinsp;179.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.453\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDHEAs (\u0026micro;g/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.749\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003econtrol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTESTO (ng/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDHT (ng/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e263.18\u0026thinsp;\u0026plusmn;\u0026thinsp;72.865\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e217.26\u0026thinsp;\u0026plusmn;\u0026thinsp;101.443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDHEAs (\u0026micro;g/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA significantly higher number of patients had normal T levels in the control group compared to the study group (p\u0026thinsp;=\u0026thinsp;0.05). However, the number of patients with normal DHT and DHEAs levels were not significantly different in the case compared with the control group (p-value\u0026thinsp;=\u0026thinsp;0.361 and p-value\u0026thinsp;=\u0026thinsp;1.000) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe number of patients with LP in the hormonal normal range compared to the abnormal range in the case and control group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSex hormones\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ecase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTESTO (ng/dL)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003enormal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eabnormal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDHT (ng/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003enormal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e26\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e22\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.361\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eabnormal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDHEAs (\u0026micro;g/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003enormal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e37\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e37\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e1.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eabnormal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNo significant differences were observed in concern with the mean serum levels of T, DHT, and DHEAs between erosive and non-erosive patients (p-value\u0026thinsp;=\u0026thinsp;0.44, p-value\u0026thinsp;=\u0026thinsp;0.23, p-value\u0026thinsp;=\u0026thinsp;0.76) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe mean serum level of sex hormones in the erosive and non-erosive patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSex hormones\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTESTO (ng/dL)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eerosive\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.259\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.445\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon erosive\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.194\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDHT (ng/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eerosive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e247.13\u0026thinsp;\u0026plusmn;\u0026thinsp;210.189\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.230\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNon erosive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e180.85\u0026thinsp;\u0026plusmn;\u0026thinsp;124.183\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDHEAs (\u0026micro;g/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eerosive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.159\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.764\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNon erosive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.994\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe hormonal level had no relationship with menopause status, type of LP, or age.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eLP is an autoimmune long-lasting disease that can affect both mucosa, skin, or both. This means it has its trace on the mucosal tissue of the mouth (OLP) in addition to the cutaneous tissues, genital mucosal tissues, scalp, and nails. The immune-mediated pathogenesis for the LP was identified in previous studies; although, the exact etiology is still unknown. As immunomodulatory, metabolic, and hormonal pathways have huge influences on LP development, and this disease is more prevalent in women (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), the researchers of this study were encouraged to assess the effect of sex hormones in women on the pathogenesis of this disorder.