Cardiometabolic Comorbidities of Lichen Planus—A Cross-Sectional Comparative Study

<b>Background/Objectives:</b> Cardiovascular disease (CVD) remains one of the leading causes of death worldwide, with several well-established risk factors. Among dermatological conditions, psoriasis is a well-known contributor to cardiometabolic risk, while lichen planus (LP) remains an underexplored chronic inflammatory disorder in this context. This study aimed to comparatively assess the prevalence and clinical patterns of metabolic syndrome (MetS) components in patients with LP versus psoriasis and healthy controls, focusing on the intrinsic inflammatory burden in patients not receiving systemic therapy. We also examined whether specific clinical subtypes of LP carry distinct metabolic profiles. <b>Methods:</b> We conducted a cross-sectional observational study at a tertiary dermatology center between January 2020 and December 2024. A total of 236 adult patients were included: 78 with LP, 79 with psoriasis, and 79 controls with minor dermatological conditions. Demographic, clinical, and laboratory data were collected. LP subtypes (cutaneous, mucocutaneous, reticular oral, erosive oral) were evaluated using the Lichen Planus Activity Index (LPAI) and Oral Lichen Planus Clinical Index (OLP-CI); psoriasis severity was assessed using the Psoriasis Area and Severity Index (PASI). Cardiometabolic comorbidities were assessed according to established guidelines. <b>Results:</b> LP patients showed significantly higher prevalence of hypertension (OR 1.94, <i>p</i> = 0.044) and type 2 diabetes mellitus (OR 3.09, <i>p</i> = 0.015) compared to controls. Compared to psoriasis, LP was associated with a higher prevalence of mixed dyslipidemia (OR 3.41, <i>p</i> = 0.033), while psoriasis showed more abdominal obesity (OR 0.35, <i>p</i> = 0.003). Mucosal LP subtypes, especially erosive and reticular oral LP, were linked to elevated cardiometabolic risk. <b>Conclusions:</b> LP, particularly its oral subtypes, is associated with a distinct cardiometabolic risk profile comparable to or exceeding that of psoriasis. These findings support the need for systematic metabolic screening in LP patients as part of comprehensive care.