Management Of Oral Lichen Planus Research Articles

Photobiomodulation Therapy in the Management of Oral Lichen Planus: A Systematic Review and Meta-Analysis.

Photobiomodulation therapy (PBMT) is a non-invasive and the latest form of therapy used in the treatment of non oncological diseases as well as cancers of various types and locations. The aim of this study was to systematically review and assess the efficacy of PBMT in managing oral lichen planus (OLP) compared to the interventions. A systematic review and meta-analysis were implemented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search using PubMed, Scopus, and Cochrane was conducted to retrieve relevant studies published until June 2023. The outcomes evaluated included the reduction in pain score and clinical severity scores (Prospero No CRD42023428626). A total of eight studies were identified for qualitative synthesis. The pooled analysis incorporating six studies revealed that there are no significant differences for both mean pain score (mean difference [MD] = 0.21, 95% confidence interval [CI] = -0.51, 0.93) as well as clinical score (MD = -0.08, 95% CI = -0.4, 0.25) between PBMT and comparison groups. Subgroup analysis based on corticosteroids as controls showed that there was no significant difference in mean reduction in pain score between PBMT and topical steroids (MD = 0.38, 95% CI = -0.54, 1.31). PBMT is as effective as other interventions in the treatment of OLP, though not superior, and can be a promising alternative treatment for cases resistant to steroids or when steroids are contraindicated. Further studies are recommended to standardize the optimal settings for the treatment of OLP.

Evaluation of Turmeric, Ashwagandha, and Aloe Vera in the Management of Oral Lichen Planus Lesion

ABSTRACT Objectives: This study was conducted to evaluate the efficacy of turmeric, ashwagandha, and aloe vera in the management of oral lichen planus (OLP) lesion. Materials and Methods: Thirty patients with histologically confirmed symptomatic OLP with gingival presentation were included in this comparative investigation. Three groups of participants were created: Group I consisted of turmeric; group II included ashwagandha; and group III included aloe vera. For 3 weeks in a row, they were told to apply topical treatments twice a day. The patients were recalled for 4 to evaluate the cessation of symptoms. Result: The participants in all the groups showed a considerable improvement in the burning lesion size and pain after 4 months of follow-up. Conclusion: For the treatment of OLP, turmeric, ashwagandha, and aloe vera can be useful as substitute topical medications, particularly for those who are not responsive to topical corticosteroids.

Efficacy of photobiomodulation in the management of oral Lichen Planus in comparison to topical corticosteroids: Systematic review, meta-analysis, and GRADE-based assessment of certainty of evidence

BackgroundThere is an urgent need to update the evidence available on the efficacy of photobiomodulation (PBM) in comparison to topical corticosteroids in the management of Oral Lichen Planus (OLP). MethodsCochrane Oral Health's Trials Register, Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE Pubmed, SCOPUS, Lilacs and Google Scholar were searched. Other sources included US National Institutes of Health Ongoing Trials Register, World Health Organization International Clinical Trials Registry Platform and Clinical Trial Registry - India were searched using variations of the keywords “Laser” and “Oral Lichen Planus”. Randomized controlled trials comparing PBM and topical corticosteroids in the resolution of pain among OLP patients were included. The studies were assessed using the Cochrane Risk-of-Bias assessment tool. Publication bias was assessed using a funnel plot, and the certainty of evidence was evaluated according to the GRADE guidelines. ResultsTen studies were included for qualitative assessment and of these eight were included in the meta-analysis. The included studies used laser parameters of varying strengths and duration. Meta-analysis favoured PBM (n = 274, MD =-0.48, CI -0.66- -0.30) for pain score. No adverse effects were reported for laser therapy. There was high heterogeneity and moderate certainty of evidence, and most studies had a high risk of bias. ConclusionThere is improvement in the clinical parameters of OLP when treated with PBM in comparison to topical corticosteroids. However, the strength of the evidence for these findings in limited. It is recommended to conduct better long-term trials with large sample size.

Evaluation of the Function of Vitamin D in Treating Oral Lichen Planus.

The objective of the current research was to evaluate the role of vitamin D in the management of oral lichen planus. Based on their vitamin D levels, 90 individuals with oral lichen planus were equally divided into three groups. Deficient subjects received oral vitamin D supplementation. The majority of improvements were observed in patients who were taking vitamin D supplements. It was discovered that the data comparison was statistically considerable. It was determined that vitamin D was crucial for the management of oral lichen planus.

Oral Lichen Planus: An Updated Review of Etiopathogenesis, Clinical Presentation, and Management.

Lichen planus (LP) is a chronic idiopathic immune-mediated inflammatory condition. LP is a heterogeneous disease with varied clinical presentations having different natural history, prognosis, sequelae, and outcomes. It can affect skin, hair, nails, and mucosae. Mucosal LP (including oral LP) tends to be persistent and resistant to treatment, compared to cutaneous LP. Oral LP (OLP) is broadly divided into two main categories: hyperkeratotic (usually asymptomatic) and erosive (commonly symptomatic). It can present with symptoms including odynophagia, dysphagia, dysgeusia, and sensitivity to hot spicy foods. Apart from the superficial epidermal changes, which vary with the type of clinical presentation, histopathologically oral LP shows a unifying similar and consistent feature of a lichenoid interface dermatitis. Recently, researchers have highlighted the critical role played by IL-17 in the pathogenesis of OLP. World Health Organization has categorized oral LP as one of the oral potentially malignant disorders (OPMD), albeit with a low risk of malignant transformation. Also, in the last couple of years there have been various reports on the usage of newer drugs like anti-IL17, anti-IL12/23, anti-IL 23, PDE4 inhibitors, and JAK inhibitors in the management of refractory OLP. The principal aim of treatment still remains to resolve the symptoms, prolong the symptoms free period, and reduce the risk of potential malignant transformation. We have described many new revelations made in recent times regarding the etiopathogenesis, associated conditions as well as management of OLP. Thus, the objective of this review is to present a comprehensive up-to-date knowledge including the recent advances made regarding OLP.

