Lack of association between Estrogen and progesterone receptors and Oral Lichen Planus

Document Type: Original Article


1 Associate Professor, Department of Oral and Maxillofacial Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran and Dental Research Center, Tehran University of Medical Sciences, Tehran, Iran

2 Assistant Professor, Department of Oral and Maxillofacial Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran

3 Associate Professor, Department of Oral and Maxillofacial Pathology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran

4 Assistant Professor, Department of Oral and Maxillofacial Medicine, School of Dentistry, Aja University of Medical Sciences, Tehran, Iran

5 Oral and Maxillofacial Medicine Specialist, Chalus, Iran


Background: Lichen planus is a T-cell mediated autoimmune and chronic inflammatory disease that affects the skin and the mucous membrane. The results of numerous studies on oral mucosa have confirmed the effects of sex hormones on oral mucosa and the expression of estrogen (ER), progesterone (PR), and androgen receptors.
Lichen planus is a common disease in middle-aged women. Therefore, the present study aimed to investigate the expression of ER and PR in patients with oral lichen planus (OLP).
Method: The participants consisted of sixty-six women. The biopsy specimens of these patients were stained via immunohistochemical staining for the detection of estrogen and progesterone markers.
Results: Despite low levels of sex hormones following menopause, ER and PR levels were lower in menopausal patients with lichen planus compared to the control group. The results also showed no significant difference in the percentage and severity of ER and PR expression in healthy non-menopausal women, menopausal women with OLP, non-menopausal women with OLP, and healthy menopausal women.
Conclusion: Low ER and PR levels in oral mucosa of the OLP patients suggest a more pronounced role of receptors on the surface of immune cells than mucosal cells in the pathogenesis of OLP. Maladaptive feedback of sex hormones was involved in the case group.


