1
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Wongpakorn P, Chantarangsu S, Prapinjumrune C. Factors involved in the remission of oral lichen planus treated with topical corticosteroids. BDJ Open 2024; 10:34. [PMID: 38719818 PMCID: PMC11078943 DOI: 10.1038/s41405-024-00217-4] [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: 03/06/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
AIM To determine the factors that affected the complete clinical remission of oral lichen planus (OLP) treated with topical corticosteroids. MATERIAL AND METHODS We retrospectively evaluated the charts of patients diagnosed as OLP. Age, sex, current medical conditions, medications, type of OLP, Thongprasom score, pain level assessed by a numeric rating scale (NRS), Candida infection, topical steroid treatment preparation, duration of treatment until the first complete clinical remission, and follow-up duration were assessed as variables. RESULTS In total 100 patients, after complete remission, 22 patients reported a relapse within 1.5-45 months, with a mean of 15.6 ± 13.2 months. Age, duration, gingiva and vestibule area, hypertension, dyslipidemia, Thongprasom score, preparation and topical corticosteroid potency were factors affecting the remission. Multivariate logistic regression analysis revealed that the patients' age and duration of treatment were significant factors after adjusted for age, sex, and independent factors with a P-value < 0.1 in the univariate analysis. The likelihood of having incomplete remission of the OLP lesion increased by 7.9% for every year increase in age and increased by 2.3% for every month of treatment. CONCLUSIONS There are many different factors between the complete remission and incomplete remission groups. However, age and duration of treatment were significant factors affecting the remission of OLP.
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Affiliation(s)
- Poosit Wongpakorn
- Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Soranun Chantarangsu
- Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chanwit Prapinjumrune
- Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand.
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2
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Hirapara B, Witheiler D, Tarnasky PR, Villamil M. Esophageal Perforation and Pneumomediastinum Due to Delayed Diagnosis of Esophageal Lichen Planus. Cureus 2023; 15:e35453. [PMID: 36994252 PMCID: PMC10042273 DOI: 10.7759/cureus.35453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 02/27/2023] Open
Abstract
Esophageal involvement of lichen planus is an under-reported and under-diagnosed manifestation that should prompt immediate treatment given its high rate of complications. We highlight a rare case of a 62-year-old Caucasian woman with history of known oral lichen planus and esophageal strictures presumed to be secondary to gastroesophageal reflux disease, that presented with esophageal food impaction resulting in perforation and subsequent pneumomediastinum after esophagogastroduodenoscopy (EGD). Further workup, including a repeat EGD, revealed that the esophageal strictures were rather a complication of lichen planus. The patient was started on oral, topical steroids and underwent serial esophageal dilations with improvement. Esophageal lichen planus should be high on the differential, especially in patients with involvement of other mucous membranes and strictures refractory to therapy. Complications such as recurrent esophageal strictures and perforation may be preventable with early diagnosis and adequate treatment.
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3
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Andabak-Rogulj A, Vindiš E, Aleksijević LH, Škrinjar I, Juras DV, Aščić A, Brzak BL. Different Treatment Modalities of Oral Lichen Planus-A Narrative Review. Dent J (Basel) 2023; 11:dj11010026. [PMID: 36661563 PMCID: PMC9857452 DOI: 10.3390/dj11010026] [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: 09/27/2022] [Revised: 12/22/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Oral lichen planus (OLP) is a chronic inflammatory disease of unknown etiology which affects the oral mucosa. OLP varies in its clinical features from a reticular form that is, in most cases, asymptomatic, to atrophic-erosive, and is accompanied by symptoms of burning sensation and pain followed by difficulty in eating. Given the fact that OLP is a disease of unknown etiology, the treatment is symptomatic and involves suppressing the signs and symptoms of the disease using various topical and systemic drugs. The first line of therapy for treating symptomatic OLP is topical corticosteroids, whereas systemic corticosteroids are used for treating persistent lesions that do not respond to local treatment. However, the lack of convincing evidence on the efficacy of previous therapies, including topical corticosteroids, and numerous side effects that have appeared over recent years has resulted in the emergence and development of new therapeutic options. Some of the therapies mentioned are tacrolimus, efalizumab, dapson, interferon, retinoic acid, photochemotherapy with psoralen and ultraviolet A rays (PUVA), aloe vera, antimalarials, antibiotics and others. These therapies only partially meet the properties of efficacy and safety of use, thus justifying the continuous search and testing of new treatment methods.
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Affiliation(s)
- Ana Andabak-Rogulj
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Clinical Hospital Zagreb, 10000 Zagreb, Croatia
| | - Ema Vindiš
- Dental Practice at Healthcare Center Ormož, 2270 Ormož, Slovenia
| | | | - Ivana Škrinjar
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Clinical Hospital Zagreb, 10000 Zagreb, Croatia
| | - Danica Vidović Juras
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Clinical Hospital Zagreb, 10000 Zagreb, Croatia
| | | | - Božana Lončar Brzak
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence:
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4
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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.
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Affiliation(s)
| | | | - Lu Jiang
- *Correspondence: Jing Li, ; Lu Jiang,
| | - Jing Li
- *Correspondence: Jing Li, ; Lu Jiang,
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5
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Bankvall M, Carda-Diéguez M, Mira A, Karlsson A, Hasséus B, Karlsson R, Robledo-Sierra J. Metataxonomic and metaproteomic profiling of the oral microbiome in oral lichen planus - a pilot study. J Oral Microbiol 2022; 15:2161726. [PMID: 36605405 PMCID: PMC9809343 DOI: 10.1080/20002297.2022.2161726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background A growing body of evidence demonstrates a different bacterial composition in the oral cavity of patients with oral lichen planus (OLP). Patients and methods Buccal swab samples were collected from affected and non-affected sites of six patients with reticular OLP and the healthy oral mucosa of six control subjects. 16S rRNA gene MiSeq sequencing and mass spectrometry-based proteomics were utilised to identify the metataxonomic and metaproteomic profiles of the oral microbiome in both groups. Results From the metataxonomic analysis, the most abundant species in the three subgroups were Streptococcus oralis and Pseudomonas aeruginosa, accounting for up to 70% of the total population. Principal Coordinates Analysis showed differential clustering of samples from the healthy and OLP groups. ANCOM-BC compositional analysis revealed multiple species (including P. aeruginosa and several species of Veillonella, Prevotella, Streptococcus and Neisseria) significantly over-represented in the control group and several (including Granulicatella elegans, Gemella haemolysans and G. parahaemolysans) in patients with OLP. The metaproteomic data were generally congruent and revealed that several Gemella haemolysans-belonging peptidases and other proteins with inflammatory and virulence potential were present in OLP lesions. Conclusion Our data suggest that several bacterial species are associated with OLP. Future studies with larger cohorts should be conducted to determine their role in the aetiology of OLP and evaluate their potential as disease biomarkers.
