Randomized trial of pimecrolimus cream versus triamcinolone acetonide paste in the treatment of oral lichen planus.

BACKGROUND: Lichen planus is a common chronic inflammatory mucocutaneous disease, affecting 0.1% to 4% of the general population. There is no published randomized active control clinical trial on pimecrolimus for the treatment of oral lichen planus (OLP). OBJECTIVE: The purpose of this study was to compare the efficacy and safety of pimecrolimus 1% cream with triamcinolone acetonide 0.1% paste in treating OLP. METHODS: In this investigator-blinded parallel-group randomized clinical trial, 40 patients were randomly assigned in two equal groups to receive either pimecrolimus 1% cream or triamcinolone acetonide 0.1% paste 4 times daily for a total of 2 months and followed up for another 2 months. The patients were assessed for painful symptoms measured by visual analog scale, the Oral Health Impact Profile score, and objective clinical score. Nonparametric tests were used to assess the main outcomes. Intention-to-treat analysis was used. RESULTS: Eighteen patients in pimecrolimus group and 17 patients in triamcinolone group finished the 4-month trial course. Both pimecrolimus and triamcinolone groups showed significant improvement in all measured efficacy end points throughout the visits. There was no significant difference between changes from baseline median values of pimecrolimus and triamcinolone groups after treatment termination in terms of visual analog scale score (-9.8 +/- 11.3 vs -8.4 +/- 18.3, P = .70), Oral Health Impact Profile score (-1.5 +/- 2.6 vs -1.6 +/- 2.1, P = .38), and clinical score (-0.7 +/- 0.6 vs -0.8 +/- 0.7, P = .86), respectively. Two patients in pimecrolimus group experienced prominent but transient burning sensation whereas none of the patients in triamcinolone group had any prominent adverse event (P = .24). LIMITATIONS: Blood levels in pimecrolimus group were not measured and carcinogenicity of pimecrolimus, especially in its long-term use for OLP, is yet to be determined. CONCLUSION: This study showed that patients with OLP may benefit from both topical pimecrolimus and triamcinolone acetonide therapy with minimal side effects. Further studies should be conducted to assess the maintenance effects and long-term safety of both drugs (Cochrane skin group identifier: CSG TrialNo. 22).

Miconazole gel compared with Zataria multiflora Boiss. gel in the treatment of denture stomatitis.

An open, randomized, controlled study with two parallel treatment groups was done to evaluate the efficacy of a miconazole 2% gel compared with Zataria multiflora 0.1% gel applied four times daily for 2 weeks, in the treatment of Candida-associated denture stomatitis. Twenty four patients were included in the study. The efficacy variables were the colony count of Candida from the palatal mucosa and the denture surface and the erythema surface of the palatal mucosa on days 0, 7, 14, 21 and 28 after commencement of therapy. Twelve patients received miconazole gel and twelve Z. multiflora gel. The erythema surface was significantly reduced by both gels. No significant difference was seen between the two groups (p < 0.05). There was a significant reduction in the colony count of the palatal mucosa in both groups (except on days 21 and 28 in the Zataria group p = 0.07 and 0.08). Miconazole treatment reduced the number of denture colonies more efficiently than Z. multiflora except for day 21 when the efficacy of both groups was similar (p = 0.17). The results indicate that Z. multiflora gel reduced the surface erythema of the palate more efficiently than miconazole gel but did not reduce the colony count of the denture surface as efficiently as miconazole.

Methylene blue-mediated photodynamic therapy: a possible alternative treatment for oral lichen planus.

BACKGROUND AND OBJECTIVES: In this study, methylene blue-mediated photodynamic therapy (MB-PDT) was used as a possible alternative method for the treatment of oral lichen planus (OLP). STUDY DESIGN/MATERIALS AND METHODS: Thirteen patients with 26 OLP lesions were enrolled in this study. Patients were instructed to gargle a 5% methylene blue solution in water for 5 minutes. Ten minutes later, irradiation was performed by laser light (lambda = 632 nm, light exposure dose = 120 J/cm(2)). Lesions were evaluated pre and post-operatively and at follow-up sessions by changes in sign and symptom (pain) scores, and size of lesions. RESULTS: Improvement in sign scores was achieved in 16 lesions. Four keratotic lesions disappeared completely. There was a statistically significant decrease in sign and symptom scores 1 week after treatment and at follow-up sessions up to 12 weeks. Average reduction in size of lesions was 44.3%. CONCLUSION: MB-PDT seems to be an effective alternative treatment for control of OLP. In our opinion, this preliminary result warrant further studies in order to show the efficacy of MB-PDT in control of OLP for a longer period of time.