\u003c/p\u003e \u003cp\u003eIn this study, the relationship between the mean serum level of sex hormones (T, DHT, and DHEAs) and OLP was analyzed, and was not significantly different between the two groups. Which indicated that LP is not affected by sex hormones. So far as we know, there has not been any similar research evaluating the serum level of these hormones in individuals with OLP. However, Akanksha et al. assessed prolactin in OLP and their result was in accordance with our data (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e); however, they reported prolactin was related to the activity of OLP. In defiance of what has been seen, it has been told that the level of prolactin has a direct relationship with the occurrence of some autoimmune disorders like systemic rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren\u0026rsquo;s syndrome, multiple sclerosis, and Hashimoto\u0026rsquo;s thyroiditis (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCorroborating the findings of the present study, Carla et al. could not see any significant differences between LP patients and the control group concerning morning levels or night levels of salivary DHEAs (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, Suzuki et al. admitted that nearly all of the patients with SLE who were examined had very low levels of serum DHEAs (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). This result was supported by a comparable study on Sjogren syndrome (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), and Rheumatoid arthritis (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) which insufficiency of DHEAs could be seen in these participants. Therefore, these differences may be related to diseases. SLE, Sjogren syndrome, and RA have different etiopathogenesis compared with LP.\u003c/p\u003e \u003cp\u003eAccording to this study, age, menopause status, and type of LP do not have any relationship with androgen hormone levels. Thus, the level of these hormones in LP is not affected by menopause status. In women before menopause, the production rate of DHEAs is about 6\u0026ndash;8 mg per day. The adrenal glands produce around 50% of this daily amount, the ovaries contribute about 1\u0026ndash;2 mg, and peripheral tissues generate the rest (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Despite the fact that T production in premenopausal women is about 0.2 to 0.25 mg per day (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), several postmenopausal women\u0026rsquo;s ovaries still make some T, but no DHEA (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough age can affect the serum concentration of DHEA (S), in our investigations, it was not significantly different between menopause and non-menopause women in the two groups. Aging affects the serum level of this hormone rather than menopause.\u003c/p\u003e \u003cp\u003eA study indicated that the highest levels of circulating DHEA and DHEAS are reached between the ages of twenty and thirty years. Then, as women get older, the body reduces these hormones\u0026rsquo; levels (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). These findings are different from the result of our study: the level of DHEAs was not affected by age or menopause status. The outcome of this study was mainly due to the limited age range of our study\u0026rsquo;s participants. However, there is significant variability among individuals throughout adulthood, resulting in a very wide normal range of serum DHEA (S) levels for each decade of life. Women in their mid-70s produce about 77% less DHEA(S) compared to women aged 20 to 30, indicating that age solely accounts for approximately 30% of the variation in DHEA (S) levels (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn accordance with our study, Henry et al. also found that the total serum levels of T were unchanged across the menopausal transition. T was also independent of age and BMI (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). However, there are some controversies about changes in serum levels of T across the menopausal transition. Bancroft and Cawood reported that the total mean T level in the group of postmenopausal patients is lower (significantly) compared with their cycling group of subjects (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur report showed that there was no significant relationship between T and females with LP. Assad et al. determined that adjusting estrogen levels in females (both pre-menopausal and post-menopausal) and T levels in males could be an effective treatment for stress-related immune imbalances that lead to autoimmune diseases in both genders (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDuring menopause, androgen levels did not change, and there was no significant relationship with LP. Since menopause is associated with a decline in estrogen levels, we suggest that the level of estrogen and progesterone be analyzed in OLP in later studies.\u003c/p\u003e \u003cp\u003eIn this study, the number of individuals with abnormal hormone levels was analyzed, and only T abnormality was different in the case and control groups and, which higher in the control group.\u003c/p\u003e \u003cp\u003eThe biggest limit in this investigation was the amount of sample size and the fact that only females were studied. A second limitation was that only T, DHT, and DHEAs were considered. Other sex hormones in LP patients may be assessed in both females and males as well, with a bigger sample size.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThere was no correlation between OLP and androgens. No difference was observed in DHEAs, DHT, and T amounts between the case and control patients; therefore, no differences were found between serum levels of androgens in the OLP group compared to healthy controls during the transition from pre-menopause to post-menopause.