Mucoadhesive mycophenolate mofetil and injectable platelet rich fibrin in the treatment of oral lichen planus

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Abstract Background Oral Lichen Planus (OLP) is an inflammatory condition implicating T cell-mediated cytotoxicity, and involving oral mucosal surfaces. Mycophenolate mofetil (MMF) an immunosuppressive drug reversibly inhibits the proliferation of activated T cells. i-PRF contains a high concentration of growth factors (GF), cytokines, and regenerative cells that induce tissue regeneration and wound healing. Aim To evaluate the efficacy of topical application of mucoadhesive MMF and intra-lesional injection of platelet rich fibrin (i-PRF) in the treatment of symptomatic OLP. Patients and method 30 patients with symptomatic OLP were randomly assigned into three groups, each group included 10 patients. Group I: Were managed by bilateral intralesional injections with autologous i-PRF (Obtained by centrifugation of patient’s venous blood sample) weekly for 6 weeks. Group II: Were managed by topical MMF (Gel prepared by mycophenolate mofetil 2% obtained from BLD PHARM) gel twice daily for 6 weeks. Group III: Were managed by bilateral intralesional injections with triamcinolone acetonide (TA) (Epirelefan ampule ‘40 mg ⁄ 1 ml’. manufactured by: Egyptian international pharmaceutical industries co. (E.I.P.I.Co. factory2)) weekly for 6 weeks. Assessment was done clinically via calculating the changes in the lesion size, the severity of pain and burning sensation. Immunologically via measuring the amount of tumor necrosis factor-alpha (TNF-α) in saliva. Clinical parameters were recorded, at base line then every 2 weeks for 2 months, samples were collected and stored for immunologic test at baseline, 4 week and 8 week. Results For the three groups all clinical and immunological parameters showed significant improvement along the study periods. Regarding the intergroup comparison: At base line, no significant deference was observed between the three groups. The group comparison at the following measuring points of time showed that the clinical and immunological amelioration was in favor of the GI compared to the other two groups. Comparing GII and GIII the preference was in favor of GIII. Conclusion i-PRF can be considered as an effective and safe treatment remedies for OLP gives superior improvement clinically and immunologically compared to corticosteroids and MMF. Topical MMF gel can be used as treatment modality with reasonable efficacy.