Abstract
BackgroundPhotodynamic therapy (PDT) is a new option for oral lichen planus (OLP) management; however, there are different opinions on the efficacy of PDT for OLP. The aim of this study was to comprehensively assess the efficacy of PDT in the treatment of OLP and compare PDT with steroid therapy.MethodsA systematic review and meta-analysis were conducted to assess the curative effect of PDT. Five electronic databases were searched, PubMed, Web of Science, the Cochrane Library, Embase, and EBSCO up to 1 December, 2019. Random and fixed effects models for pooled estimates calculation were used and the Meta package of R was applied.ResultsPooled estimates revealed that, after PDT, the lesion size decreased by 1.53 cm2 (95% confidence interval (CI): 0.71–2.35) after PDT and the partial response (PR) was 0.77 (95% CI: 0.65–0.85). The visual analogue scale (VAS) score decreased by 3.82 (95% CI: 2.80–4.85) and the Thongprasom sign score decreased by 1.33 (95% CI: 0.56–2.10) after PDT. Subgroup analyses revealed that the 5-aminolevulinic acid (5-ALA) was more effective than methylene blue (MB), with a PR of 0.87 (95% CI: 0.80–0.91). The topical use of 5-ALA yielded a better response than gargling methylene blue. In terms of VAS, the diode laser showed a better clinical PR in the treatment of OLP. In terms of changes in lesion size, the efficacy of the semiconductor laser was higher than that of the diode laser. PDT had a similar efficacy to topical corticosteroids, as shown by pooled estimates of five randomised controlled trials with 139 lesions.ConclusionThis systematic review indicates that PDT is an effective treatment modality for the management of OLP. PDT is as effective as topical corticosteroid in the treatment of OLP and could be used for cases resistant to steroids or when steroids are contraindicated.
Highlights
Photodynamic therapy (PDT) is a new option for oral lichen planus (OLP) management; there are different opinions on the efficacy of PDT for OLP
The PICO questions below were applied: Population (P): patients were diagnosed as OLP; Intervention (I): patients were treated with PDT; Comparison (C): condition of patients before PDT or topical corticosteroids; Outcome (O): lesion response and lesion size of patients with OLP
After full-text screening, 16 studies were considered for qualitative assessment and 13 studies were included for quantitative synthesis [15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30]
Summary
Photodynamic therapy (PDT) is a new option for oral lichen planus (OLP) management; there are different opinions on the efficacy of PDT for OLP. The aim of this study was to comprehensively assess the efficacy of PDT in the treatment of OLP and compare PDT with steroid therapy. The most common treatment for OLP is pharmacological therapy. There is a large difference in the curative effect of the current treatments. Topical corticosteroids are usually prescribed, such as triamcinolone acetonide and dexamethasone [4]. Long-term treatment with topical corticosteroids may cause obvious side effects, such as local pigmentation, oral candidiasis, and dry mouth [5]. Some studies have claimed that patients do not respond to drug treatment and the erosion does not heal, which increases the risk of canceration [6]
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