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Affiliation(s)
- Maria Bankvall
- Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - Miguel Carda-Diéguez
- Department of Health and Genomics, Center for Advanced Research in Public Health, FISABIO Foundation, Valencia, Spain
| | - Alex Mira
- Department of Health and Genomics, Center for Advanced Research in Public Health, FISABIO Foundation, Valencia, Spain,School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | | | - Bengt Hasséus
- Department of Oral Medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roger Karlsson
- Clinical microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jairo Robledo-Sierra
- Nanoxis Consulting AB, Gothenburg, Sweden,Faculty of Dentistry, CES University, Medellin, Colombia,CONTACT Jairo Robledo-Sierra Faculty of Dentistry, CES University, Medellin, Colombia
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6
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Sandhu S, Klein BA, Al-Hadlaq M, Chirravur P, Bajonaid A, Xu Y, Intini R, Hussein M, Vacharotayangul P, Sroussi H, Treister N, Sonis S. Oral lichen planus: comparative efficacy and treatment costs-a systematic review. BMC Oral Health 2022; 22:161. [PMID: 35524296 PMCID: PMC9074269 DOI: 10.1186/s12903-022-02168-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/11/2022] [Indexed: 12/22/2022] Open
Abstract
Objective To compare the reported efficacy and costs of available interventions used for the management of oral lichen planus (OLP). Materials and methods A systematic literature search was performed from database inception until March 2021 in MEDLINE via PubMed and the Cochrane library following PRISMA guidelines. Only randomized controlled trials (RCT) comparing an active intervention with placebo or different active interventions for OLP management were considered.
Results Seventy (70) RCTs were included. The majority of evidence suggested efficacy of topical steroids (dexamethasone, clobetasol, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus, cyclosporine), topical retinoids, intra-lesional triamcinolone, aloe-vera gel, photodynamic therapy, and low-level laser therapies for OLP management. Based on the estimated cost per month and evidence for efficacy and side-effects, topical steroids (fluocinonide > dexamethasone > clobetasol > triamcinolone) appear to be more cost-effective than topical calcineurin inhibitors (tacrolimus > pimecrolimus > cyclosporine) followed by intra-lesional triamcinolone. Conclusion Of common treatment regimens for OLP, topical steroids appear to be the most economical and efficacious option followed by topical calcineurin inhibitors. Large-scale multi-modality, prospective trials in which head-to-head comparisons interventions are compared are required to definitely assess the cost-effectiveness of OLP treatments. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02168-4.
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Affiliation(s)
- Shaiba Sandhu
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA. .,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA. .,Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Brittany A Klein
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Malak Al-Hadlaq
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Prazwala Chirravur
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Amal Bajonaid
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Yuanming Xu
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Rossella Intini
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Mai Hussein
- Harvard Medical School, Boston, MA, USA.,Ministry of Health and Population, Cairo, Egypt
| | - Piamkamon Vacharotayangul
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Herve Sroussi
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Stephen Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
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7
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Arroyo GP, Lofters A, Clarkson E. Pharmacological Management of Common Soft Tissue Lesions of the Oral Cavity. Oral Maxillofac Surg Clin North Am 2021; 34:99-114. [PMID: 34728147 DOI: 10.1016/j.coms.2021.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Soft tissue lesions commonly seen in the oral cavity tend to overlap in their onset, presentation, and location making it difficult to appreciate their etiology. In some instances, common oral soft tissue lesions can create confusion due to similar clinical appearance or unusual presentation; therefore, proper diagnosis of the lesion is key in pharmacologic management. In ulcerative conditions, topical steroids can decrease the symptoms and improve healing time, but do not affect the recurrence rate. Always be suspicious of soft tissue lesions that are nonresolving or recurrent lesions as they may warrant further investigation to rule out malignancy or associated systemic conditions. This article discusses key clinical presentations and the proper topical and systemic pharmacologic treatments.
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Affiliation(s)
- Guillermo Puig Arroyo
- Department of Oral and Maxillofacial Surgery, Woodhull Medical Center, 760 Broadway, Room 2C319, Brooklyn, NY 11206, USA.
| | - Ashley Lofters
- Department of Oral and Maxillofacial Surgery, Woodhull Medical Center, 760 Broadway, Room 2C319, Brooklyn, NY 11206, USA.
| | - Earl Clarkson
- Department of Oral and Maxillofacial Surgery, Woodhull Medical Center, 760 Broadway, Room 2C319, Brooklyn, NY 11206, USA
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8
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da Silva EL, de Lima TB, Rados PV, Visioli F. Efficacy of topical non-steroidal immunomodulators in the treatment of oral lichen planus: a systematic review and meta-analysis. Clin Oral Investig 2021. [PMID: 34342763 DOI: 10.1007/s00784-021-04072-7/figures/10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVES The aim of this systematic review was to assess the efficacy and safety of topical non-steroidal immunomodulators (TNSIs) for oral lichen planus (OLP) treatment. MATERIALS AND METHODS A search strategy designed for this purpose retrieved 1156 references. After analysis of titles and abstracts, 75 studies were selected for full-text analysis. Only randomized controlled clinical trials were selected, resulting in 28 studies included for qualitative and quantitative analysis. RESULTS The meta-analysis showed similar benefits in clinical response and symptom resolution between tacrolimus 0.1% and pimecrolimus 1% in comparison to topical steroids (TS). Pimecrolimus showed superior efficacy of clinical response but not for symptom resolution compared to placebo. Tacrolimus and pimecrolimus showed better performance preventing symptom relapse, while pimecrolimus also prevented clinical relapse better than TS. Cyclosporine was superior to placebo; however, TS showed better efficacy of clinical response. Thalidomide and retinoid were assessed in only one trial each, and both showed similar efficacy to TS. Rapamycin also presented similar clinical response to TS; however, the later showed greater reduction of symptoms. Mycophenolate mofetil 2% mucoadhesive was no better than placebo. No serious adverse effects have been reported. Cyclosporine showed a higher frequency and variety of adverse effects. CONCLUSIONS Topical tacrolimus and pimecrolimus are safe and effective alternatives for OLP treatment. CLINICAL RELEVANCE TS are usually the first choice for OLP treatment. Because some oral lesions may have a low response to treatment with TS, more topical therapeutic options, such as TNSIs, should be considered before systemic steroids are used.
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Affiliation(s)
- Eduardo Liberato da Silva
- Oral Pathology and Oral Medicine Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil
| | - Taiane Berguemaier de Lima
- Oral Pathology and Oral Medicine Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil
| | - Pantelis Varvaki Rados
- Oral Pathology and Oral Medicine Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil
| | - Fernanda Visioli
- Oral Pathology and Oral Medicine Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil. .,Experimental Center Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90035-903, Brazil.
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9
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Efficacy of topical non-steroidal immunomodulators in the treatment of oral lichen planus: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:5149-5169. [PMID: 34342763 DOI: 10.1007/s00784-021-04072-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this systematic review was to assess the efficacy and safety of topical non-steroidal immunomodulators (TNSIs) for oral lichen planus (OLP) treatment. MATERIALS AND METHODS A search strategy designed for this purpose retrieved 1156 references. After analysis of titles and abstracts, 75 studies were selected for full-text analysis. Only randomized controlled clinical trials were selected, resulting in 28 studies included for qualitative and quantitative analysis. RESULTS The meta-analysis showed similar benefits in clinical response and symptom resolution between tacrolimus 0.1% and pimecrolimus 1% in comparison to topical steroids (TS). Pimecrolimus showed superior efficacy of clinical response but not for symptom resolution compared to placebo. Tacrolimus and pimecrolimus showed better performance preventing symptom relapse, while pimecrolimus also prevented clinical relapse better than TS. Cyclosporine was superior to placebo; however, TS showed better efficacy of clinical response. Thalidomide and retinoid were assessed in only one trial each, and both showed similar efficacy to TS. Rapamycin also presented similar clinical response to TS; however, the later showed greater reduction of symptoms. Mycophenolate mofetil 2% mucoadhesive was no better than placebo. No serious adverse effects have been reported. Cyclosporine showed a higher frequency and variety of adverse effects. CONCLUSIONS Topical tacrolimus and pimecrolimus are safe and effective alternatives for OLP treatment. CLINICAL RELEVANCE TS are usually the first choice for OLP treatment. Because some oral lesions may have a low response to treatment with TS, more topical therapeutic options, such as TNSIs, should be considered before systemic steroids are used.
