The use of topical corticosteroides in the treatment of oral lichen planus in Spain: A national survey

A Decadal Bibliometric Analysis on the Therapeutic Strategies in Oral Lichen Planus

Background and Aims

Oral Lichen Planus (OLP) is a common chronic inflammatory autoimmune illness that mostly affects the oral mucosa but may also affect other mucous membrane. It has higher prevalence in female patients of fourth to sixth decade of life with reticular being the commonest clinical variant. Clinical assessment, patient history, biopsy findings, and immunofluorescence were used to diagnose OLP. This study aimed to assess research publication trends in therapeutic strategies in the treatment of OLP, examining publication growth, country and institution contributions, and collaborative networks.

Methods

Using the Dimensions and Lens.org databases with Boolean operators combined the keywords a total of 40,046 peer-reviewed international publications were initially assessed. The article was selected from 2014 to December 2023. Through rigorous application of inclusion and exclusion criteria using an advanced search, a subset of 134 papers emerged to meet the high relevance standards. This subset, constituting a representative sample, was selected for in-depth bibliometric analysis.

Results and Conclusion

The result shows a clear upward trend in the number of publications, with a notable increase in 2018. After 2018, there is decrease in the number of publications, but it has an upward trend, reaching a peak of 215 in 2022. Chaitanya Nallan CSK leads the list of authors with four publications and a respectable total citation count of 12. Cairo University is the leading institution in this data set, with the 8 number of publications and 11 citations. The analysis revealed that at the top of the list is the "Egyptian Dental Journal" from Egypt, with six publications, four citations, and a link strength of two. In the second position is "BMC Oral Health" from the United Kingdom, with five publications, one citation, and a link strength of three. This study offers valuable insights for future research, clinical practice, and policy decisions.

Hydroxychloroquine is effective in oral lichen planus: A multicenter, randomized, controlled trial

OBJECTIVES

This study was aimed to evaluate the safety and benefit of short-term application of hydroxychloroquine in the management of atrophic/erosive/ulcerative oral lichen planus (OLP).

METHODS

This multicenter, randomized, controlled, evaluator-blinded, prospective clinical trial was performed from October 1, 2019, to September 1, 2022. A total of 99 patients were randomized to receive systemic use of hydroxychloroquine (n = 50), or topical use of 0.05% dexamethasone (n = 49) for 4 weeks. The response to both treatment modalities was evaluated according to reticulation, hyperemic, and ulceration (RHU) score and visual analog scale (VAS) score.

RESULTS

After 4 weeks of medication, both groups showed substantial reduction in RHU and VAS score (p < 0.05). In hydroxychloroquine group, the average of RHU score was reduced from 10.60 to 7.68 (dropped 27.49%), and the average of VAS score was reduced from 3.74 to 2.47 (dropped 34.09%). There were no differences between the two groups in reduction of RHU score and VAS score (p > 0.05). Single factor analysis found hyperemic area (p = 0.019) and erosive/ulcerative area (p = 0.024) had impacts on drug efficacy of hydroxychloroquine, and logistic regression revealed that no factors (p > 0.05) influenced its efficacy.

CONCLUSION

These findings indicate hydroxychloroquine is a safe and effective agent in treating atrophic/erosive/ulcerative OLP.

Plant Extracts and Phytochemicals, a Promising Strategy Against Oral Lichen Planus: A Review on Clinical Trials

BACKGROUND

Oral lichen planus (OLP) is an autoimmune disease that distress keratinized cells of the oral epithelium. Topical corticosteroids and other potential therapies like immunosuppressives, hydroxychloroquine, azathioprine, mycophenolate, dapsone, retinoids, biologic agents are used for the management of OLP. However, their effectiveness, best dose, duration of treatment and safety remain mostly unidentified. Moreover, recurrence of disease and dose-related side effects are the other issues.

OBJECTIVE

The primary objective of the review is to explore the existing clinical trials for the efficacy of phytochemicals in treating OLP in comparison to corticosteroids. A comprehensive information about their mode of action is also discussed.

METHODS

We have discussed different clinical trials conducted on various phytochemicals and plant extracts/formulations like curcumin, lycopene, quercetin, glycyrrhizin, purslane, raspberry, aloe vera gel and aloe vera mouthwash for the treatment of OLP.

RESULTS

The current therapy for the management of OLP has numerous adverse effects and requires a long-term treatment. Phytochemicals can be a very good alternative in overcoming these side effects and reducing the course of treatment.