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eLichen planus (LP)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDehydroepiandrosterone (DHEAs), and testosterone (T) in patients who have oral lichen planus (OLP)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e3\u0026beta;- and 17\u0026beta;-hydroxysteroid dehydrogenases (3BHSD, 17BHSD)\u003c/p\u003e\n\u003cp\u003enonsteroidal anti-inflammatory drugs (NSAIDs)\u003c/p\u003e\n\u003cp\u003erheumatoid arthritis (RA)\u003c/p\u003e\n\u003cp\u003esystemic lupus erythematosus (SLE)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn informed consent form was taken from patients before the initiation of therapy. The study adhered to the ethical principles of the Helsinki Declaration (2002 version) and received approval from the ethics committee of Shiraz University of Medical Sciences, Shiraz, Iran (IR.SUMS.REC.1397.709).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn informed consent form was taken from patients before the initiation of therapy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset of the present study is available. Please contact the co-responding author (Aylar Afshari: [email protected]) to request the data from this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not have any conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by the Vice-Chancellor of Shiraz University of Medical Science with the grant number of 17267.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFR designed the work, analyzed and interpreted the patient data, drafted the work, and revised it.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFL interpreted the patient data, drafted the work, and revised it.\u003c/p\u003e\n\u003cp\u003eSD analyzed and interpreted the patient data, and drafted the work.\u003c/p\u003e\n\u003cp\u003eAA drafted the work, and revised it.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the Vice-chancellery of Shiraz University of Medical Science for the support of this study with the grant number of 17267. The present study based on Saba Dezhkameh thesis from dental School of Shiraz University of Medical Sciences. The authors thank the Research Consultation Center (RCC) of Shiraz University of Medical Sciences for the assistance in editing this manuscript. \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEdwards, P. C. \u0026amp; Kelsch, R. Oral lichen planus: clinical presentation and management.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLavaee, F., Zahed, P. M., Zarei, F. \u0026amp; Sardo, M. S. Evaluation the Serum Level of Sex Hormones in Patients With Trigeminal Neuralgia.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNgo, S. T., Steyn, F. J. \u0026amp; McCombe, P. A. Gender differences in autoimmune disease. \u003cem\u003eFront. Neuroendocrinol.\u003c/em\u003e \u003cb\u003e35\u003c/b\u003e (3), 347\u0026ndash;369 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnawalt, B. D. Is dihydrotestosterone a classic hormone? \u003cem\u003eEndocr. Rev.\u003c/em\u003e \u003cb\u003e38\u003c/b\u003e (3), 170\u0026ndash;172 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGibson, D. A., Simitsidellis, I., Kelepouri, O., Critchley, H. O. D. \u0026amp; Saunders, P. T. K. Dehydroepiandrosterone enhances decidualization in women of advanced reproductive age. \u003cem\u003eFertil. Steril.\u003c/em\u003e \u003cb\u003e109\u003c/b\u003e (4), 728\u0026ndash;734 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLavaee, F., Ranjbar, Z., Jalalian, M. \u0026amp; Amiri, M. A. Comparison of the sex hormones\u0026rsquo; serum level in women with recurrent aphthous stomatitis and healthy population: a cross-sectional study. \u003cem\u003eBMC Oral Health\u003c/em\u003e. \u003cb\u003e21\u003c/b\u003e (1), 1\u0026ndash;6 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta, A. et al. Roles of serum uric acid, prolactin levels, and psychosocial factors in oral lichen planus. \u003cem\u003eJ. Oral Sci.\u003c/em\u003e \u003cb\u003e59\u003c/b\u003e (1), 139\u0026ndash;146 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguyen, H. D. et al. Prolactin and its altered action in Alzheimer\u0026rsquo;s disease and Parkinson\u0026rsquo;s.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGirardi, C. et al. Salivary cortisol and dehydroepiandrosterone (DHEA) levels, psychological factors in patients with oral lichen planus. \u003cem\u003eArch. Oral Biol.\u003c/em\u003e \u003cb\u003e56\u003c/b\u003e (9), 864\u0026ndash;868 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePesce, G. et al. Low serum DHEA-S is associated with impaired lung function in women. \u003cem\u003eEClinicalMedicine\u003c/em\u003e \u003cb\u003e23\u003c/b\u003e, 100389 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLavaee, F., Rezazadeh, F., Saki, N., Tavazo, Z. \u0026amp; Baghaei, S. Evaluation of sex hormone levels in patients with pemphigus vulgaris in comparison to the healthy population. \u003cem\u003eBiomed. Res. Int.\u003c/em\u003e \u003cb\u003e2021\u003c/b\u003e (1), 9947706 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerczi, I. \u0026amp; Nagy, E. Hormones as immune modulating agents. In: Immune modulating agents. CRC; 75\u0026ndash;120. (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKlinge, C. M., Jernigan, S. C., Mattingly, K. A., Risinger, K. E. \u0026amp; Zhang, J. Estrogen response element-dependent regulation of transcriptional activation of estrogen receptors α and β by coactivators and corepressors. \u003cem\u003eJ. Mol. Endocrinol.