Comparative evaluation of the efficacy of Nigella sativa (75% v/v) cream and clobetasol propionate (0.05% w/w) gel in oral lichen planus-a double-blinded randomized control trial

OBJECTIVES

The a im of this study is to evaluate and compare the efficacy of Nigella sativa (75% v/v) cream and clobetasol propionate (0.05% w/w) gel for the management of oral lichen planus (OLP).

STUDY DESIGN

Sixty clinically diagnosed cases of OLP were stratified into moderate cases or severe cases based on burning sensation before getting allocated to group I receiving Nigella sativa cream and group II receiving clobetasol propionate gel, two times a day for 45 days. Patients were examined every 15 days for a change in burning sensation and size of the lesion using the numeric pain rating scale (NRS) and a standard Vernier caliper, respectively. Statistical tests including Mann-Whitney U, Wilcoxon signed-rank, Friedman's, Dunn's post hoc, unpaired t, paired t, one-way repeated measures ANOVA, and Bonferroni's post hoc were applied.

RESULTS

There was a statistically significant reduction in the burning sensation as well as the size of the lesion in both groups (P ≤ 0.05). There was an 87.8% (moderate cases) and 85.7% (severe cases) reduction in the mean NRS scores on the 45th day in group I when compared to the 96.5% (moderate cases) and 93.48% (severe cases) in group II. There was a 92.9% (moderate cases) and 90.7% (severe cases) reduction in the size of the lesion in group I when compared to the 92.6% (moderate cases) and 93.1% (severe cases) in group II.

CONCLUSION

The topical application of Nigella sativa cream was effective and comparable to clobetasol propionate 0.05% gel in the management of OLP, without any side effects. Hence, this study recommends the use of topical Nigella sativa cream therapy in the management of OLP.

CLINICAL RELEVANCE

The current mainstay of treatment for OLP is the administration of topical or systemic corticosteroids, which are known to cause side effects, demanding a search for an alternative. Nigella sativa oil cream could be a safe, promising, cost-effective, adjunctive, or alternative modality. Clinical trial registration number: CTRI/2020/07/026745 (India).

[Development and chinization of diagnostic criteria for oral lichen planus]

Oral lichen planus (OLP) is a common chronic inflammatory disease of oral mucosa. The diagnostic criteria of OLP is the cornerstone of clinical diagnosis and treatment and scientific research. However, there are various understandings of the diagnostic criteria in China. Thus several questions need to be answered, for example, how to combine the international diagnostic criteria with China's specific conditions, how to apply the criteria into clinical practice, and how to use the criteria guiding clinical work and scientific research in China. The authors of this article systematically introduced and discussed the development, content and difference of the international diagnostic criteria of OLP. We proposed "23 Princeples" for the selection of biopsy indications in OLP diagnosis based on authors' personal experiences in clinical and basic research and the actual conditions of Chinese clinicians. We also express our own views and suggestions about some other hot issues associated with OLP diagnosis.

[Effects of interleukin-35 on the balance of helper T cell 17/regulatory T cell in peripheral blood of patients with oral lichen planus]

Objective: To investigate the effects of exogenous interleukin (IL)-35 on the balance of helper T cell 17 (Th17) and regulatory T cell (Treg) in peripheral blood of patients with oral lichen planus (OLP). Methods: Totally 12 peripheral blood samples of OLP patients (OLP group, one male and 11 female, 26-68 years old; four cases of reticular OLP and eight cases of erosive OLP) were collected from patients of Department of Oral Mucosal Specialist of the Affiliated Hospital of Guizhou Medical University from October to December 2016. During the same period, thirteen normal peripheral blood samples were collected from the Physical Examination Center of the Affiliated Hospital of Guizhou Medical University (normal control group, one male and 12 female, 20-68 years old). The peripheral blood mononuclear cells (PBMC) were extracted in sterile condition and CD4+ T cells were sorted by flow cytometry (FCM). Quantitative real-time PCR (qPCR) technique was used to detect the mRNA expression levels of retinoid-related orphan nuclear γt (RORγt) and forkhead box3 (Foxp3). The CD4+ T cells were divided into experimental group and control group. The CD4+ T cells of experimental group were cultured in vitro by adding rhIL-35, and the CD4+ T cells of control group were cultured with the same volume of phosphate buffered saline (PBS). After the completion of the culture, the cells were collected. The expression levels of the same factors were detected by qPCR. Results: The expression [M(Q(25), Q(75))] of Foxp3 [0.15 (0.09, 0.30)] and RORγt mRNA [1.04 (0.45, 2.15)] in the CD4+ T cells of OLP were significantly higher than those in normal control group [0.04 (0.02, 0.06), 0.10 (0.05, 0.11)] (Z=-4.134, P<0.01; Z=-3.699, P<0.01). The ratio of ROR γt/Foxp3 mRNA in OLP group [6.22(3.67, 15.34)] was higher than that in normal control group [2.50 (1.24, 5.23)] (Z=-2.665, P=0.007). In the CD4+ T cells of OLP patients, the expression of Foxp3 mRNA in the experiment group [0.40 (0.21, 1.22)] was higher than that in the control group [0.15 (0.11, 0.26)](Z=-2.510, P=0.012), and the expression of ROR γt mRNA between two groups showed no significant difference (P>0.05). The ROR γt/Foxp3 mRNA ratio [3.44 (1.55, 8.16)] of the experiment group was lower than that in the control group [6.22 (4.43, 12.21)] (Z=-2.746, P=0.006). Conclusions: There was a Th17/Treg imbalance with predominated by Th17 cells in the peripheral blood of patients with OLP. Exogenous rhIL-35 had an immunomodulatory effect on the balance of Th17/Treg.

