Efficacy of injectable platelet-rich fibrin in the erosive oral lichen planus: a split-mouth, randomized, controlled clinical trial

Abstract Objective Our study compared the effects of injectable platelet-rich fibrin (i-PRF) with those of corticosteroids in the treatment of erosive oral lichen planus (EOLP). Methodology This split-mouth study included 24 individuals diagnosed histopathologically with bilateral EOLP. One bilateral lesion was injected with i-PRF, whereas the other was injected with methylprednisolone acetate in four sessions at 15-day intervals. Visual analog scale (VAS) for pain and satisfaction, oral health impact profile scale-14, and the lesion size were used. Results The intragroup comparisons showed a significant decrease in VAS-pain and lesion size in both the i-PRF group (from 81.88±17.74 to 13.33±18.34, and from 4.79±0.41 to 1.88±1.08, respectively) and the corticosteroid group (from 80.21±17.35 to 23.33±26.81, and from 4.71±0.46 to 2.21±1.35, respectively) in the 6th month compared to baseline (p<0.001). Moreover, VAS-satisfaction increased significantly in both the i-PRF group (from 26.67±17.8 to 85.63±16.24) and the corticosteroid group (from 28.33±17.05 to 74.38±24.11) in the 6th month compared to baseline (p<0.001). However, no significant difference in any value occurred in the intergroup comparisons. Conclusion In patients with EOLP, both methods decreased pain and lesion size similarly, and both increased satisfaction. Therefore, the use of i-PRF may be considered an option in cases refractory to topical corticosteroid therapy. Biochemical and histopathological studies are required to reveal the mechanism of i-PRF action in EOLP treatment.

Efficacy and safety of Nocardia rubra cell wall skeleton for the treatment of erosive oral lichen planus / 北京大学学报(医学版)

OBJECTIVE@#To observe the efficacy and safety of Nocardia rubra cell wall skeleton (Nr-CWS) for the treatment of erosive oral lichen planus (EOLP).@*METHODS@#Sixty patients with clinically and pathologically diagnosed EOLP were randomly divided into the experimental group and control group according to the random number. Patients in the experimental group were treated with lyophilized powder containing Nr-CWS combined with normal saline. Patients in the control group received topical placebo without Nr-CWS combined with normal saline. Changes in the EOLP lesion area and the patient's pain level were recorded at the timepoints of weeks 1, 2, and 4 after the two different treatments, respectively. The changes of the patient's REU scoring system (reticulation, erythema, ulceration), the visual analogue scale and the oral health impact score (OHIP-14) were compared between the experimental group and control group after treatment, and the safety indicators of the two groups at the initial diagnosis and after 4 weeks' treatment were also observed, respectively.@*RESULTS@#Totally, 62 patients with clinically and pathologically diagnosed EOLP were enrolled, 2 of whom were lost to the follow-up, with 31 in the experimental group, and 29 in the control group. The mean age of the experimental group and control group were (52.9±12.4) years and (54.07±12.40) years, respectively. There was no significant difference in the oral periodontal index between the experimental group and control group. In the experimental group, the erosive area of oral lichen planus was significantly reduced 1, 2, and 4 weeks after the Nr-CWS's treatment (P < 0.05), the reduction rate was 81.75%, the patient's pain index was also decreased (P < 0.05), and in addition, the OHIP-14 was reduced (P < 0.05). The changes of the REU scoring system, the visual analogue scale and the OHIP-14 were significantly different between the experimental group and control group after treatment. There was no significant difference in the safety index between the two groups.@*CONCLUSION@#The priliminary data show that the Nr-CWS is effective and safe to treat EOLP.