CONCLUSION

Herbal extracts and their formulations can be an effective alternative to the current therapy due to their proven therapeutic effects, reduced side effects, long-term applicability, prevention of recurrence as well as progression into cancer.

Hydroxychloroquine- A new treatment option for erosive oral lichen planus

Context

Oral Lichen planus (OLP) is a chronic, debilitating, immune-mediated disease whose management is considered a challenge in medical science.

Aims

To quantitatively evaluate the effect of administration of enteral hydroxychloroquine (HCQS) as a monotherapy for six months on the extent and severity of erosive OLP using reticular score, erythema score and ulcerative score (REU score), and to subjectively evaluate the success of HCQS as a therapeutic drug for OLP-e using Tel Aviv-San Francisco Scale, visual analogue scale (VAS) and severity of burning sensation (BURN score).

Settings and Design

Prospective clinical trial.

Methods and Material

A total of 45 subjects received 200 mg of HCQS bid for six months. REU, VAS, BURN scores and Tel Aviv-San Francisco Scale readings were taken at the beginning of the study (baseline) and three- and six-month intervals post administration of enteral HCQS. Subjects were examined for any adverse drug outcomes for one year after the cessation of enteric HCQS therapy. Data were analysed with SPSS version 25.

Results

There was a stark reduction in REU, VAS and BURN scores during the study period, with a statistically significant reduction (P < 0.05) seen at three- and six-month time intervals as compared to baseline. Further, the mean of change in R, E and U scores showed a statistically significant difference, with the highest reduction seen at baseline to six-month time interval. The Tel Aviv-San Francisco Scale showed 70%-100% remission in disease in more than 70% of subjects.

Conclusions

Enteral HCQS can be considered a viable treatment option for the enigma that is erosive OLP.

Serum 8-isoprostane levels in patients with resistant oral lichen planus before and after treatment with lycopene: a randomized clinical trial

Background

Oral lichen planus is an autoimmune disease in which topical steroids are the first line of treatment. The adverse effects of systemic corticosteroids prescribed for resistant oral lichen planus cases advocate alternative modalities. Lycopene is an antioxidant with a wide range of beneficial properties. This trial aimed to evaluate the effect of pure lycopene as compared to systemic corticosteroids (Prednisolone) on the symptoms, signs and oxidative stress in patients with erosive oral lichen planus recalcitrant to topical steroids.

Methods

Twenty patients were randomly divided into the test (lycopene) and control (corticosteroids) groups. Numeric rating scale and Escudier et al. (Br J Dermatol 4:765–770, 2007. 10.1111/j.1365-2133.2007.08106.x) lesion scores were assessed at baseline and weeks 4 and 8 from baseline. Serum levels of 8-isoprostane were measured in all patients at baseline and at the end of treatment (week 8).

Results

There was a significant reduction in signs and symptoms after the end of treatment in each group. However, no significant difference was found between the lycopene and the corticosteroids group. Moreover, a significant reduction in 8-isoprostane levels was observed in the lycopene group from baseline and as compared to the control group.

Conclusions

Based on the study results, lycopene is a safe and effective therapeutic modality for resistant oral lichen planus. 8-isoprostane is a biomarker of lipid peroxidation that can be reduced by lycopene.

Trial registration ID: PACTR202003484099670. 'Retrospectively registered on 11/3/2020'.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01711-z.

Treatment of oral lichen planus by surgical excision and acellular dermal matrix grafting: Eleven case reports and review of literature

BACKGROUND

Oral lichen planus (OLP) is a chronic inflammatory disorder, and it can affect normal oral function. The conventional treatments for OLP are not always effective, and relapse easily occurs. Therefore, treatment of OLP is difficult and challenging. In this study, we evaluated over a long period the clinical efficacy of surgical excision and acellular dermal matrix (ADM) grafting in patients with refractory OLP.

CASE SUMMARY

Eleven patients with refractory OLP underwent a standardized protocol of surgical excision and ADM grafting. The condition of the area of the grafted wound, the intraoperative maximum mouth opening, pain, and clinical healing were assessed at postoperative follow-up visits. All patients had a flat surgical area with similar mucosal tissue coverage and local scar formation. Patients had no irritation and pain in their mucous membranes when eating acidic and spicy food. All patients’ mouth openings returned to normal within 2-6 mo after surgery. During follow-up, none of the patients had recurrence of OLP after surgery. The longest follow-up was 11 yr and the shortest was 6 mo, and none of the patients relapsed during follow-up.

CONCLUSION

Surgical excision and ADM grafting could be an effective method to treat refractory OLP.