1
|
Popa C, Sciuca AM, Onofrei BA, Toader S, Condurache Hritcu OM, Boțoc Colac C, Porumb Andrese E, Brănișteanu DE, Toader MP. Integrative Approaches for the Diagnosis and Management of Erosive Oral Lichen Planus. Diagnostics (Basel) 2024; 14:692. [PMID: 38611605 PMCID: PMC11011293 DOI: 10.3390/diagnostics14070692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
Erosive oral lichen planus (EOLP) represents a significant challenge in dental and medical management due to its chronic inflammatory nature, painful symptoms, and impact on quality of life. This study aims to evaluate the current diagnostic approach with novel non-invasive techniques, such as dermoscopy, and also the landscape of treatment options for EOLP, focusing on its efficacy, safety, and the challenges that it present in clinical practice. Through a comprehensive literature review, we explored the use of topical corticosteroids, systemic immunosuppressants, biologics, and Janus kinase (JAK) inhibitors in treating EOLP, alongside examining patient compliance, psychological impacts, and the risk of adverse effects and recurrence. Our findings reveal that while topical corticosteroids are the cornerstone of EOLP treatment, offering symptomatic relief, their long-term use is limited by side effects and tolerance development. Systemic therapies and biologics provide alternatives for refractory cases but necessitate careful adverse effect monitoring. JAK inhibitors show promise as an innovative treatment avenue but require more evidence on long-term safety and efficacy. This study highlights the necessity of personalized treatment approaches due to the variable disease course and response to treatment, underscoring the importance of a multidisciplinary strategy in managing EOLP. The complexity of EOLP treatment, compounded by its psychological and quality of life impacts, demands ongoing research into targeted therapies, the establishment of standardized treatment protocols, and the development of effective outcome measures to improve patient care and treatment outcomes.
Collapse
Affiliation(s)
- Cristina Popa
- Discipline of Oral Medicine, Oral Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (C.P.); (A.M.S.); (B.-A.O.); (O.M.C.H.); (M.P.T.)
| | - Ana Maria Sciuca
- Discipline of Oral Medicine, Oral Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (C.P.); (A.M.S.); (B.-A.O.); (O.M.C.H.); (M.P.T.)
| | - Bianca-Andreea Onofrei
- Discipline of Oral Medicine, Oral Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (C.P.); (A.M.S.); (B.-A.O.); (O.M.C.H.); (M.P.T.)
| | - Stefan Toader
- Discipline of Physiopathology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Oana Mihaela Condurache Hritcu
- Discipline of Oral Medicine, Oral Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (C.P.); (A.M.S.); (B.-A.O.); (O.M.C.H.); (M.P.T.)
| | - Cristina Boțoc Colac
- Dermatology Clinic, University Clinical Railways Hospital, 1 Garabet Ibraileanu Street, 700115 Iasi, Romania
| | - Elena Porumb Andrese
- Discipline of Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (E.P.A.); (D.E.B.)
| | - Daciana Elena Brănișteanu
- Discipline of Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (E.P.A.); (D.E.B.)
| | - Mihaela Paula Toader
- Discipline of Oral Medicine, Oral Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (C.P.); (A.M.S.); (B.-A.O.); (O.M.C.H.); (M.P.T.)
| |
Collapse
|
2
|
Tran TM, Azher TN, Miller CJ, Hou JH. Topical Tacrolimus Compared With Oral Tacrolimus for Postoperative Immunosuppression in Primary Keratolimbal Allograft. Cornea 2024; 43:333-342. [PMID: 37267473 DOI: 10.1097/ico.0000000000003316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/22/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE The aim of this study was to compare outcomes between topical tacrolimus and oral tacrolimus as the primary calcineurin inhibitor for postoperative immunosuppression after primary keratolimbal allograft (KLAL) transplantation for limbal stem cell deficiency (LSCD). METHODS We performed a retrospective, comparative cohort study at a single tertiary referral center (University of MN) of all patients who underwent primary KLAL between 2014 and 2021. Eyes were grouped into those which received topical tacrolimus as the only calcineurin inhibitor (topical group) and eyes in which patients received oral tacrolimus with or without topical tacrolimus (oral group). Clinical and donor tissue data were obtained and compared between the 2 groups. RESULTS In total, 27 eyes of 22 patients (median age 42 years, range 20-79 years) were included, of which 18 eyes were in the oral group and 9 eyes were in the topical group. The mean follow-up time was 33.2 ± 22.6 months. The most frequent etiology of LSCD was alkaline burn (33.3%). At 36 months, graft failure occurred in 6 eyes in the oral group (33.3%) and 2 eyes in the topical group (22.1%) ( P = 0.57). The failure rate in the oral group was 9.1 per 1000 person-months versus 8.4 per 1000 person-months in the topical group ( P = 0.96). The median improvement in BCVA was logMAR -0.975 and logMAR -0.45 for the oral and topical group, respectively ( P = 0.50). CONCLUSIONS With careful patient selection, topical tacrolimus may be a viable alternative to oral tacrolimus in KLAL.
Collapse
Affiliation(s)
- Tu M Tran
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN; and
| | - Tayaba N Azher
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN; and
| | - Corey J Miller
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN; and
| | - Joshua H Hou
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN; and
- Lions Gift of Sight Eye Bank, Saint Paul, MN
| |
Collapse
|
3
|
Wang J, Gao B. Mechanisms and Potential Clinical Implications of Oral Microbiome in Oral Squamous Cell Carcinoma. Curr Oncol 2023; 31:168-182. [PMID: 38248096 PMCID: PMC10814288 DOI: 10.3390/curroncol31010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Microorganisms in the oral cavity are abundant in the human body. At present, more than 700 species of oral microorganisms have been identified. Recently, a lot of literature has indicated that the oral microbiota plays an important role in the occurrence, development, and prognosis of oral squamous cell carcinoma (OSCC) through various mechanisms. And researchers are now trying to utilize oral microbiota in cancer diagnosis and treatment. However, few articles systematically summarize the effects of oral microbes in the diagnosis, treatment, and disease outcomes of oral cancer. Herein, we made a summary of the microbial changes at cancerous sites and placed more emphasis on the mechanisms by which the oral microbiome promotes cancerization. Moreover, we aimed to find out the clinical value of the oral microbiome in OSCC.
