Role of intralesional platelet-rich plasma (PRP) therapy in the treatment of recalcitrant oral ulcers of pemphigus vulgaris

Abstract

Pemphigus Vulgaris is a chronic, autoimmune vesiculobullous disorder in which 80-90% of patients develop oral lesions and in 60% of cases, oral lesions are the first sign. The platelet-rich concentrate present in autologous platelet-rich plasma (PRP) therapy has a high concentration of growth factors that promote the synthesis of collagen and extracellular matrix. The wound healing property of PRP can be used to treat recalcitrant oral ulcers of pemphigus as it accelerates the healing process, prevents the patients from side effects of steroids, and reduces the pain and discomfort of the patients. To assess the role of intralesional Platelet Rich Plasma (PRP) therapy in the treatment of recalcitrant oral ulcers of pemphigus vulgaris. A total of 15 histo-pathologically proven cases of Pemphigus Vulgaris under treatment, in whom the skin lesions had healed up to 90% but the oral ulcers were still persistent were included in the study. The severity of the ulcers were monitored by calculating the POLIS (Pemphigus Oral Lesion Intensity Score). Autologous intralesional PRP was administered in 3 sittings 7 days apart and the result was evaluated by change in POLIS score after each sitting. The data was analyzed using SPSS IBM version 26.0. Out of the total cases, 12 patients were female and 3 were male. Intralesional PRP was found to accelerate the healing of recalcitrant oral erosions. It was found that POLIS was reduced after every PRP session. The paired t-test was conducted to compare the mean scores of POLIS-0 and POLIS-3. The result indicates a significant difference between the pre-intervention mean score POLIS-0 (M=19, SD=3.25) and post-intervention mean score POLIS-3 (M=6.6, SD=2.97), t(14)=13.33,p<0.001. Intralesional PRP has been found to improve the recalcitrant oral ulcers of pemphigus vulgaris. Hence, it can be a treatment option where oral and topical corticosteroids fail to respond or are contraindicated.