Interventions for treating oral lichen planus: a systematic review

Università degli Studi di Milano, Milan, Italy.
British Journal of Dermatology (Impact Factor: 3.76). 01/2012; 166(5):938-47. DOI: 10.1111/j.1365-2133.2012.10821.x
Source: PubMed

ABSTRACT Oral lichen planus (OLP) is a common chronic inflammatory disease associated with cell-mediated immunological dysfunction. Symptomatic OLP is painful and complete healing is rare. The aim of this review was to assess the evidence for the efficacy and safety of treatments for symptomatic OLP. The Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched in January 2011 to identify all randomized controlled trials (RCTs) evaluating any intervention for the treatment of symptomatic OLP. A total of 28 trials were included in this Cochrane review. There was no evidence from three RCTs that topical pimecrolimus is better than placebo in reducing pain from OLP. There was weak evidence from two RCTs that topical aloe vera may be associated with a reduction in pain compared with placebo. There was weak and unreliable evidence from two small trials, at high risk of bias, that topical ciclosporin may reduce pain and clinical signs of OLP. There was no evidence (from five trials each evaluating a different steroid and/or calcineurin inhibitor) that there is a difference between treatment with topical corticosteroids (TCSs) compared with topical calcineurin inhibitors with regard to reducing pain associated with OLP or that any specific steroid therapy is more or less effective at reducing pain. Although TCSs are considered to be the first-line treatment, we did not identify any RCTs that compared TCSs with placebo in patients with symptomatic OLP. From the 28 trials included in this systematic review, the wide range of interventions compared means there is insufficient evidence to support the superior effectiveness of any specific treatment.

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    ABSTRACT: Background Emerging evidence indicates that the interaction between glucocorticoid receptor α (GRα) and nuclear factor κB (NF-κB) is a key pathogenetic cross talk in the autoimmune and inflammatory disorders. The objective of this study was to determine the GRα expression in patients with oral lichen planus (OLP) and investigate its correlation with NF-κB in OLP. Methods We compared the expression of GRα and NF-κB in oral biopsy specimens from patients with OLP (n = 32) against normal controls (n = 12) and investigated the correlation between the expression of GRα and NF-κB in OLP. ResultsImmunohistochemistry showed that GRα mainly expressed in the cytoplasm of keratinocytes of basal and spinosum layer of OLP. Both real-time quantitative PCR and Western blots revealed that the mRNA and protein expression levels of GRα were decreased compared with normal controls (both P < 0.001). Conversely, those levels of nuclear factor-kappa B (NF-κB) were increased compared with normal controls (both P < 0.001). Importantly, a significant inverse correlation between the GRα and NF-κB was found (P < 0.05). Conclusions Our findings demonstrated that low expression of GRα in OLP correlates with activation of NF-κB, which indicates that the cross talk between GRα and NF-κB in OLP may become a new therapeutic target and represent a new approach to explore the pathogenesis of OLP.
    Journal of Oral Pathology and Medicine 02/2014; 43(8). DOI:10.1111/jop.12168 · 1.87 Impact Factor
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    ABSTRACT: Dentist is the first person who has the opportunity to detect abnormal changes in the oral cavity. As oral diseases are frequently associated with systemic diseases, this is important for the patients because early detection and correct diagnosis can save the patients' life. Many oral diseases can cause burning sensation, severe pain and difficulty in speaking, swallowing, and/or eating. These symptoms can tremendously affect the patients' general health as well as their quality-of-life. With the emerging new diseases/infections and the increase in autoimmune disease related oral lesions, achieving accurate diagnosis and effective treatment has been a challenge. Hence, knowledge in oral diagnosis and oral medicine are very important for the dental practitioners. Topical steroid such as fluocinolone acetonide was established in the Faculty of Dentistry, Chulalongkorn University since 1985. Treatment and management of Oral Lichen Planus (OLP), Oral Lichenoid Drug Reaction (OLDR), Recurrent Oral Ulceration (ROU), Glossitis, Pemphigus, Mucous Membrane Pemphigoid (MMP) and research in oral medicine have been discussed. This review presented the interesting oral diseases in Thai patients and milestone of oral medicine in Thailand.
    The Journal of the Dental Association of Thailand 01/2015; 65(1).
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    ABSTRACT: Oral lichen planus (OLP) is a relatively common chronic mucocutaneous inflammatory disease and a search for novel therapeutic options has been performed. We sought to compare the efficacy of laser phototherapy (LPT) to topical clobetasol propionate 0.05% for the treatment of atrophic and erosive OLP. Forty-two patients with atrophic/erosive OLP were randomly allocated to two groups: clobetasol group (n=21): application of topical clobetasol propionate gel (0.05%) three times a day; LPT group (n=21): application of laser irradiation using InGaAlP diode laser three times a week. Evaluations were performed once a week during treatment (Days 7, 14, 21, and 30) and in four weeks (Day 60) and eight weeks (Day 90) after treatment. At the end of treatment (Day 30), significant reductions in all variables were found in both groups. The LPT group had a higher percentage of complete lesion resolution. At follow-up periods (Days 60 and 90), the LPT group maintained the clinical pattern seen at Day 30, with no recurrence of the lesions, whereas the clobetasol group exhibited worsening for all variables analyzed. These findings suggest that the LPT proved more effective than topical clobetasol 0.05% for the treatment of OLP.
    Journal of Biomedical Optics 06/2014; 19(6):68002. DOI:10.1117/1.JBO.19.6.068002 · 2.75 Impact Factor


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May 31, 2014