Collapse
Affiliation(s)
| | - Bo Gao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China;
| |
Collapse
|
4
|
Su Z, Lu J, Ling Z, Li W, Yang X, Cheng B, Tao X. Upregulation of IL-37 in epithelial cells: A potential new mechanism of T cell inhibition induced by tacrolimus. Biochem Pharmacol 2023; 216:115796. [PMID: 37690572 DOI: 10.1016/j.bcp.2023.115796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
Oral lichen planus (OLP) is a chronic T cell-mediated mucocutaneous disease characterized by T cell infiltration at the connective tissue-epithelium interface. Traditionally, topical corticosteroids are used as the first-line drugs to treat OLP. However, long-term use of corticosteroids may lead to drug tolerance, secondary candidiasis, and autoimmune adrenal insufficiency. Although topical tacrolimus has often been recommended for short-term use in corticosteroid-refractory OLP, the precise role of tacrolimus in epithelial cells remains elusive. This study showed that tacrolimus could directly upregulate the expression of IL-37 in human gingival epithelial cells by promoting the TGF-βRI/Smad3 pathway independently of calcineurin inhibition and MAPKs. In contrast, dexamethasone, one of the corticosteroids, did not have the same effect. Moreover, IL-37 could inhibit the proliferation of activated T cells and the secretion of effector cytokines and alleviate epithelial cell apoptosis and death caused by activated T cells ina co-culturesystem. Furthermore, compared with healthy controls, IL-37 and p-Smad3 levels significantly increased in the oral mucosa affected by OLP, especially in the epithelium. IL-37 might have mediated a negative feedback mechanism to curb excessive inflammation in OLP. However, the expression of IL-37 was not associated with the infiltration of CD8+ T cells and Tregs in OLP, implying that IL-37 might mostly affect T cell activation rather than T cell differentiation and migration. Overall, this study discovered a potential novel mechanism by which tacrolimus might indirectly inhibit T cell-mediated immune damage by upregulating IL-37 in human gingival epithelial cells.
Collapse
Affiliation(s)
- Zhangci Su
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, Guangdong, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510080, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, Guangdong, China
| | - Jingyi Lu
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, Guangdong, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510080, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, Guangdong, China
| | - Zihang Ling
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, Guangdong, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510080, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, Guangdong, China
| | - Wei Li
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, Guangdong, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510080, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, Guangdong, China
| | - Xi Yang
- Department of Periodontology, Stomatological Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China.
| | - Bin Cheng
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, Guangdong, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510080, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, Guangdong, China.
| | - Xiaoan Tao
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, Guangdong, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510080, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, Guangdong, China.
| |
Collapse
|
5
|
Sriram S, Hasan S, Alqarni A, Alam T, Kaleem SM, Aziz S, Durrani HK, Ajmal M, Dawasaz AA, Saeed S. Efficacy of Platelet-Rich Plasma Therapy in Oral Lichen Planus: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040746. [PMID: 37109704 PMCID: PMC10146996 DOI: 10.3390/medicina59040746] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Oral lichen planus (OLP) is an autoimmune, mucocutaneous, oral potentially malignant disorder (OPMD), which characteristically manifests with chronic, recalcitrant lesions, with frequent flare-ups and remissions. The precise etiopathogenesis of OLP is still debatable, although it is believed to be a T-cell-mediated disorder of an unidentified antigen. Despite the availability of various treatments, no cure for OLP exists due to its recalcitrant nature and idiopathic etiology. Platelet-rich plasma (PRP) has antioxidant, anti-inflammatory, and immunomodulatory properties, in addition to its regulatory action on keratinocyte differentiation and proliferation. These salient properties substantiate the possible role of PRP in the treatment of OLP. Our systematic review focuses on assessing the therapeutic potential of PRP as a treatment modality in OLP. Materials and Methods: We conducted a detailed literature search for studies assessing PRP as a therapeutic regimen in OLP, using the Google Scholar and PubMed/MEDLINE search engines. The search was limited to studies published from January 2000 to January 2023 and included a combination of Medical Subject Heading (MeSH) terms. ROBVIS analysis was carried out for the assessment of publication bias. Descriptive statistics were performed using Microsoft Excel. Results: This systematic review included five articles that met the inclusion criteria. Most of the included studies demonstrated that PRP treatment considerably ameliorated both objective and subjective symptoms in OLP subjects, with comparable efficacy to the standard corticosteroid treatment. Further, PRP therapy offers the added benefit of minimal adverse effects and recurrences. Conclusion: This systematic review suggests that PRP has significant therapeutic potential for treating OLP. However, further research with larger sample sizes is imperative to corroborate these findings.
