Diagnosing and managing oral lichen planus

Treatment trends in oral lichen planus and oral lichenoid lesions (Review)

Oral lichen planus (OLP) is a chronic inflammatory disease, associated with altered cell-mediated immunological function. It has long-term evolution, repeated exacerbations, sometimes painful and resistant to treatment, even all of these, OLP significantly affects patient's life quality. Not least, OLP is accompanied by an increased risk of malignant transformation. A wide spectrum of therapeutic options is available, but none are curative. In this review, 58 structured studies on the clinical symptomatology and treatment strategy of OLP were analyzed. The literature research was performed according to the criteria of the PRISMA system. This study summarizes current knowledge regarding management of OLP and oral lichenoid lesions, discusses the challenges of choosing an adequate treatment and, in attempt to improve the quality of patient life, trying to describe a therapeutic algorithm that takes into consideration the clinical features of the disease. Current OLP therapy aims at eliminating all mucosal-related lesions, reduce symptomatology and decrease the risk of oral cancer and include corticosteroids, immunomodulatory agents, retinoids, ultraviolet irradiation and/or laser therapy.

Oral Lichen Planus : A Review

Oral lichen planus (OLP) is a chronic mucosal condition commonly encountered in clinical dental practice. Lichen planus is believed to represent an abnormal immune response in which epithelial cells are recognized as foreign, secondary to changes in the antigenicity of the cell surface. It has various oral manifestations, the reticular form being the most common. The erosive and atrophic forms of OLP are less common, yet are most likely to cause symptoms. Topical corticosteroids constitute the mainstay of treatment for symptomatic lesions of OLP. Recalcitrant lesions can be treated with systemic steroids or other systemic medications. However, there is only weak evidence that these treatments are superior to placebo. Given reports of a slightly greater risk of squamous cell carcinoma developing in areas of erosive OLP, it is important for clinicians to maintain a high index of suspicion for all intraoral lichenoid lesions. Periodic follow-up of all patients with OLP is recommended.

Reduction of micronuclei in oral lichen planus supplemented with beta-carotene

An elevated frequency of micronucleated exfoliated cells (MEC) in atrophic and erosive oral lichen planus (OLP) has been reported. To evaluate the effects of supplemental beta-carotene (BC) on MEC frequency in OLP lesions, we performed an open trial in 20 patients with atrophic and/or erosive OLP. Each patient received 15 mg of BC four times daily for 3 months. The frequency of MEC in both lesions and adjacent normal mucosa in each patient was evaluated and compared before and after supplementation. Serum levels of BC and retinol were also determined. After BC supplementation, all patients had higher levels of serum BC and retinol. The MEC frequency in OLP lesions was significantly reduced (P < 0.01). No significant changes were seen in the MEC frequency in adjacent normal mucosa. BC supplementation thus significantly reduces MEC frequency in atrophic and erosive OLP.

Randomized trial of pimecrolimus cream versus triamcinolone acetonide paste in the treatment of oral lichen planus

BACKGROUND

Lichen planus is a common chronic inflammatory mucocutaneous disease, affecting 0.1% to 4% of the general population. There is no published randomized active control clinical trial on pimecrolimus for the treatment of oral lichen planus (OLP).

OBJECTIVE

The purpose of this study was to compare the efficacy and safety of pimecrolimus 1% cream with triamcinolone acetonide 0.1% paste in treating OLP.

METHODS

In this investigator-blinded parallel-group randomized clinical trial, 40 patients were randomly assigned in two equal groups to receive either pimecrolimus 1% cream or triamcinolone acetonide 0.1% paste 4 times daily for a total of 2 months and followed up for another 2 months. The patients were assessed for painful symptoms measured by visual analog scale, the Oral Health Impact Profile score, and objective clinical score. Nonparametric tests were used to assess the main outcomes. Intention-to-treat analysis was used.

RESULTS

Eighteen patients in pimecrolimus group and 17 patients in triamcinolone group finished the 4-month trial course. Both pimecrolimus and triamcinolone groups showed significant improvement in all measured efficacy end points throughout the visits. There was no significant difference between changes from baseline median values of pimecrolimus and triamcinolone groups after treatment termination in terms of visual analog scale score (-9.8 +/- 11.3 vs -8.4 +/- 18.3, P = .70), Oral Health Impact Profile score (-1.5 +/- 2.6 vs -1.6 +/- 2.1, P = .38), and clinical score (-0.7 +/- 0.6 vs -0.8 +/- 0.7, P = .86), respectively. Two patients in pimecrolimus group experienced prominent but transient burning sensation whereas none of the patients in triamcinolone group had any prominent adverse event (P = .24).

LIMITATIONS

Blood levels in pimecrolimus group were not measured and carcinogenicity of pimecrolimus, especially in its long-term use for OLP, is yet to be determined.

CONCLUSION

This study showed that patients with OLP may benefit from both topical pimecrolimus and triamcinolone acetonide therapy with minimal side effects. Further studies should be conducted to assess the maintenance effects and long-term safety of both drugs (Cochrane skin group identifier: CSG TrialNo. 22).

Prevalence of oral lichen planus in patients with diabetes mellitus

The purpose of this study was to determine the prevalence of oral lichen planus in a population of patients with diabetes mellitus compared with a control population and to determine if patient medications had any influence on the presence of such lesions. Two hundred seventy-three patients with diabetes and an identical number of age-, gender- and race-matched controls were examined for clinical evidence of oral lichen planus. Patient medication histories were also obtained from each group. Eleven diabetic patients (4%) and eight control patients (3%) had clinical evidence of oral lichen planus. Ingestion of nonsteroidal anti-inflammatory drugs or angiotensin-converting enzyme inhibitors was associated with the presence of oral lichen planus lesions in six patients. There was no apparent association of diabetes and oral lichen planus in this population, and the ingestion of medications known to cause lichenoid mucosal reactions had no influence per se on the presence of oral lichen planus lesions (p > 0.05). However, the type of medication ingested by those patients who had oral lichen planus lesions was either nonsteroidal anti-inflammatory drug or angiotensin-converting enzyme inhibitor, which was a significant association (p < 0.00).