Bacillus Calmette-Guerin polysaccharide nucleic acid extract versus triamcinolone acetonide intralesional injection in the treatment of oral lichen planus: a comparative study

Abstract

Background Oral lichen planus (OLP) is a chronic inflammatory disease of unknown etiology and pathogenesis with frequent relapses. OLP has several patterns; some are asymptomatic whereas others may affect patient’s quality of life. Corticosteroids (CS) (either topical, intralesional, or systemic) are the cornerstone in OLP treatment. Unfortunately, CS are associated with variable local and systemic adverse effects; therefore, other therapeutic modalities have been tried for OLP treatment. Among these modalities was the Bacillus Calmette-Guerin polysaccharide nucleic acid extract (BCG-PSN). Aim The aim of this study was to evaluate the efficacy, safety, and recurrence after intralesional BCG-PSN injection in comparison with intralesional triamcinolone acetonide (TA) injection in treatment of OLP. Patients and methods BCG-PSN was extracted from BCG vaccine in the Immunology Research Laboratory, Department of Microbiology and Immunology, Zagazig University. A total of 26 patients with clinically proved OLP were enrolled in the study. They were divided into two groups (group A and group B). Group A included 13 patients with OLP who were treated with two intralesional injections of TA (20 mg/ml) once weekly for 2 weeks. Group B included 13 patients with OLP who were treated with six intralesional injections of BCG-PSN, 0.5 ml every other day for 2 weeks. The responses of OLP lesions to intralesional injection of BCG-PSN and TA were evaluated based on reduction in their surface area. A semiquantitative (reticulation/erythema/ulceration) scoring system was used for monitoring the response of OLP lesions. Pain was assessed using a numerical rating scale. Results No statistically significant differences were found between the groups in the reduction of erosion areas (t=7.10, P=0.47), reticulation/erythema/ulceration scores (t=80.5, P=0.83), and numerical rating scale scores (t=80.0, P=0.81). There was no statistically significant difference between both groups regarding the response to therapy (χ2=1.87, P=0.39). Nonsignificant difference was found in the occurrence of adverse effects between the groups (P=0.500). There was nonsignificant difference in the recurrence rate (77.8 vs. 71.4%, P=0.61) between the two groups. Conclusion Intralesional BCG-PSN injection can be used as an effective alternative to intralesional TA in the treatment of OLP especially in patients resistant to or with contraindications for CS.