Case Report: Recalcitrant oral lichen planus involving bilaterally buccal mucosae treated with a combination of photodynamic and photobiomodulation therapies.

Background: Managing recalcitrant oral lichen planus (OLP) can be challenging. Laser therapy has been suggested as an alternative to corticosteroids for treatment. Photodynamic therapy (PDT) is a non-invasive technique that enables the removal of lesions without surgery. Photobiomodulation therapy (PBMT) can promote healing and recovery of the lesions. Case presentation: The objective was to treat unresponsive bilateral OLP of the whole buccal mucosae with a combination of PDT and PBMT. Results: A 43-year-old Thai male presented with the severe painful reticular type of OLP of bilateral buccal mucosae involving upper and lower vestibular areas. The lesions were not remitted with either prednisolone systemic steroids or fluocinolone topical corticosteroids. After undergoing ten sessions of PDT with 10% 5-Aminolevulinic acid (5-ALA) in the form of thermoplastic gel and a 635 nm diode laser at 100 to 400 mW with an energy density of 20 to 30 J/cm 2 in continuous wave mode, combined with five interim-sessions of PBMT using a 635 nm diode laser at 200 to 300 mW with an energy density of 6 to 10 J/cm 2 in continuous wave, the patient reported relief of burning sensation beside remission of lesions without any complications. Conclusion: The wide-spreading recalcitrant OLP with burning sensation can be managed by combining PDT and PBMT.

Efficacy and safety of two artificial saliva-based polymers containing 0.1% pilocarpine for treatment of xerostomia: A randomized clinical pilot trial.

BACKGROUND: Topical agents are the mainstay in the treatment of xerostomia, a common complaint most frequently associated with salivary dysfunction. This study aimed to compared the efficacy and safety for xerostomia treatment of 2 artificial saliva preparations containing 0.1% pilocarpine, and, either sodium carboxymethylcellulose (SCMC), or, sodium polyacrylate (SPA). MATERIAL AND METHODS: Thirty-one xerostomia patients were randomly allocated into either a SCMC-treated group (15 patients), or, a SPA-treated group (16 patients). The formulations were taken 0.5 ml, 4 times daily for 6 weeks and double-blinded assessed before and after treatments using Xerostomia Inventory (XI) and Clinical Oral Dryness Score (CODs). Unstimulated and stimulated whole salivary flow rates were measured. RESULTS: After treatment, the SCMC-treated group had significantly lower CODs and higher unstimulated and stimulated whole salivary flow rates (p<0.001, p=0.035, and p=0.013, respectively), while the SPA-treated group showed significantly lower CODs only (p=0.004). In contrast, SCMC-treated and SPA-treated groups at the 6th week after treatments showed non-significant differences in all assessments (p>0.05, all). Some adverse events (AEs) were reported, e.g., burning tongue, dizziness and watery eyes, but no severe AEs. CONCLUSIONS: This randomized controlled pilot trial demonstrated superior efficacy of SCMC-formula over a SPA-formula after 6 weeks of xerostomia treatment. These formulations with topical pilocarpine proved safe in clinical use with minimal reported AE. Key words:Xerostomia, artificial saliva, sodium carboxymethylcellulose, sodium polyacrylate, pilocarpine.

Expression of IFN-gamma before and after treatment of oral lichen planus with 0.1% fluocinolone acetonide in orabase.

BACKGROUND: Oral lichen planus (OLP) is a common chronic inflammatory mucosal disease in which T-cell-mediated immune responses are implicated in the pathogenesis. The purpose of this study was to investigate the effect of 0.1% fluocinolone acetonide in orabase (FAO) on the in situ expression of IFN-gamma in patients with OLP. METHODS: Twenty OLP patients were enrolled in this study. Biopsy specimens and serum samples were obtained before and 1-month after the treatment with 0.1% FAO. In situ expression and serum levels of IFN-gamma were determined using immunohistochemistry and ELISA, respectively. RESULTS: The number of IFN-gamma-positive mononuclear cells in OLP lesions before the treatment was significantly higher as compared with that after the treatment. Similarly, the mean number of total mononuclear cells was clearly decreased after the treatment. However, the serum levels of IFN-gamma were not detectable. CONCLUSIONS: Our results suggest that IFN-gamma expression in OLP tissue may involve in the immunopathogenesis and the treatment with 0.1% FAO had an immunomodulating effect on the decrease of IFN-gamma.

Expression of TNF-alpha in oral lichen planus treated with fluocinolone acetonide 0.1%.

BACKGROUND: Oral lichen planus (OLP) is a common chronic inflammatory disease involving T cells-mediated immunity. Tumor necrosis factor (TNF)-alpha has been reported to be involved in the disease process. The purpose of this study was to investigate the effect of fluocinolone acetonide in orabase (FAO) 0.1% on the expression of TNF-alpha in patients with OLP. METHODS: Eighteen Thai patients with atrophic or erosive OLP were recruited. Biopsy specimens were taken before and 1 month after treatment with FAO 0.1% and sent for histopathologic examination where they were immunohistochemically stained with antibody to TNF-alpha. Twenty normal mucosa specimens were identically processed. Oral squamous cell carcinoma tissue was used as a positive control for TNF-alpha expression, whereas OLP sections without primary antibody were served as negative control. RESULTS: Sixteen of 18 cases (88.89%) of OLP exhibited positive staining for TNF-alpha. Most of the TNF-alpha was observed in the mononuclear cells. Ten cases (55.56%) of OLP demonstrated TNF-alpha expression in keratinocytes. The number of mononuclear cells positive for TNF-alpha before the treatment with FAO 0.1% in orabase was statistically higher than that after the treatment (P=0.000) and in the normal mucosa (P=0.000). Moreover, the number of mononuclear cells after treatment with FAO 0.1% in orabase was statistically lower than before the treatment (P=0.000). CONCLUSION: Our study exhibited that TNF-alpha may be associated with the immunopathogenesis of OLP in Thai patients and FAO 0.1% had an effect on the reduction of TNF-alpha expression.