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10
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Santonocito S, Polizzi A, De Pasquale R, Ronsivalle V, Lo Giudice A, Isola G. Analysis of the Efficacy of Two Treatment Protocols for Patients with Symptomatic Oral Lichen Planus: A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E56. [PMID: 33374791 PMCID: PMC7794703 DOI: 10.3390/ijerph18010056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
Oral lichen planus (OLP) is a chronic, inflammatory, immune-mediated disease, which can alter the quality of life of patients. The aim of this randomized clinical trial was to compare the therapeutic efficacy of clobetasol oral gel 0.05% versus an anti-inflammatory in oral solution (mouthwash) in the management of patients suffering from symptomatic OLP. The secondary objective was to analyze which one of the two treatments induced a greater risk of developing side effects. Forty patients were assigned (20 patients for group), through a randomized design, to receive clobetasol gel 0.05% or an anti-inflammatory mouthwash, which contains calcium hydroxide, hyaluronic acid, umbelliferone and oligomeric pro-anthocyanidins) for three months. At baseline (T0) and after 3 months (T1), patients underwent dental and dermatological examinations to assess their symptoms (Numerical Pain Scale (NRS) score) and signs (Thongprasom score). Data were calculated using T-test for the dependent variable, Wilcoxon test and Mann-Whitney u test. Both clobetasol and anti-inflammatory resulted in a statistically significant reduction of signs, (p < 0.001 and p = 0.02, respectively) and symptoms (p < 0.001 for clobetasol and p = 0.02 for anti-inflammatory). In conclusion, the results evidenced that, compared to clobetasol, the anti-inflammatory was less effective in determining the reduction of signs and symptom in OLP patients.
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Affiliation(s)
- Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Rocco De Pasquale
- Department of General Surgery and Surgical-Medical Specialties, Unit of Dermatology, University of Catania, 95124 Catania, Italy;
| | - Vincenzo Ronsivalle
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
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11
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Porat Ben Amy D, Kassem R. Custom-made trays for targeted treatment of oral vesiculobullous diseases: A proposed protocol. Dermatol Ther 2020; 33:e14446. [PMID: 33105060 DOI: 10.1111/dth.14446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/08/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022]
Abstract
Topical and intralesional corticosteroids (CS) are effective treatments for oral manifestations of autoimmune vesiculobullous diseases (VBD); however, may cause unnecessary absorption in the adjacent healthy mucosal surfaces, local infections, atrophy, and injection pain. To propose a protocol using a unique modality for targeted administration of CS for the treatment of local manifestations of oral VBD. The medical records of nine patients with systemic CS-resistant VBD oral lesions, were reviewed following 3 weeks of treatment and 3 months of tapering using a custom-made tray designed for precise application of topical CS targeted to the involved mucosa. Following treatment, lesions have healed in 8/9 patients. Involvement of surrounding mucosa was minimal, and no systemic adverse effects were recorded. The proposed protocol using custom-made trays for targeted CS treatment could be an effective alternative treatment for oral VBD.
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Affiliation(s)
- Dalit Porat Ben Amy
- Oral Medicine Unit, Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Poria, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Riad Kassem
- Department of Dermatology, Sheba Medical Center, Ramat Gan, Israel.,Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Ferri EP, Cunha KRL, Abboud CS, de Barros Gallo C, de Sousa Sobral S, de Fatima Teixeira da Silva D, Horliana ACRT, Franco ALDS, Rodrigues MFSD. Photobiomodulation is effective in oral lichen planus: A randomized, controlled, double-blind study. Oral Dis 2020; 27:1205-1216. [PMID: 33012017 DOI: 10.1111/odi.13662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/11/2020] [Accepted: 09/11/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare the efficacy of photobiomodulation to that of topical clobetasol 0.05% in patients with symptomatic oral lichen planus (OLP). SUBJECTS Thirty-four patients with symptomatic OLP were randomly allocated into two groups: (a) the Control group (n = 17), application of topical clobetasol propionate 0.05% three times a day for 30 consecutive days with laser placebo applied twice a week to mask the treatment, and (b) the photobiomodulation group (n = 17), laser application twice a week, totalling 8 sessions, and gel placebo for 30 consecutive days to mask the treatment. Evaluations were performed once a week during treatment and 30, 60 and 90 days after treatment. The following parameters were evaluated: pain, clinical scores, clinical resolution and recurrence rate. RESULTS Photobiomodulation and propionate clobetasol 0.05% were able to significantly decrease pain in oral lichen planus patients and improve clinical scores during treatment and follow-up. Both the Control and photobiomodulation groups presented similar clinical resolution and recurrence rates. Most importantly, no difference was observed between treatments during treatment and follow-up. CONCLUSIONS These findings indicate that photobiomodulation twice a week is as effective as corticoid therapy in treating oral lichen planus. Moreover, photobiomodulation is a safe and non-invasive therapy with the remarkable advantage of no adverse effects.
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Affiliation(s)
- Elza P Ferri
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University, UNINOVE, São Paulo, Brazil
| | - Karen R L Cunha
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University, UNINOVE, São Paulo, Brazil
| | - Clery S Abboud
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University, UNINOVE, São Paulo, Brazil
| | - Camila de Barros Gallo
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Sérgio de Sousa Sobral
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University, UNINOVE, São Paulo, Brazil
| | | | - Anna Carolina R T Horliana
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University, UNINOVE, São Paulo, Brazil
| | - Adriana L-D-S Franco
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University, UNINOVE, São Paulo, Brazil
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13
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Samimi M, Le Gouge A, Boralevi F, Passeron T, Pascal F, Bernard P, Agbo-Godeau S, Leducq S, Fricain JC, Vaillant L, Francès C. Topical rapamycin versus betamethasone dipropionate ointment for treating oral erosive lichen planus: a randomized, double-blind, controlled study. J Eur Acad Dermatol Venereol 2020; 34:2384-2391. [PMID: 32128907 DOI: 10.1111/jdv.16324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 02/18/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although superpotent topical corticosteroids are the first-line treatment for oral erosive lichen planus (OELP), topical rapamycin was found efficient in a previous case series. OBJECTIVES To compare the efficacy and safety of topical rapamycin and betamethasone dipropionate ointment for OELP in a randomized, double-blind trial. METHODS Patients were randomized to receive treatment with betamethasone dipropionate ointment 0.05% in Orabase® or topical rapamycin solution (1 mg/mL) on lesions twice daily for 3 months, followed by 3 months of observation. The primary outcome was clinical remission after 3 months of treatment. Secondary outcomes were clinical remission after 1 and 2 months, reduced oral pain and reduced impact on food intake after 3 months, clinical recurrence after treatment withdrawal, and adverse events. RESULTS During a 4-year period, 76 patients were randomized and 75 received treatment (rapamycin, n = 39; betamethasone, n = 36). At 3 months, 39.4% of patients with betamethasone and 27.3% with rapamycin showed clinical remission (odds ratio 0.68, 95% CI [0.24; 1.89]; P = 0.46). Rates of remission after 1 and 2 months, reduction in pain and impact on food intake after 3 months, were higher with betamethasone than rapamycin. Recurrence of oral erosions was similar between groups. Adverse events occurred in 43.6% of patients with rapamycin (mostly burning sensation, impaired taste) and 27.8% with betamethasone (mostly oral candidiasis). CONCLUSION Although the study was limited by insufficient recruitment, we did not find any superiority of topical rapamycin over betamethasone dipropionate ointment for OELP. Given the rapid remission and pain improvement in the betamethasone group, it appears that superpotent topical corticosteroids should remain the first-line treatment for OELP.