Collapse
Affiliation(s)
- Shyamkumar Sriram
- Department of Social and Public Health, Ohio University, Athens, OH 45701, USA
| | - Shamimul Hasan
- Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi 110025, India
| | - Abdullah Alqarni
- Department of Diagnostic Dental Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha 62529, Saudi Arabia
| | - Tanveer Alam
- Department of Diagnostic Dental Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha 62529, Saudi Arabia
| | - Sultan Mohammed Kaleem
- Department of Diagnostic Dental Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha 62529, Saudi Arabia
| | - Shahid Aziz
- Department of Medicine, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Humayoun Khan Durrani
- Department of Medicine, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Muhammed Ajmal
- Department of Diagnostic Dental Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha 62529, Saudi Arabia
| | - Ali Azhar Dawasaz
- Department of Diagnostic Dental Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha 62529, Saudi Arabia
| | - Shazina Saeed
- Amity Institute of Public Health & Hospital Administration, Amity University, Noida 201303, India
| |
Collapse
|
6
|
Polizzi A, Santonocito S, Lo Giudice A, Alibrandi A, De Pasquale R, Isola G. Analysis of the response to two pharmacological protocols in patients with oral lichen planus: A randomized clinical trial. Oral Dis 2023; 29:755-763. [PMID: 34252252 DOI: 10.1111/odi.13960] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/10/2021] [Accepted: 07/08/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of two different therapies on oral lichen planus (OLP) treatment through the analysis of OLP symptoms and signs and to analyze the risk of side effects related to the adopted protocols. METHODS Thirty-eight patients with OLP were selected according to van der Meij and van der Waal clinical and histopathological criteria. Through a randomized design, 19 patients received Tacrolimus 0.1% ointment (T group) and 19 an anti-inflammatory mouthwash (M group) composed of calcium hydroxide 10%, hyaluronic acid 0.3%, umbelliferone, and oligomeric proanthocyanidins. The patients were examined on a regular basis for OLP symptoms, signs, and disease severity score changes over a 3-month follow-up period. RESULTS Both treatments were effective in the reduction of OLP signs and symptoms. However, at 3 months (T3), in comparison with the M group, T group patients showed significantly lower mean values of OLP signs (p = 0.035), symptoms (p = 0.045), and disease severity scores (p = 0.041). Moreover, the Spearman test showed that there was a significant correlation between OLP signs and symptoms at each follow-up session in all patients. CONCLUSIONS Both treatments demonstrated a significant approach to control OLP. However, tacrolimus determined a more effective improvement in OLP signs and symptoms compared to anti-inflammatory mouthwash at 3-month follow-up.
Collapse
Affiliation(s)
- Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Angela Alibrandi
- Department of Economical, Business and Environmental Sciences and Quantitative Methods, University of Messina, Messina, Italy
| | - Rocco De Pasquale
- Department of General Surgery and Surgical-Medical Specialties, Unit of Dermatology, University of Catania, Catania, Italy
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania, Italy
| |
Collapse
|
7
|
Ibrahim SS, Ragy NI, Nagy NA, El-kammar H, Elbakry AM, Ezzatt OM. Evaluation of muco-adhesive tacrolimus patch on caspase-3 induced apoptosis in oral lichen planus: a randomized clinical trial. BMC Oral Health 2023; 23:99. [PMID: 36788511 PMCID: PMC9930326 DOI: 10.1186/s12903-023-02803-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The study compared the clinical effectiveness of topical Tacrolimus (TAC) in patches or gel with Triamcinolone acetonide (TRI) gel for erosive/atrophic oral lichen planus (OLP) and investigated the influence of these therapies on Caspase-3 expression as a marker of apoptosis. METHODS Thirty patients were randomly assigned into three equal groups to receive either topical TAC 0.1% patch twice daily, topical TAC 0.1% gel, or topical TRI 0.1% gel four times daily for 8 weeks. Each patient's clinical score (CS), visual analogue scale (VAS), and total atrophic area (TAA) of the marker lesion were measured at baseline, 2, 4, and 8 weeks of treatment, as well as after 4 weeks of treatment free period. Caspase-3 expression and lymphocytic counts (LC) were assessed in pre- and post-treatment biopsied stained sections. RESULTS TAC patch resulted in a higher reduction in CS [- 14.00 (15.54%)] and VAS [- 70.21 (15.82%)] followed by TAC gel then TRI gel within the first two weeks. The reduction in VAS and TAA were significantly higher in TAC groups compared to TRI gel, although the difference between TAC treatment was not significant and this was observed throughout the treatment and follow-up periods. Caspase-3 expression increased in connective tissue in all groups. It decreased significantly within the epithelium in both TAC groups but increased in TRI gel. (LC) were significantly lowered with the TAC patch compared to other groups. The percentage change in Caspase-3 epithelial expression was significantly correlated to the CS, TAA, and LC. CONCLUSION Both TAC patch and gel significantly decreased pain and lesion size than TRI gel, with a significant reduction in Caspase-3 expression within the epithelium in comparison to the increase seen with TRI gel. The study protocol was registered at www. CLINICALTRIALS gov (NCT05139667) on 01/12/2021.