P-glycoprotein expression in oral lichen planus

Abstract: Oral lichen planus (OLP) is a stress induced inflammatory condition with malignant potency. The mdr1 (multidrug resistance) is a stress gene overexpressed in cancerous conditions and its translated form, the p-glycoprotein efflux transporter is usually overexpressed with chemotherapy, leading to chemoresistance. OLP, a lesion with carcinogenic potency, is broadly classified into the asymptomatic reticular form and the aggressive erosive form. The objective of the study was to verify the expression level of p-glycoprotein in antifungal-treated and untreated reticular OLP, in untreated erosive OLP and erosive OLP patients treated with corticosteroid. Semi-quantitative reverse transcriptase polymerase chain reaction (SQ-RTPCR) and ELISA were performed on biopsy tissue samples to evaluate the mdr1 mRNA and protein expression of p-glycoprotein, respectively. The present study shows for the first time that mdr1 mRNA as well as its translated form p-glycoprotein are overexpressed in OLP subjects compared to healthy individuals. This overexpression is significantly higher in erosive than in reticular OLP patients, further confirming that the erosive form has higher risk for multidrug resistance. A higher expression is also observed in corticosteroid-treated erosive cases than similar untreated ones. The gradation of expression is in conformity with severity of the disease.

Comparing the effects of cryotherapy with nitrous oxide gas versus topical corticosteroids in the treatment of oral lichen planus.

Background: Oral lichen planus (OLP) is a chronic inflammatory disease of the oral mucosa with treatment challenges for clinicians. Aims: The objective of this study is to compare the effects of cryotherapy as a new modality with topical corticosteroids as a conventional therapy in the treatment of OLP. Materials and Methods: Thirty patients with bilateral OLP lesions were selected. From each patient a lesion on one side was chosen randomly for a single session of cryotherapy with nitrous oxide gas and the lesion on the other side received triamcinolone acetonide 0.1% ointment in orabase. Treatment outcome was measured by means of an appearance score, pain score (visual analogue scale), and severity of lesions before treatment and after 2, 4 and 6 weeks of treatment. Statistical Analysis Used: Paired samples t‑test and Wilcoxon test. Results: In both methods of treatment sign score, pain score and severity of lesions was significantly reduced in all follow‑up sessions (P < 0.05). But the treatment outcome and relapse was not significantly different between the two treatment methods (P > 0.05). Conclusion: Cryotherapy with nitrous oxide gas is as effective as topical triamcinolone acetonide in the treatment of OLP with no systemic side effects and needs less patient compliance. It can be considered as an alternative or adjuvant therapy in OLP patients to reduce the use of treatments with adverse effects.

Lichen Planus in Four Clinical Forms.

Lichen planus is an autoimmune disorder which comes under lichenoid reactions. It is T-cell mediated cytotoxic reaction directed against antigen expressed by basal cell layer of the oral mucosa. Autoreactive T-lymphocytes may be of primary importance for the development of oral lichen planus. Lichen planus presentations in the oral cavity are in 6 forms: Reticular, papular, plaque, bullous, erythematous and ulcerative. We present a case report of 4 forms in a patient.

Oral lichen planus: a look from diagnosis to treatment / Liquen plano oral: una mirada desde el diagnóstico al tratamiento

Oral lichen planus (OLP) is a chronic mucocutaneous disease of unknown etiology. Its pathogenesis is multifactorial and it may affect the oral mucosa, skin and other mucous membranes. Diagnosis is based on clinic and histopathology; direct immunofluorescence techniques can also be of use. It affects about one to two percent of the population, mainly women between the fifth and sixth decades of life. In the mouth, the most affected area is the buccal mucosa, followed by the gums, tongue and/or palate. Its three most representative clinical forms are reticular, erythematous and erosive; evolution depends on the type it is. Lesion treatment is determined by the clinical form and, since no fully effective treatment has been found yet, it is directed towards controlling the disease. The treatment of choice involves topical or systemic corticosteroids, but other drugs may also be used. The aim of this paper is to gather current and relevant information about oral lichen planus: its pathogenesis, diagnosis, treatment and management.

El liquen plano oral (LPO) es una enfermedad crónica mucocutánea de etiología poco conocida, cuya patogénesis es multifactorial, y puede afectar a la mucosa oral, piel y otras mucosas. El diagnóstico está basado en la clínica y la histopatología. Además, técnicas como la inmunofluorescencia directa pueden contribuir al diagnóstico de la enfermedad. Afecta del 1 al 2 por ciento de la población, principalmente mujeres, entre la quinta y sexta décadas de la vida. En boca, la zona más afectada es la mucosa yugal, seguido de encías, lengua y/o paladar. Las tres formas clínicas más representativas son: reticular, eritematosa y erosiva, cuya evolución varía según el tipo. El tratamiento de las lesiones depende de la forma clínica y está dirigido hacia un control de la enfermedad, ya que en la actualidad no se conoce un tratamiento del todo efectivo. El tratamiento de elección es la utilización de corticoides, en forma tópica o sistémica, aunque otros fármacos también pueden ser utilizados para el manejo de la enfermedad. El objetivo del presente artículo es recopilar información actualizada y relevante del liquen plano oral en su etiopatogenia, diagnóstico, tratamiento y manejo de la enfermedad.