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Affiliation(s)
- M Samimi
- Department of Dermatology, University Hospital of Tours, University of Tours, Tours, France.,ISP 1282 INRA University of Tours, Tours, France
| | - A Le Gouge
- Biometrical Department, Centre d'Investigation Clinique, INSERM CIC1415, University Hospital of Tours, Tours, France
| | - F Boralevi
- Department of Dermatology, National Centre for Rare Skin Disorders, University Hospital of Bordeaux and INSERM U1035, Bordeaux, France
| | - T Passeron
- Department of Dermatology, CHU Nice, INSERM U1065, Centre Méditerranéen de Médecine Moléculaire (C3M), Université Côte d'Azur, Nice, France
| | - F Pascal
- Department of Dermatology and Stomatology, Saint-Louis Hospital, AP-HP, Université Paris 7-Diderot, Paris, France
| | - P Bernard
- Department of Dermatology, Reims University Hospital, University of Reims-Champagne-Ardenne, Reims, France
| | - S Agbo-Godeau
- Department of Stomatology and Maxillo-Facial Surgery, Groupe hospitalier Pitié-Salpêtrière-Charles-Foix, AP-HP, Paris, France
| | - S Leducq
- Department of Dermatology, University Hospital of Tours, University of Tours, Tours, France.,Biometrical Department, Centre d'Investigation Clinique, INSERM CIC1415, University Hospital of Tours, Tours, France
| | - J C Fricain
- Department of Dentistry and Oral Health, Inserm U1026 Bioingénierie Tissulaire - BioTis, Bordeaux, University Hospital of Bordeaux, France
| | - L Vaillant
- Department of Dermatology, University Hospital of Tours, University of Tours, Tours, France
| | - C Francès
- Department of Dermatology and Allergology, Hospital Tenon, Université Paris VI Pierre et Marie Curie, Sorbonnes Universités, Paris, France
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14
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Carrozzo M, Porter S, Mercadante V, Fedele S. Oral lichen planus: A disease or a spectrum of tissue reactions? Types, causes, diagnostic algorhythms, prognosis, management strategies. Periodontol 2000 2019; 80:105-125. [PMID: 31090143 DOI: 10.1111/prd.12260] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Oral lichen planus and lichenoid lesions comprise a group of disorders of the oral mucosa that likely represent a common reaction pattern to 1 or more unknown antigens. The coexistence of hyperkeratotic striation/reticulation, varying degrees of mucosal inflammation from mild erythema to severe widespread ulceration, and a band-like infiltrate of mononuclear inflammatory cells including activated T lymphocytes, macrophages, and dendritic cells, are considered suggestive of oral lichen planus and lichenoid lesions. Several classification systems of oral lichen planus and lichenoid lesions have been attempted, although none seem to be comprehensive. In this paper, we present a classification of oral lichen planus and lichenoid lesions that includes oral lichen planus, oral lichenoid contact lesions, oral lichenoid drug reactions, oral lichenoid lesions of graft vs. host disease, discoid lupus erythematosus, and systemic lupus erythematosus, lichen planus-like variant of paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome, chronic ulcerative stomatitis, lichen planus pemphigoides, solitary fixed drug eruptions, and lichen sclerosus. We present the clinical and diagnostic aspects of oral lichen planus and lichenoid lesions, and discuss related treatment options.
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Affiliation(s)
- Marco Carrozzo
- Centre for Oral Health Research, Oral Medicine Department, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Porter
- UCL Eastman Dental Institute, University College London, London, UK
| | | | - Stefano Fedele
- UCL Eastman Dental Institute, University College London, London, UK.,NIHR University College London Hospitals Biomedical Research Centre, London, UK
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15
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Husein‐ElAhmed H, Gieler U, Steinhoff M. Lichen planus: a comprehensive evidence‐based analysis of medical treatment. J Eur Acad Dermatol Venereol 2019; 33:1847-1862. [DOI: 10.1111/jdv.15771] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/21/2019] [Indexed: 12/15/2022]
Affiliation(s)
- H. Husein‐ElAhmed
- Department of Dermatology and Venereology Hospital de Baza Granada Spain
- Translational Research Institute Academic Health System Medical School Hamad Medical Corporation Doha Qatar
| | - U. Gieler
- Translational Research Institute Academic Health System Medical School Hamad Medical Corporation Doha Qatar
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
| | - M. Steinhoff
- Translational Research Institute Academic Health System Medical School Hamad Medical Corporation Doha Qatar
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
- College of Medicine Weill Cornell Medicine‐Qatar Doha Qatar
- Medical School Qatar University Doha Qatar
- College of Medicine Weill Cornell University New York NY USA
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16
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How I treat refractory chronic graft-versus-host disease. Blood 2019; 133:1191-1200. [PMID: 30674472 PMCID: PMC6418480 DOI: 10.1182/blood-2018-04-785899] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 01/20/2019] [Indexed: 02/07/2023] Open
Abstract
Approximately 35% to 50% of patients otherwise cured of hematologic malignancies after allogeneic hematopoietic stem cell transplantation will develop the pleomorphic autoimmune-like syndrome known as chronic graft-versus-host disease (cGVHD). Since in 2005, National Institutes of Health (NIH) consensus panels have proposed definitions and classifications of disease to standardize treatment trials. Recently, the first agent was approved by the US Food and Drug Administration for steroid-refractory cGVHD. Despite these advances, most individuals do not achieve durable resolution of disease activity with initial treatment. Moreover, standardized recommendations on how to best implement existing and novel immunomodulatory agents and taper salvage agents are often lacking. Given the potential life-threatening nature of cGVHD, we employ in our practice patient assessment templates at each clinic visit to elucidate known prognostic indicators and red flags. We find NIH scoring templates practical for ongoing assessments of these complex patient cases and determination of when changes in immunosuppressive therapy are warranted. Patients not eligible or suitable for clinical trials have systemic and organ-directed adjunctive treatments crafted in a multidisciplinary clinic. Herein, we review these treatment options and offer a management and monitoring scaffold for representative patients with cGVHD not responding to initial therapy.
