Association between COVID-19 vaccination, SARS-CoV-2 infection, and oral lichen planus (OLP) flares: Results from a patient survey

BACKGROUND: Oral lichen planus (OLP) is a chronic immune-mediated mucocutaneous disease. During the COVID-19 pandemic, new cases and flares of OLP were reported after SARS-CoV-2 infection or vaccination. Immune activation and cytokine release triggered by infection or vaccines are proposed mechanisms, although current evidence is limited. Clarifying this relationship is important for improving patient counseling and management during vaccination efforts. OBJECTIVES: The study aimed to explore the association with an increased occurrence of OLP flares following COVID-19 vaccination or infection. MATERIAL AND METHODS: An 11-question survey was distributed to OLP patients. The questionnaire aimed to inquire about the history of COVID-19 vaccination and infection as it related to subjective flares of OLP (oral redness, ulcerations, pain, or discomfort). Associations with complications were assessed with Fisher's exact or Wilcoxon tests. RESULTS: Seventy-six patients participated in the survey. Twenty percent of study participants reported experiencing a flare after COVID-19 vaccination (n = 13), and 33% after an infection (n = 13). Self-reported OLP flares were significantly associated with whether or not participants also reported vaccine side effects (p = 0.005). Among the 27 participants who reported experiencing systemic post-vaccination side effects (tiredness, headache, muscle pain, chills, fever, nausea), 37% (n = 10) also reported an OLP flare compared with 8% (n = 3) of the 38 who did not report systemic side effects from the COVID-19 vaccination. Of the 63 participants who received a 2nd vaccine dose, 21% (n = 13) reported experiencing an OLP flare. Experiencing systemic side effects following the 2nd vaccination was again significantly associated with reporting an OLP flare (p = 0.048). CONCLUSIONS: Overall, OLP flares were not reported at high rates with COVID-19 vaccination or infection. Within these limitations, the findings of the study suggest that participants who experience systemic side effects following a COVID-19 vaccine may be more susceptible to OLP flares. Experiencing an OLP flare following the 1st COVID-19 vaccination was significantly associated with experiencing a flare again after receiving the 2nd vaccination.