Collapse
Affiliation(s)
- Suzan S. Ibrahim
- grid.7269.a0000 0004 0621 1570Department of Oral Medicine, Periodontology and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt ,grid.442628.e0000 0004 0547 6200Department of Oral Medicine, Periodontology Oral Diagnosis and Radiology, Faculty of Dental Medicine, Nahda University, Beni Suef, Egypt
| | - Nivine I. Ragy
- grid.440865.b0000 0004 0377 3762Department of Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Oral and Dental Medicine, Future University in Egypt, St. South 90Th, New Cairo 1, Cairo, 11835 Egypt
| | - Noha A. Nagy
- grid.440865.b0000 0004 0377 3762Department of Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Oral and Dental Medicine, Future University in Egypt, St. South 90Th, New Cairo 1, Cairo, 11835 Egypt
| | - Hala El-kammar
- grid.440865.b0000 0004 0377 3762Department of Oral Pathology, Faculty of Oral and Dental Medicine, Future University in Egypt, Cairo, Egypt
| | - Asmaa M. Elbakry
- grid.411303.40000 0001 2155 6022Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt ,grid.449009.00000 0004 0459 9305Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Heliopolis University, Cairo, Egypt
| | - Ola M. Ezzatt
- grid.7269.a0000 0004 0621 1570Department of Oral Medicine, Periodontology and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt ,grid.7269.a0000 0004 0621 1570Department of Oral Medicine, Periodontology and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, 20 Organization of African Union St., Cairo, 1156 Egypt
| |
Collapse
|
8
|
Serafini G, De Biase A, Lamazza L, Mazzucchi G, Lollobrigida M. Efficacy of Topical Treatments for the Management of Symptomatic Oral Lichen Planus: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1202. [PMID: 36673955 PMCID: PMC9859481 DOI: 10.3390/ijerph20021202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
Oral lichen planus (OLP) is a chronic mucosal inflammatory disease associated with T-cell-mediated immunological dysfunction. Symptomatic OLP is a painful condition, and complete healing is often not achieved. The aim of this systematic review was to assess the effectiveness of topical drugs, medications, and other interventions compared to placebo or to other treatments in pain reduction and clinical resolution in adult patients with symptomatic OLP. A detailed electronic literature search was performed through the MEDLINE (PubMed) database between 1 January 2005 and 30 September 2022. Eligible studies were selected based on the inclusion criteria, and a quality assessment was conducted. From 649 titles, 121 articles were selected as abstracts, 75 papers were assessed as full text, along with 15 other papers obtained through a manual search. A total of 15 RCTs were finally included in the review process. Because of the significant heterogeneity in the study design of the included studies, no meta-analysis of the data could be performed. Topical corticosteroids represent the first-line treatment in the management of symptomatic OLP due to their efficacy and minimal adverse effects. Calcineurin inhibitors seem to be equally effective and are indicated in recalcitrant cases, extensive lesions, patients susceptible to oral candidiasis, or cases unresponsive to corticosteroids. Other treatments, such as aloe vera, chamomile, isotretinoin, ozone, and laser therapy, could be beneficial as adjunct therapies in association with first-line treatments.
Collapse
Affiliation(s)
- Giorgio Serafini
- Department of Oral and Maxillo Facial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy
| | | | - Luca Lamazza
- Department of Oral and Maxillo Facial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy
| | | | | |
Collapse
|
9
|
Deng X, Wang Y, Jiang L, Li J, Chen Q. Updates on immunological mechanistic insights and targeting of the oral lichen planus microenvironment. Front Immunol 2023; 13:1023213. [PMID: 36700192 PMCID: PMC9870618 DOI: 10.3389/fimmu.2022.1023213] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Oral lichen planus (OLP) is a chronic immune inflammatory disease that is an oral potentially malignant disorder (OPMD), occurs in the oral mucosa and affects approximately 0.5% to 4% of the general population. There are usually five types of OLP: reticular/papular, plaque-like, atrophic/erythematous, erosive/ulcerative, and bullous. Furthermore, the chance of causing oral squamous cell carcinoma (OSCC) is 1.4%. Although the etiology of OLP is still unknown, accumulating evidence supports that immune dysregulation may play a vital role in the pathogenesis of OLP, especially the massive production of various inflammatory cells and inflammatory mediators. In this review, we focus on the relationship between OLP and its immune microenvironment. We summarize current developments in the immunology of OLP, summarizing functional cell types and crucial cytokines in the OLP immune microenvironment and the underlying mechanisms of key signaling pathways in the OLP immune microenvironment. We highlight the application potential of targeted immune microenvironment therapy for OLP.
Collapse
Affiliation(s)
| | | | - Lu Jiang
- *Correspondence: Jing Li, ; Lu Jiang,
| | - Jing Li
- *Correspondence: Jing Li, ; Lu Jiang,
| | | |
Collapse
|
10
|
Utz S, Suter V, Cazzaniga S, Borradori L, Feldmeyer L. Outcome and long-term treatment protocol for topical tacrolimus in oral lichen planus. J Eur Acad Dermatol Venereol 2022; 36:2459-2465. [PMID: 35870137 PMCID: PMC9804806 DOI: 10.1111/jdv.18457] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 07/12/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Topical tacrolimus has been shown to be beneficial in the treatment of oral lichen planus (OLP). However, long-term effects and its optimal application protocol with gradual reduction have not been studied. Accordingly, we analysed the clinical response of OLP to tacrolimus in our daily clinical practice with a focus on the optimal long-term therapeutic scheme. METHODS Retrospective analysis of all consecutive patients diagnosed with OLP and treated with topical tacrolimus (0.03% oral rinse) in a clinical setting between 2015 and 2020. The objective clinical response was measured by a 4-point scale (complete remission, major remission, partial remission and no response), and subjective impairment by a 3-point scale (severe, moderate and none). RESULTS Fifty-seven patients (74% women; median age: 66 years) were included. Fifty-six (98%) patients had prior treatment with topical steroids. After introduction of tacrolimus, objective remission (major or complete) was reached by 28%, 62%, 87% and 97% of patients after 3, 6, 12 and 24 months respectively. Subjective remission was reported by 16%, 48%, 69% and 83% after 3, 6, 12 and 24 months of treatment respectively. The treatment frequency could be gradually reduced from initially twice daily to once daily or less in 28%, 61%, 78% and 87% after 3, 6, 12 and 24 months respectively; 41% of patients completely suspended the treatment at one point, but 67% of them experienced a relapse after a median time of 3.3 months. Four patients (7%) developed a squamous cell carcinoma (SCC) during the observation period. Otherwise, there were only few and minor side-effects. CONCLUSION Topical tacrolimus can be an effective second-line therapy for OLP refractory to potent topical corticosteroids. The therapy frequency can often be reduced during the maintenance period. Both signs of clinical activity and subjective impairment should guide therapy. Regular follow-up is necessary to recognize possible SCC.