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17
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Arduino PG, Campolongo MG, Sciannameo V, Conrotto D, Gambino A, Cabras M, Ricceri F, Carossa S, Broccoletti R, Carbone M. Randomized, placebo-controlled, double-blind trial of clobetasol propionate 0.05% in the treatment of oral lichen planus. Oral Dis 2018; 24:772-777. [PMID: 29297958 DOI: 10.1111/odi.12821] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To perform a randomized, placebo-controlled, double-blind study, with a follow-up period of 6 months, for the use of topical clobetasol in cases of symptomatic oral lichen planus (OLP). SUBJECTS AND METHODS Thirty-two participants were analyzed, with the aims of: (I) to compare the usefulness of topically applied clobetasol propionate 0.05% (mixed with 4% hydroxyethyl cellulose gel) and 4% hydroxyethyl cellulose gel alone (considered as placebo) in the management of OLP; (II) to describe which of them is quicker in decreasing signs and reported symptoms, and (III) which is able to give the proper longer remission in the follow-up. RESULTS Symptoms improved in all clobetasol-treated patients during the first 2 months of therapy, while only 50% of placebo control group (p = .005) displayed similar results; of the remaining half, 12.5% did experienced a worsening while 37.5% remained stable. Regarding clinical signs, 87.5% of clobetasol-treated patients improved, while only 62.5% of the placebo-treated patients had a positive response (p = .229). CONCLUSIONS It is possible to report that clobetasol, at this dosage, has been more effective than a placebo at provoking symptoms improvement in subjects affected by atrophic-erosive oral lesions.
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Affiliation(s)
- P G Arduino
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - M G Campolongo
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - V Sciannameo
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Italy
| | - D Conrotto
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - A Gambino
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - M Cabras
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - F Ricceri
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Italy
| | - S Carossa
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - R Broccoletti
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - M Carbone
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
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18
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García-Pola MJ, González-Álvarez L, Garcia-Martin JM. Treatment of oral lichen planus. Systematic review and therapeutic guide. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.medcle.2017.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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García-Pola MJ, González-Álvarez L, Garcia-Martin JM. Tratamiento del liquen plano oral. Revisión sistemática y protocolo de actuación. Med Clin (Barc) 2017; 149:351-362. [DOI: 10.1016/j.medcli.2017.06.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 06/11/2017] [Accepted: 06/12/2017] [Indexed: 01/03/2023]
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20
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Microenvironmental regulation of the progression of oral potentially malignant disorders towards malignancy. Oncotarget 2017; 8:81617-81635. [PMID: 29113419 PMCID: PMC5655314 DOI: 10.18632/oncotarget.20312] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/04/2017] [Indexed: 02/05/2023] Open
Abstract
Oral potentially malignant disorders (OPMD) develop in a complex tissue microenvironment where they grow sustainably, acquiring oral squamous cell carcinoma (OSCC) characteristics. The malignant tumor depends on interactions with the surrounding microenvironment to achieve loco-regional invasion and distant metastases. Unlike abnormal cells, the multiple cell types in the tissue microenvironment are relatively stable at the genomic level and, thus, become therapeutic targets with lower risk of resistance, decreasing the risk of OPMD acquiring cancer characteristics and carcinoma recurrence. However, deciding how to disrupt the OPMD and OSCC microenvironments is itself a daunting challenge, since their microenvironments present opposite capacities, resulting in diverse consequences. Furthermore, recent studies revealed that tumor-associated immune cells also participate in the process of differentiation from OPMD to OSCC, suggesting that reeducating stromal cells may be a new strategy to prevent OPMD from acquiring OSCC characteristics and to treat OSCC. In this review, we discuss the characteristics of the microenvironment of OPMD and OSCC as well as new therapeutic strategies.
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21
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He Y, Gong D, Shi C, Shao F, Shi J, Fei J. Dysbiosis of oral buccal mucosa microbiota in patients with oral lichen planus. Oral Dis 2017; 23:674-682. [PMID: 28199766 DOI: 10.1111/odi.12657] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/15/2016] [Accepted: 01/25/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Y He
- Department of Oral Medicine, School & Hospital of Stomatology, Tongji University; Shanghai Engineering Research Center of Tooth Restoration and Regeneration; Shanghai China
| | - D Gong
- Department of Oral Medicine, School & Hospital of Stomatology, Tongji University; Shanghai Engineering Research Center of Tooth Restoration and Regeneration; Shanghai China
| | - C Shi
- Department of Oral Medicine, School & Hospital of Stomatology, Tongji University; Shanghai Engineering Research Center of Tooth Restoration and Regeneration; Shanghai China
| | - F Shao
- Department of Oral Medicine, School & Hospital of Stomatology, Tongji University; Shanghai Engineering Research Center of Tooth Restoration and Regeneration; Shanghai China
| | - J Shi
- School of Life Science and Technology; Tongji University; Shanghai China
| | - J Fei
- School of Life Science and Technology; Tongji University; Shanghai China
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22
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Siponen M, Huuskonen L, Kallio-Pulkkinen S, Nieminen P, Salo T. Topical tacrolimus, triamcinolone acetonide, and placebo in oral lichen planus: a pilot randomized controlled trial. Oral Dis 2017; 23:660-668. [PMID: 28168769 DOI: 10.1111/odi.12653] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/26/2016] [Accepted: 01/15/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To carry out a double-blind randomized controlled trial (RCT) to compare the effectiveness of topical tacrolimus (TAC), triamcinolone acetonide (TRI), and placebo (PLA) in symptomatic oral lichen planus (OLP). SUBJECTS AND METHODS A clinical score (CS, range 0-130) was developed to measure the clinical signs and symptoms of OLP. Twenty-seven OLP patients with a CS of ≥20 were randomly allocated to receive 0.1% TAC ointment (n = 11), 0.1% TRI paste (n = 7), or Orabase® paste as PLA (n = 9) for 3 weeks. If the CS dropped ≥20% (interpreted as response), the patients continued the same medication for another 3 weeks. If the CS dropped <20% or increased (non-response), the patients were switched to TAC for 6 weeks. A 6-month follow-up period ensued. The primary outcome variable was the change in CS from baseline to week 3. In primary outcome analysis, CS values between the treatment arms were compared. RESULTS Tacrolimus and TRI were more effective (P = 0.012 and 0.031, respectively) than PLA in reducing the CS at week 3. No difference in the efficacy was noted between TAC and TRI (P = 0.997). CONCLUSIONS This pilot RCT provides evidence for the effectiveness of TAC and TRI over PLA in the management of OLP.
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Affiliation(s)
- M Siponen
- Institute of Dentistry, University of Oulu, Oulu, Finland.,Cancer and Translational Medicine Research Unit, University of Oulu, Oulu, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| | - L Huuskonen
- Institute of Dentistry, University of Oulu, Oulu, Finland
| | | | - P Nieminen
- Medical Informatics and Statistics Research Group, University of Oulu, Oulu, Finland
| | - T Salo
- Institute of Dentistry, University of Oulu, Oulu, Finland.,Cancer and Translational Medicine Research Unit, University of Oulu, Oulu, Finland.,Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
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23
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Gupta S, Ghosh S, Gupta S. Interventions for the management of oral lichen planus: a review of the conventional and novel therapies. Oral Dis 2017; 23:1029-1042. [PMID: 28055124 DOI: 10.1111/odi.12634] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This narrative review focuses on the rationale and role of conventional and newer therapies in the management of oral lichen planus (OLP) with emphasis on randomized controlled trials (RCTs) reported over two decades. MATERIALS AND METHODS Literature search was conducted to identify RCTs for the management of OLP from 1 January 1995 to 31 December 2015; Medline and Cochrane databases complemented with manual search were used. Primary outcome as resolution of pain was evaluated with the analysis of clinical resolution of erythema and ulceration as secondary outcome. RESULTS The search provided 260 abstracts, of which 70 full-text articles were included. Majority of trials used topical steroids with very few trials on newer therapies. It was found that topical steroids are effective for symptomatic management of OLP with equal efficacy shown by topical calcineurin inhibitors and retinoids. However, the side effect of transient burning sensation with relapse was more with calcineurin inhibitors. CONCLUSION Although the newer therapies offer advantage over steroids for the management of OLP in recalcitrant cases, extensive lesions, and cases unresponsive to steroids, but sufficient clinical data on their use are still lacking. Hence, more RCTs with large sample size, adequate treatment duration, and long-term follow-up are required for clinical utility.