\u003c/em\u003e \u003cb\u003e33\u003c/b\u003e (2), 387\u0026ndash;410 (2004).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoreau, K. L., Babcock, M. C. \u0026amp; Hildreth, K. L. Sex differences in vascular aging in response to testosterone. \u003cem\u003eBiol. Sex. Differ.\u003c/em\u003e \u003cb\u003e11\u003c/b\u003e (1), 1\u0026ndash;14 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavis, S. R. Androgens in premenopausal women and women with premature ovarian insufficiency. \u003cem\u003eClimacteric\u003c/em\u003e \u003cb\u003e24\u003c/b\u003e (5), 459\u0026ndash;465 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang, C. et al. 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Biol.\u003c/em\u003e \u003cb\u003e22\u003c/b\u003e (2), 96\u0026ndash;118 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmbikairajah, A., Walsh, E., Tabatabaei-Jafari, H. \u0026amp; Cherbuin, N. Fat mass changes during menopause: a metaanalysis. \u003cem\u003eAm. J. Obstet. Gynecol.\u003c/em\u003e \u003cb\u003e221\u003c/b\u003e (5), 393\u0026ndash;409 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAssad, S. et al. Role of sex hormone levels and psychological stress in the pathogenesis of autoimmune diseases. \u003cem\u003eCureus\u003c/em\u003e ;\u003cb\u003e9\u003c/b\u003e(6). (2017).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Lichen Planus, Gonadal Steroid Hormones, Dehydroepiandrosterone, Testosterone","lastPublishedDoi":"10.21203/rs.3.rs-6083473/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6083473/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: Lichen planus (LP), an inflammatory and chronic disorder, is immune-mediated and influences nails, skin, hair, and mucosal tissues. Autoimmune diseases affect females more commonly, and it is reported that there is an association between certain sex hormones and autoimmune diseases.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: This study aims to evaluate the serum levels of DHT, Dehydroepiandrosterone (DHEAs), and testosterone (T) in patients who have oral lichen planus (OLP) compared to healthy people. Forty female patients diagnosed with OLP were selected. They were considered to have the same mean age as 40 patients in the control group. The enzyme-linked immunosorbent assay investigated Androgens' serum levels (Monobomal kit, Sherkat Azmayeshgah Bartar).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: The age mean 51.90 ±11.52 for the patient group and 49.10 ± 11.63 for the control group. Erosive LP was the most common subtype of LP, 72.5% of LP lesions. \u0026nbsp;The differences between DHEAs (p-value=0.126), DHT (p-value =0.710), and T’s serum level (p-value =0.376) groups were not significant. There was no difference between hormonal levels during menopause and the non-menopause group.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: There was no correlation between OLP and androgens. DHEAs, DHT, and T levels were not different between case and control groups; therefore, the results did not support any neuroendocrine etiology for OLP. Also, there was no change in these androgens’ serum levels during the transition from pre-menopause to post-menopause.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003e The study adhered to the ethical principles of the Helsinki Declaration (2002 version) and received approval from the ethics committee of Shiraz University of Medical Sciences, Shiraz, Iran (IR.SUMS.REC.1397.709).\u003c/p\u003e","manuscriptTitle":"The Serum Evaluation of Sex Hormones Including DHEAs, DHT, Testosterone in Oral Lichen Planus Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-21 08:14:01","doi":"10.21203/rs.3.rs-6083473/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-06T07:06:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-01T15:45:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-26T09:08:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"236876924864734974010344190112074564733","date":"2025-04-18T23:25:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76025228556772278913549545343849154884","date":"2025-04-17T14:22:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-17T14:17:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-16T13:00:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-04-02T18:45:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"37fe329c-0f7b-4209-8ee4-1a6613ae7dc5","owner":[],"postedDate":"April 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":47320228,"name":"Biological sciences/Cancer/Cancer screening"},{"id":47320229,"name":"Biological sciences/Cancer/Head and neck cancer"},{"id":47320230,"name":"Health sciences/Diseases"}],"tags":[],"updatedAt":"2025-05-19T16:02:30+00:00","versionOfRecord":{"articleIdentity":"rs-6083473","link":"https://doi.org/10.1038/s41598-025-01750-4","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-05-14 15:58:01","publishedOnDateReadable":"May 14th, 2025"},"versionCreatedAt":"2025-04-21 08:14:01","video":"","vorDoi":"10.1038/s41598-025-01750-4","vorDoiUrl":"https://doi.org/10.1038/s41598-025-01750-4","workflowStages":[]},"version":"v1","identity":"rs-6083473","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6083473","identity":"rs-6083473","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}