Treatment of oral lichen planus: a narrative review

Abstract

Event Abstract Back to Event Treatment of oral lichen planus: a narrative review Luca Oberti1*, Federica Gabrione1, Alberta Lucchese2, Dario Di Stasio2, Francesco Carinci3 and Dorina Lauritano1 1 University of Milano-Bicocca, Department of Medicine and Surgery, Italy 2 Second University of Naples, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Italy 3 University of Ferrara, Department of Morphology, Experimental Medicine and Surgery, Italy Aim. The aim of this study was to perform a narrative review of treatment of oral lichen planus. Materials and Methods. We examined the main publications related to OLP management, identified by searching the PubMed electronic database. We used the following search items: oral lichen planus, oral lichen planus management, oral lichen planus treatment, oral lichen planus therapy, randomized trial oral lichen planus, oral lichen planus placebo, oral lichen planus steroids, oral lichen planus laser, oral lichen planus photo-dynamic therapy, oral lichen planus calcineurin inhibitors, and oral lichen planus curcumin. A total of 216 citations were considered, but only randomized controlled trials, comparing an active treatment with placebo, or between different active treatments, were included in this systematic review. We examined 25 RCTs controlled trials: 22 of these were parallel group studies, 1 was a cross-sectional study and 2 were split-mouth design studies. Furthermore, 4 were single-blind studies and 9 were double-blind studies. Only patients with symptomatic OLP were included and interventions of all types were considered (topical treatment, systemic drugs, non-pharmacological intervention). Results. The examined studies confirm that the most efficient and effective therapy in patients with symptomatic OLP is topical treatment with corticosteroids, which, nowadays, remains the first-line therapy for this type of lesion. The use of intralesional steroids, although fairly uncommon, can represent a valid alternative in cases that only partially respond to topical steroid therapy, while the use of systemic corticosteroids is only indicated in patients whose condition is unresponsive to topical first- and second-line therapies, or with a relevant involvement of oral mucosa. The use of photodynamic therapy and lasertherapy appear to be very effective in reducing the size of injuries and pain. Even the use of calcineurin inhibitors (tacrolimus and pimecrolimus) has also produced excellent results with fewer relapses. Finally, many other therapies, which have proved to be effective, have been proposed but they must be further investigated (curcuma derivatives, retinol, tocopherol and other natural substances, often used as an addition to conventional steroid therapy). Discussion. Topical steroids remain the first-line treatment for symptomatic OLP, however, many different pharmacological and non-pharmacological therapies would represent a valid alternative for its management, but, nowadays they require further investigations.