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Affiliation(s)
- S Gupta
- Department of Oral Medicine & Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - S Ghosh
- Department of Oral Medicine & Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - S Gupta
- Department of Oral Medicine & Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
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24
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Wei J, Ma D, Qiu M, Dan H, Zeng X, Jiang L, Zhou Y, Wang J, Chen Q. Medical treatments for pregnant patients with oral lichen planus. Acta Odontol Scand 2017; 75:67-72. [PMID: 27826983 DOI: 10.1080/00016357.2016.1250944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Oral lichen planus (OLP) is a common chronic inflammatory disorder that manifests as papular, reticular, or erosive lesions. OLP seriously affects a patient's quality of life, as it is associated with symptoms such as pain and a burning sensation. It is also accompanied by a risk of carcinogenic tendency. During pregnancy, the treatment will be more complicated because of the effect of medical treatment on both the mother and foetus. Thus, appropriate drugs for those pregnant patients will be more essential. This study aimed to review the safety of drugs used for the treatment of OLP during pregnancy and to establish an appropriate treatment plan for pregnant patients with OLP.
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25
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González-Moles MA, Scully C. Vesiculo-erosive Oral Mucosal Disease—Management with Topical Corticosteroids: (1) Fundamental Principles and Specific Agents Available. J Dent Res 2016; 84:294-301. [PMID: 15790732 DOI: 10.1177/154405910508400401] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Vesiculo-erosive diseases of the oral mucosa pose a major challenge in oral medicine, because they are chronic, painful, and interfere with the daily activities and quality of life of the patients, including disturbing eating, drinking, talking, and personal relationships. Many are autoimmune diseases, and corticosteroid therapy is currently central to their treatment. These diseases present with inflammation and alterations to epithelial integrity, through cell and/or humoral immunity-mediated attack on epithelial-connective tissue targets. Until recently, despite their serious adverse effects, it was necessary to prescribe systemic corticosteroids to control severe erosive oral diseases. Now, however, many of these diseases can be controlled by high-potency topical corticosteroids, which have proved to be highly efficacious and to cause fewer adverse effects compared with systemic corticosteroids. Nevertheless, although topical corticosteroids are still the most widely used drugs in the practice of oral medicine, the scientific body of evidence for their use in the oral cavity is virtually non-existent, and therefore many of the protocols followed are, of necessity, drawn from experience of their use in a dermatological setting. This review aims to set out the key aspects of the use of topical corticosteroids in oral medicine. The issues covered include the indications and basic rules for their use, the types of corticosteroids, the drug selection, and the specific formulations.
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Affiliation(s)
- M A González-Moles
- Departamento de Medicina Oral, Facultad de Odontología, Universidad de Granada, Campus de Cartuja sn, 18071, Granada, Spain.
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26
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González-Moles MA, Scully C. Vesiculo-erosive Oral Mucosal Disease—Management with Topical Corticosteroids: (2) Protocols, Monitoring of Effects and Adverse Reactions, and the Future. J Dent Res 2016; 84:302-8. [PMID: 15790733 DOI: 10.1177/154405910508400402] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although topical corticosteroids (TCs) are the most widely used drugs in oral medicine, and specifically in the treatment of vesiculo-erosive oral mucosal disease, there are few evidence-based data for the correct use of these drugs. In this review, we outline the most widely used protocols, the most common reasons for treatment failure, and the adverse effects documented in the literature.
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Affiliation(s)
- M A González-Moles
- Professor of Oral Medicine, Departamento de Medicina Oral, School of Dentistry, Facultad de Odontología, Universidad de Granada, Campus de Cartuja sn, 18071, Granada, Spain.
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27
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Alrashdan MS, Cirillo N, McCullough M. Oral lichen planus: a literature review and update. Arch Dermatol Res 2016; 308:539-51. [PMID: 27349424 DOI: 10.1007/s00403-016-1667-2] [Citation(s) in RCA: 220] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/16/2016] [Accepted: 06/17/2016] [Indexed: 12/22/2022]
Abstract
Lichen planus (LP) is a common chronic inflammatory condition that can affect skin and mucous membranes, including the oral mucosa. Because of the anatomic, physiologic and functional peculiarities of the oral cavity, the oral variant of LP (OLP) requires specific evaluations in terms of diagnosis and management. In this comprehensive review, we discuss the current developments in the understanding of the etiopathogenesis, clinical-pathologic presentation, and treatment of OLP, and provide follow-up recommendations informed by recent data on the malignant potential of the disease as well as health economics evaluations.
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Affiliation(s)
- Mohammad S Alrashdan
- Department of Oral Medicine and Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Nicola Cirillo
- Melbourne Dental School, The University of Melbourne, Victoria, Australia
| | - Michael McCullough
- Melbourne Dental School, The University of Melbourne, Victoria, Australia
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28
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Herrera D, Alonso B, de Arriba L, Santa Cruz I, Serrano C, Sanz M. Acute periodontal lesions. Periodontol 2000 2015; 65:149-77. [PMID: 24738591 DOI: 10.1111/prd.12022] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 11/30/2022]
Abstract
This review provides updates on acute conditions affecting the periodontal tissues, including abscesses in the periodontium, necrotizing periodontal diseases and other acute conditions that cause gingival lesions with acute presentation, such as infectious processes not associated with oral bacterial biofilms, mucocutaneous disorders and traumatic and allergic lesions. A periodontal abscess is clinically important because it is a relatively frequent dental emergency, it can compromise the periodontal prognosis of the affected tooth and bacteria within the abscess can spread and cause infections in other body sites. Different types of abscesses have been identified, mainly classified by their etiology, and there are clear differences between those affecting a pre-existing periodontal pocket and those affecting healthy sites. Therapy for this acute condition consists of drainage and tissue debridement, while an evaluation of the need for systemic antimicrobial therapy will be made for each case, based on local and systemic factors. The definitive treatment of the pre-existing condition should be accomplished after the acute phase is controlled. Necrotizing periodontal diseases present three typical clinical features: papilla necrosis, gingival bleeding and pain. Although the prevalence of these diseases is not high, their importance is clear because they represent the most severe conditions associated with the dental biofilm, with very rapid tissue destruction. In addition to bacteria, the etiology of necrotizing periodontal disease includes numerous factors that alter the host response and predispose to these diseases, namely HIV infection, malnutrition, stress or tobacco smoking. The treatment consists of superficial debridement, careful mechanical oral hygiene, rinsing with chlorhexidine and daily re-evaluation. Systemic antimicrobials may be used adjunctively in severe cases or in nonresponding conditions, being the first option metronidazole. Once the acute disease is under control, definitive treatment should be provided, including appropriate therapy for the pre-existing gingivitis or periodontitis. Among other acute conditions affecting the periodontal tissues, but not caused by the microorganisms present in oral biofilms, infectious diseases, mucocutaneous diseases and traumatic or allergic lesions can be listed. In most cases, the gingival involvement is not severe; however, these conditions are common and may prompt an emergency dental visit. These conditions may have the appearance of an erythematous lesion, which is sometimes erosive. Erosive lesions may be the direct result of trauma or a consequence of the breaking of vesicles and bullae. A proper differential diagnosis is important for adequate management of the case.