Lycopene in the management of oral lichen planus: A placebo-controlled study.

Context: Oxidative stress has been implicated in the pathogenesis of lichen planus, and a lower level of lycopene has been reported in erosive and atrophic oral lichen planus (OLP) patients. However, its efficacy in the management of OLP has not been reported. Aim: This study was designed to assess the efficacy of systemic lycopene in the management of OLP. Settings and Design: This prospective, randomized, double-blind, placebo-controlled study was done in the Oral Medicine Department of a postgraduate teaching dental hospital in India. Materials and Methods: Thirty symptomatic OLP patients, randomly divided into two groups of 15 each, were administered lycopene 8 mg/day and an identical placebo, respectively, for 8 consecutive weeks. Burning sensation using visual analogue scale and overall treatment response using Tel Aviv-San Francisco scale were recorded at every visit. The data obtained were analyzed statistically using Wilcoxon Rank test, Mann-Whitney and Fischer's Exact test. Results: A higher (84%) reduction in burning sensation was seen in lycopene than in the placebo group (67%). All 15 (100%) patients in the lycopene group showed 50% or more benefit and 11 (73.3%) patients showed 70-100% benefit, while this number was only 10 and 4 (26.7%), respectively, in the placebo group. Conclusion: Lycopene was very effective in the management of OLP, and oxidative stress may have a role in disease pathogenesis.

Líquen plano oral / Oral lichen planus

O líquen plano da mucosa oral (LPO) é afecção relativamente comum, que pode aparecer isolado ou associado ao líquen plano cutâneo, havendo, no entanto, significantes diferenças clínicoevolutivas: o LPO tende a ser crônico, recidivante e de difícil tratamento, levando a importante morbidade, principalmente em sua forma erosiva. Novas formas clínicas agressivas têm sido salientadas na literatura, como a forma gingivo-vulvar. Este artigo revisa a etiopatogenia, as formas clínicas, a diagnose diferencial e laboratorial, a prognose e o tratamento do LPO, além de mencionar, brevemente, a experiência dos autores com esta enfermidade, vivida no Ambulatório de Estomatologia da Divisão de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.

Oral lichen planus (OLP) is a relatively common mucosal disease that can present isolated or associated with cutaneous lichen planus. Contrarily to its cutaneous counterpart, though, OLP tends to be chronic, relapsing, and difficult to treat. Severe morbidity is related to erosive forms, and more aggressive presentations have been described, such as the "gingivo-vulvar syndrome". This article reviews the current knowledge about the pathogenesis, clinical picture, differential and laboratorial diagnosis, prognosis, and treatment of OLP.

Oral lichen planus: two case reports in male patients / Líquen plano oral: relato de dois casos em pacientes masculinos

Purpose: Lichen planus is a chronic systemic disease that commonly involves the mucosa of the oral cavity, most often in the absence of skin lesions. Although relatively frequent, oral lichen planus is the target of much controversy, mainly in relation to its pathogenesis and possible potential for malignancy. Thus, the objective of this paper is to report two cases of lichen planus in male patients and to discuss the main aspects of this disease in relation to etiopathogenesis and treatment. Case description: Physical and histopathological examinations were carried out to confirm the diagnosis of oral lichen planus. An elixir of dexamethasone was prescribed in the first case, and in the second case, topical 0.05% clobetasol propionate was prescribed. After fifteen days, both patients presented regression of the lesion. Conclusion: Although the occurrence of oral lichen planus is common, an accurate diagnosis is necessary so that the correct treatment can be established.