Collapse
Affiliation(s)
- S. Utz
- Department of Dermatology, Inselspital Bern University HospitalUniversity of BernBernSwitzerland
| | - V.G.A. Suter
- Department of Oral Surgery and Stomatology, School of Dental MedicineUniversity of BernBernSwitzerland
| | - S. Cazzaniga
- Department of Dermatology, Inselspital Bern University HospitalUniversity of BernBernSwitzerland,Centro Studi GISEDBergamoItaly
| | - L. Borradori
- Department of Dermatology, Inselspital Bern University HospitalUniversity of BernBernSwitzerland
| | - L. Feldmeyer
- Department of Dermatology, Inselspital Bern University HospitalUniversity of BernBernSwitzerland
| |
Collapse
|
11
|
Didona D, Caposiena Caro RD, Sequeira Santos AM, Solimani F, Hertl M. Therapeutic strategies for oral lichen planus: State of the art and new insights. Front Med (Lausanne) 2022; 9:997190. [PMID: 36267615 PMCID: PMC9578567 DOI: 10.3389/fmed.2022.997190] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022] Open
Abstract
Oral lichen planus (OLP) is a chronic inflammatory disease of the oral mucosa. Several clinical subtypes of OLP have been reported, including the reticular and erosive one. On the one hand, reticular OLP is usually asymptomatic and is characterized by white streaks surrounded by well-defined erythematous borders. On the other hand, erosive OLP shows ulcerations and erosions surrounded by erythematous mucosa. While reticular OLP is relatively easy to control, erosive OLP is extremely painful and refractory to therapies, limiting the quality of life of the patients. In addition, treating erosive OLP is extremely tricky, and a gold standard treatment has not yet been established. However, several therapeutic approaches have been reported as effective, including systemic corticosteroids, systemic retinoids, and anti-interleukin (IL)-17/anti-IL-23 drugs. Indeed, our group and other several authors reported the effectiveness of anti-IL17, anti-IL12/23, and anti-IL23 agents in refractory OLP, highlighting the urgency of clinical studies on the use of anti-IL agents in OLP patients. In this paper, we reviewed the English- and German-language literature about therapeutic strategies for treating OLP, focusing on new systemic therapies for erosive OLP.
Collapse
Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany,*Correspondence: Dario Didona
| | | | | | - Farzan Solimani
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany,Berlin Institute of Health at Charité - Universitátsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| |
Collapse
|
12
|
Sadeghi S, Kalantari Y, Seirafianpour F, Goodarzi A. The Efficacy and Safety of Topical Cyclosporine-A in Dermatology: A Systematic Review. Dermatol Ther 2022; 35:e15490. [PMID: 35384191 DOI: 10.1111/dth.15490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 11/29/2022]
Abstract
Cyclosporine-A (Cyc-A) was initially prescribed as systemic therapy for patients receiving solid organ transplants or in patients with graft versus host disease (GVHD). Topical Cyc-A is an ideal form of Cyclosporine in the treatment of mucocutaneous disorders as it causes fewer systemic side effects and has more stable results than steroids; however, poor absorption through the skin makes the development of new formulations necessary to improve skin permeability. To evaluate the efficacy and safety of topical Cyc-A in different dermatological conditions. A thorough systematic review was performed on PubMed/Medline, Embase, Scopus, and Web of Science databases as well as Google Scholar, and relevant studies from 2000 until January 3rd, 2022, were selected. The study was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA). Topical Cyc-A was observed to be an effective medication in the treatment of oral lichen planus, psoriasis, burning mouth syndrome, Pyoderma Gangrenosum, and Zoon's balanitis. Adverse side effects such as dysphagia, burning sensation, lips swealing, and gastrointestinal upset were reported following Cyc-A mouthwash use, whereas mild erythema, dryness, and fissuring of the skin were observed following the Cyc-A lipogel application. Topical Cyc-A was found to be a good alternative to traditional treatment regimens for immune-mediated mucocutaneous conditions. Cyc-A can be considered as a safe and efficient option in cases of long-term treatment as it does not have the same adverse effects of long-term steroids. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Sara Sadeghi
- Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Yasamin Kalantari
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnoosh Seirafianpour
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Faculty of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Iran Jordan Dermatology and Hair Transplantation Center, Tehran, Iran
| |
Collapse
|
13
|
Kuriakose M, Birur P, Patrick S, Warnakulasuriya S, Gurushanth K, Raghavan S, Rath G, Chaturvedi P, Chandru V, Mathew B, Prabhash K, Gurudath S, Mukhia N, Sunny S, Mehrotra R, Vivek V, Patil S, Kumar GS, Fasalkar S, Pratima R. Consensus guidelines on management of oral potentially malignant disorders. Indian J Cancer 2022; 59:442-453. [DOI: 10.4103/ijc.ijc_128_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
14
|
Immunosuppressive Drugs. ENCYCLOPEDIA OF INFECTION AND IMMUNITY 2022. [PMCID: PMC8987166 DOI: 10.1016/b978-0-12-818731-9.00068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Immunosuppressant is a class of medicines that inhibit or decrease the intensity of the immune response in the body. Most of these medications are used to allow the body less likely to resist a transplanted organ. In solid organ transplantation, immunosuppressive agents are needed for the activation of early-stage immunosuppression, the management of late-stage immunosuppression or for the maintenance of organ rejection. The emergence of novel agents and improvements in immunosuppression regimens after transplantation are significant factors leading to this progress. However, these drugs also increase the risk of infection, cancers and specific adverse side effects specific to each agent in patients particularly in pregnant women and fertility issues. Corona virus disease being hot topic of debate is has given positive outcome to immunosuppressive drugs however need more attention in future. Transplant centers across the world utilize multiple immunosuppression protocols; nevertheless, each patient can require an individually formulated immunosuppression regimen to manage the advantages and possible damage of treatment thus eliminating the likelihood of their primary disease recurrence.