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Kunz M, Urosevic-Maiwald M, Goldinger S, Frauchiger A, Dreier J, Belloni B, Mangana J, Jenni D, Dippel M, Cozzio A, Guenova E, Kamarachev J, French L, Dummer R. Efficacy and safety of oral alitretinoin in severe oral lichen planus - results of a prospective pilot study. J Eur Acad Dermatol Venereol 2015; 30:293-8. [DOI: 10.1111/jdv.13444] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- M. Kunz
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | | | - S.M. Goldinger
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - A.L. Frauchiger
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - J. Dreier
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - B. Belloni
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - J. Mangana
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - D. Jenni
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - M. Dippel
- MD Medscript; Health Care Consulting and Writing; Bad Durkheim Germany
| | - A. Cozzio
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - E. Guenova
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - J. Kamarachev
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - L.E. French
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - R. Dummer
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
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Ní Ríordáin R, Shirlaw P, Alajbeg I, Al Zamel GY, Fung PL, Yuan AD, McCreary C, Stoopler ET, De Rossi SS, Lodi G, Greenberg MS, Brennan MT. World Workshop on Oral Medicine VI: Patient-reported outcome measures and oral mucosal disease: current status and future direction. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:152-60.e11. [DOI: 10.1016/j.oooo.2015.01.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/26/2014] [Accepted: 01/14/2015] [Indexed: 02/08/2023]
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Chamani G, Rad M, Zarei MR, Lotfi S, Sadeghi M, Ahmadi Z. Efficacy of tacrolimus and clobetasol in the treatment of oral lichen planus: a systematic review and meta-analysis. Int J Dermatol 2015. [DOI: 10.1111/ijd.12925] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Goli Chamani
- Orofacial Pain Clinic; Department of Oral Medicine; Dental School; Kerman Iran
| | - Maryam Rad
- Oral and Dental Diseases Research Center; Kerman University of Medical Sciences; Kerman Iran
| | - Mohammad Reza Zarei
- Orofacial Pain Clinic; Department of Oral Medicine; Dental School; Kerman Iran
| | - Sodabeh Lotfi
- Orofacial Pain Clinic; Department of Oral Medicine; Dental School; Kerman Iran
| | - Masoumeh Sadeghi
- Research Center for Modeling in Health; Kerman University of Medical Sciences; Kerman Iran
| | - Zahra Ahmadi
- Oral and Dental Diseases Research Center; Kerman University of Medical Sciences; Kerman Iran
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Dmitrieva LA, Nemeryuk DA, Gerasimova EV, Glibina NA. [Possibility of combined system enzyme therapy and antioxidants in treatment of periodontal and oral mucosa diseases]. STOMATOLOGII︠A︡ 2015; 94:69-72. [PMID: 26171550 DOI: 10.17116/stomat201594269-72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - D A Nemeryuk
- Moscow State Medical and Dental University, Moscow
| | | | - N A Glibina
- Moscow State Medical and Dental University, Moscow
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Córdova P, Rubio A, Echeverría P. Oral lichen planus: A look from diagnosis to treatment. JOURNAL OF ORAL RESEARCH 2013. [DOI: 10.17126/joralres.2014.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Liu C, Xie B, Yang Y, Lin D, Wang C, Lin M, Ge L, Zhou H. Efficacy of intralesional betamethasone for erosive oral lichen planus and evaluation of recurrence: a randomized, controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:584-90. [DOI: 10.1016/j.oooo.2013.07.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 07/21/2013] [Accepted: 07/23/2013] [Indexed: 02/06/2023]
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Manousaridis I, Manousaridis K, Peitsch WK, Schneider SW. Individualizing treatment and choice of medication in lichen planus: a step by step approach. J Dtsch Dermatol Ges 2013; 11:981-91. [PMID: 23981330 DOI: 10.1111/ddg.12141] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 04/25/2013] [Indexed: 12/19/2022]
Abstract
Although lichen planus is one of the most common dermatological entities, very few reviews on its management exist in the literature. Standard therapeutic approaches include various topical treatments (including topical corticosteroids, calcineurin inhibitors, vitamin D analogs) and phototherapy modalities, as well as systemic corticosteroids and systemic retinoids. While localized skin lesions are easily managed with standard modalities, generalized forms and in particular involvement of hair follicles, nails and mucosa, as well as eyes are often challenging. This review proposes an evidence-based and differential therapeutic regime, taking into account many new emerging systemic therapies to help clinicians optimize treatment according to the type, extent and severity of the disease. An individual therapeutic ladder has been developed for each location, starting with standard modalities and ranking alternative systemic treatments (mainly methotrexate and hydroxychloroquine, as well as cyclosporine, azathioprine and mycophenolate mofetil) according to efficacy, evidence level and side-effect profile.
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Affiliation(s)
- Ioannis Manousaridis
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kleanthis Manousaridis
- Department of Ophthalmology, LKH Feldkirch, Academic Hospital of the University of Innsbruck, Feldkirch, Austria
| | - Wiebke Katharina Peitsch
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefan Werner Schneider
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
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Patil A, Prasad S, Ashok L, Sujatha GP. Oral bullous lichen planus: Case report and review of management. Contemp Clin Dent 2013; 3:344-8. [PMID: 23293497 PMCID: PMC3532804 DOI: 10.4103/0976-237x.103634] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A 34-year-old female patient with the chief complaint of burning sensation in the oral cavity associated with generalized pruritis, scalp and skin lesions diagnosed as Bullous lichen planus and treated with systemic prednisolone, levamisole, benzydamine oral rinse. Patient is in follow up since 1 year and free of lesions. Here we report the case and review current modalities in the management of oral lichen planus.
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Affiliation(s)
- Archana Patil
- Department of Oral Medicine and Radiology, Bapuji Dental College and Hospital, Davangere, Karnataka, India
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Ni Riordain R, Meaney S, McCreary C. A patient-centered approach to developing a quality-of-life questionnaire for chronic oral mucosal diseases. ACTA ACUST UNITED AC 2011; 111:578-86, 586.e1-2. [DOI: 10.1016/j.tripleo.2010.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 12/13/2010] [Accepted: 12/18/2010] [Indexed: 12/26/2022]
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Abstract
AbstractObjective:We report an extremely rare case of laryngeal lichen planus.Method:A case report and literature review of the aetiopathogenesis, clinical features and management of laryngeal lichen planus are presented.Results:A male patient presented with hoarseness and a history suggestive of squamous cell carcinoma of the larynx. However, characteristic histopathological findings demonstrated lichen planus. The patient responded very well to oral steroids, and at the time of writing had remained symptom-free for two years.Conclusion:This is the first English language report of laryngeal lichen planus. Lichen planus is a diagnosis of exclusion and responds well to steroids. However, patients should be followed up regularly as malignant change is known to occur.