Objetivo: O líquen plano é uma doença crônica sistêmica comum que envolve a mucosa oral, na maioria das vezes na ausência de lesões em pele. Embora relativamente comum, o líquen plano oral é alvo de muita controvérsia, especialmente em relação à sua patogênese e possibilidade de uma eventual transformação maligna. Assim, o objetivo deste trabalho é relatar dois casos de líquen plano em pacientes do sexo masculino e discutir os principais aspectos dessa lesão em relação a etiopatogênese e tratamento. Descrição do caso: Exames físicos e histopatológicos foram realizados para confirmar o diagnóstico de líquen plano oral. Foi prescrito elixir de dexametasona no primeiro caso e no segundo caso, foi prescrito o uso tópico de propionato de clobetasol 0,05%. Após quinze dias, os pacientes retornaram com regressão da lesão. Conclusão: Embora a ocorrência de líquen plano oral é comum, o diagnóstico preciso é necessário para que o correto tratamento possa ser realizado.

Double-blind, crossover, placebo-controlled clinical trial with clobetasol propionate in desquamative gingivitis

The aim of this study was to evaluate the efficacy of a 0.05 percent clobetasol propionate ointment administered in trays to 22 patients with desquamative gingivitis in a double-blind, crossover, placebo-controlled trial. Patients received container number 1 and were instructed to apply the ointment 3 times a day for 2 weeks, and to reduce the application to once a day in the third week. Next, the patients were then instructed to discontinue the treatment for 2 weeks, and were then given container 2, used in the same way and for the same length of time as container 1. Regarding signs, 17 patients presented some improvement, while 5 experienced worsening with clobetasol propionate. With the placebo, 14 patients presented some improvement, and 8 patients presented worsening. For symptoms, there was complete improvement in 2 patients, partial improvement in 12, no response in 7, and worsening in 1 with clobetasol propionate. With the placebo, there was partial improvement in 8 patients, no response in 12 and worsening in 2. No statistically significant difference was found between clobetasol and placebo (p>0.05). Within the period designed to treat the gingival lesions of the patients, clobetasol propionate did not significantly outperform the placebo.

O objetivo deste estudo foi avaliar a eficácia do propionato de clobetasol a 0,05 por cento administrada com moldeiras em 22 pacientes com gengivite descamativa por meio de estudo duplo-cego, cruzado, placebo-controlado. Pacientes receberam bisnaga número 1 e foram instruídos a aplicar a pomada 3 vezes ao dia por um período de 2 semanas, e reduzir a aplicação para 1 vez ao dia na terceira semana. Os pacientes foram instruídos a suspender o tratamento por 2 semanas, e então receberam a bisnaga 2, usando-a da mesma maneira que o container 1. Com relação aos sinais, 17 pacientes apresentaram alguma melhora, enquanto 5 apresentaram piora com o propionato de clobetasol. Com o uso do placebo, 14 pacientes apresentaram alguma melhora, e 8 pacientes apresentaram piora do seu quadro clínico. Com relação aos sintomas, houve completa melhora em 2 pacientes, melhora parcial em 12, ausência de resposta em 7, e piora em 1 pacientes durante o uso do propionato de clobetasol. Com o uso do placebo, houve melhora parcial em 8 pacientes, ausência de resposta em 12 e piora dos sintomas em 2 pacientes. Não foi verificada diferença estatisticamente significante em nenhum dos parâmetros entre o uso do clobetasol e placebo; p>0,05. Baseado no protocolo utilizado neste grupo de pacientes, o propionato de clobetasol não demonstrou efetividade significante quando comparado ao placebo.

Líquen plano: a importância dos exames complementares para o seu diagnóstico e tratamento / Liquen plan: the importance of complementary exames for its diagnosis and treatment

O líquen plano é uma doença que se apresenta na forma de placa branca mucocutânea que ocorre usualmente após os 30 anos de idade e com uma maior freqüência em mucosa jugal. Sua etiologia é desconhecida, sendo ainda associadas a inúmeros fatores desencadeantes. É caracterizada por pequenas pápulas angulares planas, medindo poucos milímetros, podendo estar isoladas ou coalescer gradualmente em placas maiores, cobertas por finas escamas brilhantes. Muitas vezes o desaparecimento coincide com a melhora do estado emocional do paciente e o uso de corticóides

Oral lichen planus. Clinical aspects and management in fifty-two Brazilian patients