[Research progress of dental implant in patients with oral lichen planus]

In recent years, the range of indications for dental implants has undergone many modifications and has been widened. In the past, oral lichen planus was regarded as contraindication for the placement of implants. According to recent literature, some patients with oral lichen planus have been selected for dental implantology, indicating comparable implant survival rate to patients without oral lichen planus. Nevertheless, clinical information on this topic is still scarce and evidence-based treatment guidelines are not available. This paper reviews the research progress of dental implant in patients with oral lichen planus, discusses the benefits and risks of implant rehabilitation in this group of patients and proposes treatment recommendations based on existing studies.

[Expression and significance of interleukin-35 in lesion tissue of oral lichen planus patients]

Objective: To investigate the expression of Epstein-Barr virus-induced gene 3 (EBi3) and interleukin-12p35 (IL-12p35) in two subunits of interleukin-35 (IL-35) in oral lichen planus (OLP) lesions, and to explore the role of IL-35 played in the formation and development of OLP lesions. Methods: Totally 41 samples of OLP lesions and 15 samples of normal tissues were collected from patients of the Department of Periodontology and Oral Medicine, Affiliated Stomatological Hospital of Guizhou Medical University from October 2010 to December 2016. The expression levels of EBi3 mRNA and IL-12p35 mRNA in the samples were detected by quantitative real-time PCR (qPCR) and the distribution and expression of protein EBi3 and IL-12p35 were detected by immunohistochemistry. The potential relationship between IL-35 and clinicopathological features of OLP was analyzed. Results: The expression [M(Q(25), Q(75))] of EBi3 [3.38 (1.63, 11.25)] and IL-12p35 mRNA [6.39 (2.55, 14.30)] in OLP lesion tissues were significantly higher than those in normal control group [1.41 (0.33, 3.16), 2.47 (1.10, 5.14)] (Z=-2.806, P=0.005; Z=-2.276, P=0.023), respectively. The positive expression rates of EBi3 and IL-12p35 were 66% (27/41) and 39% (16/41), respectively, were significantly higher in OLP lesion tissues comparing with that in normal oral mucosa tissues [0%(0/15)] (P<0.05). The relative expressions of EBi3 and IL-12p35 were positively correlated (r=0.404, P=0.009). A significant correlation was found between EBi3 protein over expression and the degeneration of base cells in OLP lesions (χ(2)=9.172, P=0.010). The positive expression rate of IL-12p35 protein in erosive type lesions was higher than that in non-erosive type lesions (χ(2)=7.220, P=0.007). The positive expression rate of IL-35 protein in OLP lesions [34% (14/41)] was higher than that in normal control group (χ(2)=6.829, P=0.009). The expression rate of IL-35 in erosive type lesions (10/20) was significantly higher than that in eruption type lesions (4/21) (χ(2)=4.364, P=0.037). Conclusions: The expression of IL-35 in OLP localized lesions was up-regulated, suggesting that IL-35 might play an important role in OLP lesion formation.

[The research progress of CO(2) laser in the treatment of oral lichen planus]

Oral lichen planus (OLP) is a common oral mucosal disease. The etiology of OLP is not clear. The treatment of OLP is difficult as some of the OLP patients have little effects to the conventional mucosal treatments. In recent years, laser therapy has been adopted to treat patients with OLP. The CO(2) laser therapy has drawn much attention of doctors and scholars because of its advantages in treating the OLP. This review article mainly discusses the principle, effects and some state-of-the-art progresses in OLP treatment using CO(2) laser.