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McCaughey C, Machan M, Bennett R, Zone JJ, Hull CM. Pimecrolimus 1% cream for oral erosive lichen planus: a 6-week randomized, double-blind, vehicle-controlled study with a 6-week open-label extension to assess efficacy and safety. J Eur Acad Dermatol Venereol 2010; 25:1061-7. [PMID: 21175873 DOI: 10.1111/j.1468-3083.2010.03923.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of topical pimecrolimus 1% cream in the treatment of oral erosive lichen planus. DESIGN A 6-week randomized, double-blind, vehicle-controlled phase followed by a 6-week open-label phase. SETTING Outpatients of the Department of Dermatology, University of Utah. PATIENTS Twenty-one patients with oral erosive lichen planus were randomized and treated with either pimecrolimus 1% cream or vehicle cream. INTERVENTION Pimecrolimus 1% cream, or its vehicle, were applied twice daily for 6 weeks to each side of the mouth with a 2×2 inch gauze pad folded in half and placed directly on the erosive lesion. MAIN OUTCOME MEASURES Efficacy was based on clinical evaluation of Investigator's Global Assessment (IGA) of the overall severity of the disease, erythema, measurement of the size of any target erosion in millimetres, and assessment of spontaneous pain. Blood levels of pimecrolimus were monitored in all subjects on day 0 and repeated on day 7. RESULTS Pimecrolimus 1% cream was superior to vehicle cream in reducing mean IGA, pain, and erosion size. For the vehicle group that entered the open-label phase, pimecrolimus 1% cream improved the mean IGA, pain, erosion size, and erythema. Pimecrolimus levels were detected in nine out of 10 of the pimecrolimus-treated subjects. These levels were consistently low. The pimecrolimus cream was well-tolerated. No clinically relevant, drug-related adverse events were reported. CONCLUSION Pimecrolimus 1% cream was superior to vehicle in reducing pain, erythema, decreasing erosion size, and improving overall severity of disease when compared with vehicle treatment.
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Affiliation(s)
- C McCaughey
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
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Greater therapeutic efficacy of prednisolone plus medicinal herbs than prednisolone or medicinal herbs alone in patients with oral lichen planus. J Dent Sci 2010. [DOI: 10.1016/j.jds.2010.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Abstract
Abstract: Allergists/immunologists see patients with a variety of skin disorders. Some, such as atopic and allergic contact dermatitis, are caused by abnormal immunologic reactions, whereas others, such as seborrheic dermatitis or rosacea, lack an immunologic basis. This review summarizes a select group of dermatologic problems commonly encountered by an allergist/immunologist.
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Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies. Clin Dermatol 2010; 28:100-8. [PMID: 20082959 DOI: 10.1016/j.clindermatol.2009.03.004] [Citation(s) in RCA: 197] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lichen planus (LP) is an inflammatory disease of the stratified squamous epithelia of unknown etiology. LP affects most frequently the oral mucosa, but it may also involve other mucosa and the skin. Oral LP (OLP) most frequently affects woman aged between 30 and 60 years. Histopathologic examination typically shows orthokeratotic hyperkeratosis, basal cell degeneration, and a dense well-defined infiltrate of lymphocytes in the superficial dermis. OLP lesions may result from the induction of keratinocytes apoptosis by cytotoxic CD8+ T cells stimulated by a yet unidentified self-antigen on a genetically predisposed patient. The association of OLP with hepatitis C virus (HCV) has been more consistently demonstrated in the Mediterranean area. Although HCV RNA and HCV-specific CD4+ and CD8+ T cells have been retrieved in the mucosal lesions of patients with chronic HCV infection and OLP, the eventual pathophysiology of HCV in OLP lesions remains unclear. Available treatments of OLP are not curative, and many have potentially prominent side effects. The objectives of OLP management should be to prevent and screen for malignant transformation and alleviate symptoms on the long-term. Avoidance of potential precipitating drugs, tobacco, alcohol, and local trauma, as well as strict oral hygiene, is essential. The first-line pharmacologic treatment relies on topical steroids. Systemic steroids should be limited to the short-term cure of severe refractory OLP. Life-long clinical follow-up, at least annually, is fundamental.
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Affiliation(s)
- David Farhi
- Department of Dermatology and Venereology, Hôpital Cochin, APHP, Université Descartes - Paris 5, Pavillon Tarnier, 75006 Paris, France.
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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; 4:3-9. [PMID: 22991586 PMCID: PMC3429956 DOI: 10.5681/joddd.2010.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 02/22/2010] [Indexed: 01/16/2023] Open
Abstract
Lichen planus is a chronic inflammatory mucocutaneous disease. Mucosal lesions are classified into six clinical forms and there is malignant potential for two forms of OLP; therefore, follow-up should be considered. There are many un-established etiological factors for OLP and some different treatment modalities are based on etiology. The aims of current OLP therapy are to eliminate mucosal erythema and ulceration, alleviate symptoms and reduce the risk of oral cancer. We have used review papers, case reports, cohort studies, and case-and-control studies published from 1985 to 2010 to prepare this review of literature.
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Affiliation(s)
- Marzieh Boorghani
- Assistant Professor, Department of Oral Medicine, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
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Gonzalez-Moles MA, Scully C. HPA-suppressive effects of aqueous clobetasol propionate in the treatment of patients with oral lichen planus. J Eur Acad Dermatol Venereol 2010; 24:1055-9. [PMID: 20158585 DOI: 10.1111/j.1468-3083.2010.03591.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Oral topical corticosteroids have potential to produce inhibition of the hypothalamus-pituitary-adrenal (HPA) axis. OBJECTIVE To assess whether clobetasol propionate (CP) in aqueous solution causes HPA inhibition. PATIENTS AND METHODS Sixty-two patients with oral lichen planus or oral lichenoid lesions presenting with severe lesions were treated with topical oral 0.05% CP plus 100,000 IU/cm(3) nystatin in aqueous solution. Initial treatment of three 5-min mouthwashes (10 mL) daily was reduced, when the response was deemed complete or excellent, to a maintenance treatment of one 5-min mouthwash on alternate days for 6 months; treatment was then withdrawn and patients were followed up for 1 year. HPA function was assessed by plasma cortisol measurement and adrenocorticotropin (ACTH) stimulation at the end of the initial and maintenance treatment regimens. RESULTS The HPA axis was more frequently inhibited during initial (53/62; 85.5%) vs. maintenance (2/49; 4%) regimens of aqueous CP. LIMITATIONS In patients with morning plasma cortisol levels between 3 and 18 microg/dL, a normal result for the ACTH stimulation test only moderately reduces the possibility that a patient has secondary adrenal insufficiency. This can be considered a minor limitation in our study, as only three patients required additional assessment with the ACTH stimulation test. CONCLUSIONS Hypothalamus-pituitary-adrenal inhibition is substantial during initial treatment with aqueous CP three times daily.
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Affiliation(s)
- M A Gonzalez-Moles
- Oral Medicine Department, School of Dentistry, Granada University, Granada, Spain.
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Abstract
Steroids have been found to be effective in treating symptomatic oral lichen planus (OLP) by reducing pain and inflammation. In fact, systemic corticosteroids should be reserved for acute exacerbation, and multiple or widespread lesions. They may be indicated in patients whose condition is unresponsive to topical steroids. However, various potent topical steroids have been reported to be effective in the treatment of symptomatic OLP. They can be used as the first line drugs in the treatment of OLP with no serious side-effects. During the therapy, candidiasis was commonly found and in addition, bad taste, nausea, dry mouth, sore throat and swollen mouth may occur as minor side-effects from some topical steroids. Because OLP is a chronic disorder that requires long-term treatment, topical steroids are recommended for the treatment OLP because of minimal side-effects and the cost benefit. This manuscript reviews the use of steroids, especially its topical application, in the treatment of OLP.
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Affiliation(s)
- Kobkan Thongprasom
- Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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