Collapse
|
15
|
Topical Cyclosporine in Oral Lichen Planus-A Series of 21 Open-Label, Biphasic, Single-Patient Observations. J Clin Med 2021; 10:jcm10225454. [PMID: 34830736 PMCID: PMC8622196 DOI: 10.3390/jcm10225454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
Topical cyclosporine (CSA) has been reported as an alternative treatment in steroid-refractory oral lichen planus (OLP), but evidence is limited and conflicting. An N-of-1 trial setting could be appropriate to evaluate interindividual differences in treatment response. We studied a series of 21 open-label, biphasic single-patient observations. Patients (15 women, 6 men) with OLP recalcitrant to topical steroids received four weeks of CSA mouth rinse (200 mg/twice daily) followed by four weeks of drug withdrawal. Pain (visual analogue scale (VAS) score), disease extent (physicians’ global assessment (PGA) score) and quality of life (Dermatology Life Quality Index (DLQI) score,) were assessed at baseline (T0), after four weeks of treatment (T1) and after another four weeks without treatment (T2). Median age was 58 years (interquartile range/IQR = 52–67) and median disease duration was 18 months (IQR = 12–44). Median baseline VAS score decreased significantly at T1 (p = 0.0003) and increased at T2 (p = 0.032) (T0 = 5 (IQR = 3–6.5); T1 = 2 (IQR = 0.5–3.4); T2 = 3 (IQR = 2–4.8)). Similarly, median baseline PGA score decreased significantly at T1 (p = 0.001) and increased at T2 (p = 0.007) (T0 = 2 (IQR = 1.3–2.5); T1 = 1 (IQR = 1–2); T2 = 2 (IQR = 1–2)). Median baseline DLQI score also decreased significantly at T1 (p =.027) but did not change at T2 (p = 0.5) (T0 = 2.5 (IQR = 1–5.8); T1 = 1 (IQR = 0–3); T2 = 1 (IQR = 1–4)). CSA responders (n = 16) had significantly higher median baseline VAS scores (5.2 (IQR = 5–6.5)) than nonresponders (n =5) (2 (IQR = 2–3.5) (p = 0.02). In our study, pain, disease extent and quality of life of patients with OLP improved significantly during therapy with low-dose CSA mouth rinse and exacerbated after drug withdrawal. Remarkably, patients with high initial VAS scores seemed to profit most.
Collapse
|
16
|
Solimani F, Forchhammer S, Schloegl A, Ghoreschi K, Meier K. Lichen planus – ein Klinikleitfaden. J Dtsch Dermatol Ges 2021; 19:864-883. [PMID: 34139075 DOI: 10.1111/ddg.14565_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Farzan Solimani
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | | | | | - Kamran Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | - Katharina Meier
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| |
Collapse
|
17
|
Su Z, Hu J, Cheng B, Tao X. Efficacy and safety of topical administration of tacrolimus in oral lichen planus: An updated systematic review and meta-analysis of randomized controlled trials. J Oral Pathol Med 2021; 51:63-73. [PMID: 34133803 DOI: 10.1111/jop.13217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/08/2021] [Accepted: 06/04/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Symptomatic oral lichen planus is a common chronic T-cell-mediated disorder characterized by pain and inflammation. The meta-analysis aimed to compare and evaluate the effects and safety of tacrolimus for treating patients with symptomatic oral lichen planus. METHODS A comprehensive literature review was performed, including PubMed, the Cochrane Library, Embase, and Web of Science published up to and including December 2020. ClinicalTrials.gov was searched for ongoing trials. There were no restrictions on language or date of publication. Using the Cochrane Collaboration tool, we assessed the risk of bias for randomized controlled trials and estimated the proportion of between-trial heterogeneity. RESULTS A total of 9 RCTs evaluating the effects of tacrolimus were included in this study. The results revealed no significant difference in clinical resolution and relapse between tacrolimus and corticosteroids. However, tacrolimus may be more likely to cause mild adverse effects. In particular, clinical resolution was not significantly different between tacrolimus and clobetasol propionate, and between tacrolimus and triamcinolone acetonide, while tacrolimus was more likely to cause adverse effects than triamcinolone acetonide and clobetasol propionate. Moreover, there was no significant difference in pain resolution between tacrolimus and clobetasol. Furthermore, adverse effects were not significantly different between tacrolimus and pimecrolimus. CONCLUSIONS This systematic review and meta-analysis of 9 clinical trials supported the short-term application of tacrolimus as an effective regimen in OLP patients resistant to other topical and systemic therapies. Furthermore, the adverse effects of tacrolimus were minor and transient and did not affect tacrolimus' continued application.
Collapse
Affiliation(s)
- Zhangci Su
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China.,Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Jiaqi Hu
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China.,Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Bin Cheng
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China.,Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Xiaoan Tao
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China.,Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| |
Collapse
|
18
|
Solimani F, Forchhammer S, Schloegl A, Ghoreschi K, Meier K. Lichen planus - a clinical guide. J Dtsch Dermatol Ges 2021; 19:864-882. [PMID: 34096678 DOI: 10.1111/ddg.14565] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/05/2021] [Indexed: 12/15/2022]
Abstract
Lichen planus (LP) is a chronic lichenoid inflammatory disorder of the skin, mucosa and of the appendages. LP is classically characterized by the presence of a rich infiltration of inflammatory T cells, which migrate in the upper part of the dermis, arranged in a band-like pattern. Different sub types of the disease have been so far described. Albeit LP is clinically well defined, the disease still represents a therapeutic enigma. Especially with regard to mucosal or scalp affecting LP types, which often present a recalcitrant and treatment unresponsive course, efficacious therapeutic options are still lacking. Thus, LP represents a disease with a high psychosocial burden. Yet, development in the deciphering of LP pathogenesis reveals possible new druggable targets, thus paving the way for future therapeutic options. In this clinical guide, we summarize the current clinical knowledge and therapeutic standards and discuss the future perspective for the management of LP.
