Clinical features and management of oral lichen planus (OLP) with emphasis on the management of hepatitis C virus (HCV)-related OLP.

Alexandru Mester,Dragos Apostu,Radu Septimiu Campian,Lidia Ciobanu,Aranka Ilea,Ondine Lucaciu

doi:10.17305/bjbms.2018.3133

Abstract

Oral lichen planus (OLP) is a chronic inflammatory disease characterized by the occurrence of multiple, symmetrical lesions in the oral cavity. Hepatitis C virus (HCV) infection has been suggested as an etiological factor in OLP. The purpose of this review was to summarize the current literature regarding the treatment of OLP in patients with HCV infection. An electronic search of the PubMed database was conducted until January 2018, using the following keywords: OLP, HCV, corticosteroids, retinoids, immunomodulatory agents, surgical interventions, photochemotherapy, laser therapy, interferon, ribavirin, and direct-acting antivirals. We selected the articles focusing on the clinical features and treatment management of OLP in patients with/without HCV infection. Topical corticosteroids are considered the first-line treatment in OLP. Calcineurin inhibitors or retinoids can be beneficial for recalcitrant OLP lesions. Systemic therapy should be used in the case of extensive and refractory lesions that involve extraoral sites. Surgical intervention is recommended for isolated lesions. In patients with HCV, monotherapy with interferon (IFN)-α may either improve, aggravate or trigger OLP lesions, while combined IFN-α and ribavirin therapy does not significantly influence the progression of lesions. Direct-acting antiviral (DAA) therapy appears to be a promising approach in patients with HCV-related OLP, as it can improve symptoms of both liver disease and OLP, with fewer side effects. Nevertheless, for clinical utility of DAAs in OLP patients, further studies with larger sample sizes, adequate treatment duration, and long term follow-up are required.

Highlights

Lichen planus (LP) is a chronic, inflammatory, mucocutaneous disease that affects 1–2% of the general population
An electronic search of the PubMed database was conducted until January 2018, using the following keywords: oral LP (OLP), Hepatitis C virus (HCV), corticosteroids, retinoids, immunomodulatory agents, surgical interventions, photochemotherapy, laser therapy, interferon, ribavirin, and direct-acting antivirals
HCV replication was demonstrated in epithelial LP lesions from buccal mucosa by reverse transcription polymerase chain reaction (RT-PCR) or in situ hybridization, and the presence of HCV-specific CD4+ and cluster of differentiation 8 (CD8)+ lymphocytes was shown in the sub-epithelial band

Summary

INTRODUCTION

Lichen planus (LP) is a chronic, inflammatory, mucocutaneous disease that affects 1–2% of the general population. HCV replication was demonstrated in epithelial LP lesions from buccal mucosa by reverse transcription polymerase chain reaction (RT-PCR) or in situ hybridization, and the presence of HCV-specific CD4+ and CD8+ lymphocytes was shown in the sub-epithelial band Both findings suggest that HCV-specific T lymphocytes may play a role in OLP pathogenesis, where the characteristic band-like lymphocytic infiltrates are directed toward HCV-infected cells. Pimecrolimus topical cream has been successfully used for the treatment of erosive OLP lesions and seems to have a similar effect as triamcinolone acetonide [12,38,39] Topical retinoids such as tretinoin, isotretinoin or fenretinide, have been reported to cause temporary reversal of white striae in OLP [12]. OLP lesions neither disappeared nor improved in patients with negative HCV RNA results following therapy, suggesting that HCV was likely not the main causative agent of OLP. OLP: Oral lichen planus; HCV: Hepatitis C virus; IFN‐α: Interferon alpha; SVR: Sustained virologic response; DAA: Direct‐acting antivirals

Systemic steroids No OLP resolution from topical steroids

Findings

CONCLUSION