  1. Ahmed SA. The immune system as a potential target for environmental estrogens (endocrine disrupters): a new emerging field. Toxicology 2000; 150(1-3):191-206.
  2. Jayasekharan V, Ramya R, Rajkumar K, Kumar TD, Nandhini G, Kumar SS. Estimation of nitric oxide and malondialdehyde in serum and saliva of patients with oral lichen planus. SRM Journal of Research in Dental Sciences 2014; 5(4):230-6.
  3. Agha-Hosseini F, Moosavi MS, Sadrzadeh Afshar MS, Sheykhbahaei N. Assessment of the relationship between stress and oral lichen planus: a review of literature. J Islam Dent Assoc Iran 2016; 28(2):78-85.
  4. Gustafsson JA. Estrogen receptor beta-a new dimension in estrogen mechanism of action. J Endocrin 1999; 163(3):379-83.
  5. Vina J, Sastre J, Pallardo FV, Gambin J, Borras C. Role of mitochondrial oxidative stress to explain the different longevity between genders: protective effect of estrogens. Free Radic Res 2006; 40(12):1359-65.
  6. Lu R, Zeng X, Han Q, Lin M, Long L, Dan H, et al. Overexpression and selectively regulatory roles of IL-23/IL-17 axis in the lesions of oral lichen planus. Mediators Inflamm 2014; 2014:701094.
  7. Alrashdan MS, Cirillo N, McCullough M. Oral lichen planus: a literature review and update. Arch Dermatol Res 2016; 308(8):539-51.
  8. Boorghani M, Gholizadeh N, Taghavi Zenouz A, Vatankhah M, Mehdipour M. Oral lichen planus: clinical features, etiology, treatment and management; a review of literature. J Dent Res Dent Clin Dent Prospects 2010; 4(1):3-9.
  9. Greenberg M, Glick M, Ship JB. Oral Medicine. Hamilton: Bc Decker Inc, 2008:266-7.
  10. Shahrabi S, Moosavi Rad S. Distribution of estrogen and progesterone receptors in epulis fissuratum. Journal of Dental Medicine 2005; 18(2):59-66. [In Persian].
  11.  Olson MA, Rogers RS 3rd, Bruce AJ. Oral lichen plannus. Clin Dermatol 2016; 34(4): 495-504.
  12.  Agha-Hosseini F, Sheykhbahaei N, Sadrzadeh-Afshar MS. evaluation of potential risk that contributes to the malignant transformation of oral lichen plannus: a literature review. J Contemp Dent Pract 2016; 17(8):692-701.
  13.  Gholizadeh N, Khoini Poorfar H, Taghavi Zenouz A, Vatandoost M, Mehdipour M. Comparison of serum autoantibodies to desmogleins I, III in patients with oral lichen planus and healthy controls. Iran J Pathol 2015; 10(2):136-40.
  14. Güncü GN, Tözüm TF, Caglayan F. Effects of endogenous sex hormones on the periodontium—review of the literature. Aust Dent J 2005; 50(3):138-45.
  15. Leimola-Virtanen R, Pennanen R, Syrjänen K, Syrjänen S. Estrogen response in buccal mucosa—a cytological and immunohistological assay. Maturitas 1997; 27(1):41-5.
  16. Pires FR, da Cruz Perez DE, de Almeida OP, Kowalski LP. Estrogen receptor expression in salivary gland mucoepidermoid carcinoma and adenoid cystic carcinoma. Pathol Oncol Res 2004; 10(3):166-8.
  17. Razavi SM, Talebi A, Movahedian Attar B, Asgari I. Immunohistochemical evaluation of estrogen and progesterone receptors in peripheral and central giant cell granuloma of the jaws. Journal of Dental Medicine 2006; 19(2):87-95. [In Persian].
  18. Whitaker SB, Bouquot JE, Alimario AE, Whitaker TJ Jr. Identification and semi-quantification of estrogen and progesterone receptors in pyogenic granulomas of pregnancy. Oral Surg Oral Med Oral Pathol 1994; 78(6):755-60.
  19. Agha-Hosseini F, Tirgari F, Shaigan S. Immunohistochemical analysis of estrogen and progesterone receptor expression in gingival lesions. Iran J Public Health 2006; 35(2):38-41.
  20. Grimm M, Biegner T, Teriete P, Hoefert S, Krimmel M, Munz A, et al. Estrogen and progesterone hormone receptor expression in oral cavity cancer. Med Oral Patol Oral Cir Bucal 2016; 21(5):e554-8.
  21. Bouman A, Heineman MJ, Faas MM. Sex hormones and the immune response in humans. Hum Reprod Update 2005; 11(4):411-23
  22.  Losordo DW, Isner JM. Estrogen and angiogenesis. Arterioscler Thromb Vasc Biol 2001; 21(1):6-12.
  23.  Hughes GC. Progesterone and autoimmune disease. Autoimmun Rev 2012; 11(6-7):A502-14.
  24.  Struub RH. The complex role of estrogens in inflammation. Endocr Rev 2007; 28(5):521-74.
  25.  Rider V, Jones SR, Evans M, Abdon NI. Molecular mechanisms involved in estrogen-dependent regulation of calcineurin in systemic lupus erythematous T-cell. Clin Immunol 2000; 95(2):124-34.
  26.  Vohra S, Signal A, Sharma SB. Clinical and serological efficacy of topical calcineurin inhibitors in oral lichen plannus: a prospective randomized controlled trial. Int J Dermatol 2016; 55(1):101-5.
  27. Yih WY, Richardson L, Kratochvil FJ, Avera SP, Zieper MB. Expression of estrogen receptors in desquamative gingivitis. J Periodontol 2000; 71(3):482-7.
  28. Greenstein B, Roa R, Dhaher Y, Nunn E, Greenstein A, Khamashta M, et al. Estrogen and progesterone receptors in murine models of systemic lupus erythematosus. Int Immunopharmacol 2001; 1(6):1025-35.
  29. Yang JK, Park YJ, Jung SE, Park MJ, Kang HY,Kim YC, et al. Clinical, histopathological and immunohistochemical differences between men and women with psoriasis according to disease severity: possible role of estrogen. Korean J Dermatol 2017; 55(9):565-571. [In Korean].
  30.  Mattila KM, Luomala M, Lehtimäki T, Laippala P, Koivula T, Elovaara I. Interaction between ESR, and HLA-DR2 may contribute to the development of MS in women. Neurology 2001; 56(9):1246-7.
  31.  Sicotte NL, Liva SM, Kluth R, Pfeiffer P, Bouvier S, Odes S, et al. Treatment of multiple sclerosis with the pregnancy hormone estriol. Ann Neurol 2002; 52(4):421-8.
  32. Holmdahl R, Klareskog L, Rubin K, Björk J, Smedegård G, Jonsson R, et al. Role of T lymphocytes in murine collagen-induced arthritis. Agents Actions 1986; 19(5-6):295-305.
  33. Jonsson L, Holmdahl R. Oestrogen induced suppression of collagen arthritis. IV: progesterone alone does not affect the course of arthritis but enhances the oestrogen-mediated therapeutic effect. J Reprod Immunol 1989; 15(2):141-50.
  34.  Jochems C, Islander U, Erlandsson M, Engdahl C, Lagerquist M, Gjertsson I, et al. Role of endogenous and exogenous female sex hormones in arthritis and osteoporosis development in B10.Q-ncf1*/* mice with collagen-induced chronic arthritis. BMC Musculoskelet Disord 2010; 11:284.
  35.  Ngo ST, Steyn FJ, McCombe PA. Gender differences in autoimmune disease. Front Neuroendocrinol 2014; 35(3):347-69.