Collapse
Affiliation(s)
- Farzan Solimani
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Forchhammer
- Department of Dermatology, University Medical Center, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Alexandra Schloegl
- Department of Dermatology, University Medical Center, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
19
|
Li Y, Wang Y, Li J, Ling Z, Chen W, Zhang L, Hu Q, Wu T, Cheng B, Wang Y, Xia J. Tacrolimus inhibits oral carcinogenesis through cell cycle control. Biomed Pharmacother 2021; 139:111545. [PMID: 33873145 DOI: 10.1016/j.biopha.2021.111545] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 12/29/2022] Open
Abstract
Tacrolimus (TAC, FK506) is a major calcineurin inhibitor and has been commonly used in treatments of patients with organ transplants and immune diseases. Moreover, tacrolimus is recommended by the treatment guidelines for oral potentially malignant disorders (OPMDs) such as oral lichen planus (OLP). However, whether tacrolimus increases the risk of cancer remains controversial. We observed that in a 4-Nitroquinoline N-oxide (4NQO)-induced oral carcinogenesis model, tacrolimus treatment was associated with a significantly lower ratio of cancer formation (52.94% vs. 90%) and a lower proportion of Ki67 and proliferation cell nuclear antigen (PCNA) -positive cells in lesion areas (P < 0.001). Liver, kidney, and lung functions of rats and the tumor immune microenvironment of the tongue were not affected. These observations suggest that tacrolimus blocked oral carcinogenesis through epithelial cell proliferation inhibition, independent of its immunosuppressive effects. As a processing factor, tacrolimus decreased tumor formation and cell proliferation in different stages of oral squamous cell carcinoma (OSCC) progression in vivo and in vitro. Furthermore, we investigated effects on the cell cycle and expression of related proteins. Tacrolimus induced G1/S phase arrest and significantly downregulated the expression of cyclinD1, cyclinE1, and c-Myc. These results suggest that tacrolimus induces G1/S phase arrest via inhibition of cyclinD1, cyclinE1, and c-Myc expression and retards oral cell carcinogenesis in vitro and in vivo. Thus, application of tacrolimus is a safe therapeutic strategy for treating OPMDs.
Collapse
Affiliation(s)
- Yuanyuan Li
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR, China
| | - Yanting Wang
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR, China
| | - Jie Li
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR, China
| | - Zihang Ling
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR, China
| | - Wei Chen
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR, China
| | - Liping Zhang
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR, China
| | - Qinchao Hu
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR, China
| | - Tong Wu
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR, China
| | - Bin Cheng
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR, China.
| | - Yun Wang
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR, China.
| | - Juan Xia
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR, China.
| |
Collapse
|
20
|
Yuan P, Qiu X, Ye L, Hou F, Liang Y, Jiang H, Zhang Y, Xu Y, Sun Y, Deng X, Xu H, Jiang L. Efficacy of topical administration for oral lichen planus: A network meta-analysis. Oral Dis 2021; 28:670-681. [PMID: 33529456 DOI: 10.1111/odi.13790] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/04/2021] [Accepted: 01/21/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine the comparative efficacy and safety of topical administration for oral lichen planus. MATERIALS AND METHODS An electronic database search (1st January 1946 to 1st May 2020) for randomised controlled trials identified 34 studies involving eight interventions (clobetasol, betamethasone, triamcinolone, dexamethasone, fluocinolone, tacrolimus, pimecrolimus, and cyclosporine); these studies were subjected to network meta-analysis using direct and indirect comparisons [efficacy indicators: clinical response rate, symptom-reducing effect (visual analogue scale score), sign-reducing effect (Thongprasom-scale score) and relapse; safety indicator: adverse event occurrence]. RESULTS Compared with placebo, tacrolimus had the best clinical response rate (odds ratio (OR), 57.78 [95% CI 3.15-1060.52]; P-score, 0.8654) and cyclosporine had the worst (OR, 3.61[95% CI 0.20-66.62]; P-score, 0.2236); tacrolimus had the best symptom-reducing effect (standardised mean difference (SMD), 1.06 [95% CI 0.41-1.71]; P-score, 0.9323) and fluocinolone had the worst (SMD, -0.54 [95% CI -1.44-0.36]; P-score, 0.0157); dexamethasone had the best sign-reducing effect (SMD, 3.60 [95% CI 1.74-5.45]; P-score, 0.8306) and clobetasol had the worst (SMD, 2.63 [95% CI 1.66-3.61]; P-score, 0.2581); and pimecrolimus performed best (OR, 0.04 [95% CI 0.00-0.64]; P-score, 0.9227) and clobetasol performed the worst [OR, 0.60; 95% CI 0.15-2.45; P-score, 0.2545] in reducing relapse. Regarding safety, dexamethasone was the safest compared with placebo [OR, 0.37; 95% CI 0.05-2.57; P-score, 0.9337), whereas fluocinolone ranked low for safety [OR, 9.48; 95% CI 1.50- 60.03; P-score, 0.1189]. CONCLUSIONS The relative ranking of topical administration varies according to the different indicators. Based on the joint consideration of clinical response rate and adverse event occurrence, dexamethasone, triamcinolone and betamethasone are recommended for better efficacy and safety. The optimal treatment for oral lichen patients varies under different conditions.