This study aimed to characterize the clinical profile of patients with oral lichen planus (OLP) and to evaluate the efficacy of topical, systemic and/or intralesional corticosteroids in the management of symptomatic cases. Fifty-two patients with OLP, 33 females and 19 males, aged from 17 to 75 years (mean 49.7 years) were studied. Information regarding the clinical forms, sites of involvement, patients' medical history and habits were recorded. Diagnosis of OLP was made using clinical criteria alone in 32 cases, while biopsy examination was required in the remaining 20. Symptomatic lesions were seen in 29 patients, who were treated with corticosteroid. Asymptomatic cases (23) were only clinically monitored. The forms of OLP found in this study were reticular (47), atrophic (24), erosive (21) and plaque-like (8). The buccal mucosa was the site predominantly affected. Systemic diseases were found in 17 patients (seven diabetic and ten with hypertension) but these data lacked statistical significance (p > 0.05) when compared with a control group of age and gender matched patients without any type of mucocutaneous disease. A habit of tobacco and/or alcohol use was reported by 11.5 of the patients, most of them with the reticular form of the disease. Topical corticosteroid therapy alone was effective in producing relief of symptoms in 18 of the 29 patients, although some relapses occurred after discontinuation. For lesions non-responsive to topical treatment, intralesional injection and/or short-term use of systemic corticosteroids were used

Oral lichen planus. Clinical aspects and management in fifty-two Brazilian patients

This study aimed to characterize the clinical profile of patients with oral lichen planus (OLP) and to evaluate the efficacy of topical, systemic and/or intralesional corticosteroids in the management of symptomatic cases. Fifty-two patients with OLP, 33 females and 19 males, aged from 17 to 75 years (mean 49.7 years) were studied. Information regarding the clinical forms, sites of involvement, patients' medical history and habits were recorded. Diagnosis of OLP was made using clinical criteria alone in 32 cases, while biopsy examination was required in the remaining 20. Symptomatic lesions were seen in 29 patients, who were treated with corticosteroid. Asymptomatic cases (23) were only clinically monitored. The forms of OLP found in this study were reticular (47), atrophic (24), erosive (21) and plaque-like (8). The buccal mucosa was the site predominantly affected. Systemic diseases were found in 17 patients (seven diabetic and ten with hypertension) but these data lacked statistical significance (p > 0.05) when compared with a control group of age and gender matched patients without any type of mucocutaneous disease. A habit of tobacco and/or alcohol use was reported by 11.5 of the patients, most of them with the reticular form of the disease. Topical corticosteroid therapy alone was effective in producing relief of symptoms in 18 of the 29 patients, although some relapses occurred after discontinuation. For lesions non-responsive to topical treatment, intralesional injection and/or short-term use of systemic corticosteroids were used

lichen erosif buccal: a propos de 9 cas

Erosive oral lichen planus [EOLP] is uncommon. We present nine cases of EOLP in patients aged from 39 to 77 years. The aim of our retrospective study was to determine the clinical particularities and the treatment difficulties of this disease

Actualización en liquen plano oral / Update in oral lichen planus

El liquen plano LP es un desorden inflamatorio del epitelio escamoso estratificado relativamente común. Las lesiones pueden afectar la piel y membranas mucosas. El Liquen Plano Oral LPO, usualmente, presenta una morfología y distribución característica, pudiendo mostrar una disposición confusa de patrones y formas de tal manera que otros desórdenes pueden simularlo clínicamente. El LP es probablemente de origen multifactorial, algunas veces es inducido por drogas o materiales dentales, a menudo idiopático y con una inmunopatogénesis que involucra a las células T en particular. La etiopatogénesis parece ser compleja con interaccioes entre factores genéticos, ambientales y de estilo de vida, aunque en la actualidad se han aclarado varios aspectros acerca de los mecanismos involucrados y han surgido nuevas asociaciones interesantes con otras enfermedades. El manejo del LP aún no es satisfactorio, pues hasta ahora no existe un tratamiento definitivo y aunque no hay método curativo disponible, la inmunomodulación puede controlar la condición. Clásicamente se ha considerado como una entidad premaligna, pero estudios recientes sugieren que existe una condición conocida como displasia liquenoide que requiere diagnóstico diferencial con el LP. Se precisa más investigación en los aspectos genéticos, ambientales, potencial maligno, asociación con otros desórdenes y más estudios clínicos acerca de su terapia