Collapse
Affiliation(s)
- Peiyang Yuan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuemei Qiu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lu Ye
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Feifei Hou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuye Liang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Han Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuting Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yiming Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yutong Sun
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoting Deng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hao Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lu Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| |
Collapse
|
21
|
Kulkarni R, Alawi F, Sollecito TP, Stoopler ET. Chronic symptomatic oral ulcers. J Am Dent Assoc 2020; 152:948-953. [PMID: 33323285 DOI: 10.1016/j.adaj.2020.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 12/30/2022]
|
22
|
Iglesias-Sancho M, Llambí Mateos F, Salleras-Redonnet M. Formulación magistral en patología de la mucosa oral. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:822-828. [DOI: 10.1016/j.ad.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 11/16/2022] Open
|
23
|
Drug Compounding for Diseases of the Oral Mucosa. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
24
|
Böer-Auer A, Lütgerath C. [Lichen planus: fundamentals, clinical variants, histological features, and differential diagnosis]. Hautarzt 2020; 71:1007-1021. [PMID: 33201324 DOI: 10.1007/s00105-020-04717-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Lichen planus (LP) is a relatively common inflammatory skin disease in dermatological practice. The typical presentation of LP is usually diagnosed clinically. Less common variants such as LP inversus, atrophic LP, the palmoplantar manifestation or childhood LP may pose diagnostic difficulties so that a biopsy is taken to confirm the diagnosis. Differentiation from LP-like drug eruption may be challenging and biologicals have to be considered as triggers. Etiology and pathogenesis of LP are discussed based on recent literature. Finally, an overview of therapeutic options for different variants of the condition includes most recent approaches to treatment.
Collapse
Affiliation(s)
- Almut Böer-Auer
- Klinik für Hautkrankheiten, Dermatologie, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland.
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland.
| | | |
Collapse
|
25
|
Veneri F, Bardellini E, Amadori F, Conti G, Majorana A. Efficacy of ozonized water for the treatment of erosive oral lichen planus: a randomized controlled study. Med Oral Patol Oral Cir Bucal 2020; 25:e675-e682. [PMID: 32683383 PMCID: PMC7473429 DOI: 10.4317/medoral.23693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 06/14/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Management of erosive Oral Lichen Planus (eOLP) is challenging. Currently, topical corticosteroids are widely used as first-line therapy, but they might be associated with side-effects and incomplete clinical response. Among non-pharmacological strategies, ozone at low medical concentration has proven to induce a mild activation of protective anti-oxidant pathways, thus exerting therapeutic effects in many inflammatory diseases. The aim of this randomized controlled study was to investigate the effectiveness of ozonized water in association with conventional topical corticosteroids for the treatment of eOLP. MATERIAL AND METHODS Fifty-one patients were included in the study and randomized into 2 groups: study group (n=26) included patients receiving ozonized water treatment; control group (n=25) included patients receiving placebo treatment (i.e. double-distilled water). Treatment protocol consisted of 1-minute oral rinses, repeated for 4 times, twice a week for 4 weeks. All patients received conventional corticosteroid topical therapy (betamethasone soluble tablets, 2 rinses/day for 4 weeks). Assessment of size of lesions, sign and pain scores was performed before treatment, after 2 weeks of treatment (T1) and at the end of 4-week treatment (T2). Efficacy Index (EI) of treatment, candidiasis and relapse rates were also recorded. RESULTS All patients experienced significant improvement of sign and pain scores with a higher rate of improvement in ozone-treated group (T1 improvement rates: Thongprasom 92.2% vs 28%; VAS pain 76.9% vs 32%; p<0.05). Pain and size reduction were significantly higher in ozone-treated group both at T1 and T2 (p<0.05). Ozone-treated group showed a higher EI at every time point (T0-T2: 72.77% vs 37.66%, p<0.01). Candidiasis (32% vs 11.5%) and relapse (40% vs 34.6%) rates were higher in control group, however the differences were not statistically significant. CONCLUSIONS Within the limitations of this study, ozonized water seems to be effective as an adjunct therapy, in combination with topical corticosteroids, for the treatment of eOLP.
Collapse
Affiliation(s)
| | - E Bardellini
- Dental Clinic, p.le Spedali Civili n.1 25133 Brescia
| | | | | | | |
Collapse
|
26
|
Yan YR, Hua F, He MJ, Lei T, Tan YQ, Zhou G. Heterogeneity of Outcome Measures Used in Randomized Controlled Trials for the Treatment of Oral Lichen Planus: A Methodological Study. J Evid Based Dent Pract 2020; 20:101468. [DOI: 10.1016/j.jebdp.2020.101468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/02/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023]
|
27
|
Hussein H, Brown R. Hydroxychloroquine and the treatment of Sjogren syndrome, chronic ulcerative stomatitis, and oral lichen planus in the age of COVID-19. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:e9-e13. [PMID: 32654931 PMCID: PMC7305926 DOI: 10.1016/j.oooo.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 12/12/2022]
Abstract
The Food and Drug Administration has recently approved the off-label use of hydroxychloroquine (HCQ) for the treatment of coronavirus disease 2019 (COVID-19) infections. However, a recent study not only failed to demonstrate HCQ efficacy but also documented a serious side effect of COVID-19 therapy with HCQ: QT prolongation and secondary arrhythmia. HCQ has been used as an off-label drug and deemed safe and effective for the treatment of oral lesions, such as Sjogren syndrome (SS), chronic ulcerative stomatitis (CUS), and oral lichen planus (OLP). Because HCQ may be appropriately used for the off-label treatment of SS, CUS, and OLP, relevant safety concerns regarding HCQ therapy with regard to dosage, drug-to-drug interactions, and QT prolongation and secondary arrhythmia are discussed here. Because of the possibility of decreased pharmacy supplies of HCQ, replacement drugs with respect to patients with SS, CUS, and OLP being successfully treated with HCQ are also discussed.
Collapse
Affiliation(s)
- Heba Hussein
- Department of Oral Medicine, Diagnosis, and Periodontology, Faculty of Dentistry, Cairo University, Cairo
| | - Ronald Brown
- Department of Oral Diagnosis & Radiology, Howard University College of Dentistry, Washington, DC; Department of Otolaryngology, Georgetown University Medical Center, Washington, DC.
| |
Collapse
|
28
|
Thongprasom K. Challenges in using topical calcineurin inhibitors as a treatment for recalcitrant oral lichen planus. Br J Dermatol 2019; 181:1120. [PMID: 31361328 DOI: 10.1111/bjd.18304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- K Thongprasom
- Oral Medicine Department, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand
| |
Collapse
|