Efficacy of Clobetasol Propionate (0.05%), Amlexanox (5%), and Triamcinolone Acetonide (0.1%) in the Treatment of Oral Lichen Planus.

This study aimed to compare the efficiencies of 0.05% clobetasol propionate, 0.1% triamcinolone acetonide, and 5% amlexanox in the management of oral lichen planus (OLP). A total of 120 patients diagnosed with oral lichen planus were equally divided into three groups and treated with 0.05% clobetasol propionate (group A), 0.1% triamcinolone acetonide (group B), and 5% amlexanox (group C) topical medicaments. The patients were evaluated for pain using the visual analog scale (VAS) and erosive lesion. There was a statistically significant decrease in the VAS pain scale score from day 1 to day 15 in all of the tested groups. There was also a reduction in the erosive area on the right and left buccal mucosa on the 15th day with all three tested drugs. Triamcinolone acetonide (0.1%) was effective in reducing the erosive lesions on buccal mucosa when compared with 0.05% clobetasol propionate and 5% amlexanox. Clobetasol propionate, triamcinolone acetonide, and amlexanox were effective in treating OLP patients.

Efficacy of Aloe Vera, Amlexanox (5%), and Triamcinolone Acetonide (0.1%) in the Management of Oral Lichen Planus.

This research assessed the efficiencies of aloe vera, 0.1% triamcinolone acetonide, and 5% amlexanox in the management of OLP. A total of 120 participants diagnosed with oral lichen planus (OLP) were equally divided into three groups and treated with: aloe vera, (Group A), 0.1% triamcinolone acetonide (Group B), and 5% amlexanox (Group C) topical medicaments. The patients were evaluated for pain, using the visual analogue scale (VAS). They were also evaluated for ulcerative lesion type and erosive area on days 1, 7, and 15 of the study. There was a statistically considerable decrease in the VAS pain scale score, reduction in the erosive area on buccal mucosa, and healing of ulcer from day 1st to 15th day with all three tested drugs. All drugs used in this study; aloe vera, triamcinolone acetonide, and amlexanox were effective in treating OLP patients.

Comparison of topical purslane & topical 0.1% triamcinolone acetonide in the management of oral lichen planus - a double blinded clinical trial

Aim and backgroundOral lichen planus (OLP) is a chronic autoimmune mucocutaneous disorder of unknown etiology and treatment is targeted at alleviating symptoms. At present, corticosteroids are the mainstay treatment, and their side effects hamper their long-term use, demanding alternative therapy. This study intended to assess the efficacy of topical purslane (Portulaca oleracea) at two concentrations, 5% and 10%, in OLP and to compare the level of clinical improvement in comparison to topical 0.1% triamcinolone acetonide gel.Materials and methodsAfter sample size determination, thirty-four subjects confirmed histopathologically with OLP were included in the study. They were divided into 3 groups, Group 1(Control) was treated with 0.1% triamcinolone acetonide, and Group 2(Case) and 3 (Case) were treated with topical purslane 5% and 10%, respectively. They were examined at baseline, 14 days, 30 days, 60 days, and 90 days. Clinical improvement was then analyzed at the end of 90 days using a visual analog scale (VAS) and Thongprasom’s criteria.ResultsThe study was analyzed statistically and a P value of < 0.05 was considered statistically significant. Intragroup comparison revealed a statistically significant difference between the five time periods (baseline, 14 days, 30 days, 60 days, and 90 days) for the study variables (burning sensation, pain, lesion score, clinical response, symptomatic response) for all three groups (p = 0.001). Alleviation of all symptoms and remission of the lesion were noted for all three groups at the end of three months.ConclusionPurslane is a magical herb with a plethora of rich nutrients, ease in accessibility and devoid of side effects. It was concluded that its preparation is beneficial and can be a safer alternative long-term drug for the management of OLP.Clinical significanceWith available literature evidence, our present study is the first of its kind to formulate a topical gel with purslane to treat symptomatic OLP. Our study had a longer follow-up of 3 months compared to other studies in the literature.

Hypertension in oral lichen planus: A systematic review and meta-analysis.

To perform a systematic review and meta-analysis in order to qualitatively and quantitatively evaluate the prevalence and magnitude of the association of hypertension in patients with oral lichen planus (OLP). MEDLINE, Embase, Scopus, and Web of Science databases were searched for studies published before May 2022, not restricted by publication language or date. The methodological quality and risk of bias of primary-level studies were critically assessed. Meta-analyses were performed, as well as meta-regression, stratified, sensitivity and small-study effects analyses, a Galbraith (radial) plot, and trial sequential analysis. Quality of evidence was evaluated using GRADE system. 104 studies, including 16,587 patients, met the inclusion criteria. The results show that patients who suffer from OLP have a high prevalence of hypertension (PP = 24.17%, 95% CI = 21.45-27.00), with a low quality of evidence. A significant association between hypertension and oral lichen planus was also reported (OR = 1.28, 95% CI = 1.01-1.63, p = 0.04), showing a moderate quality of evidence. Patients with OLP could be at an increased risk of suffering from hypertension which is probably due to multiple factors. Healthcare practitioners involved in OLP management should be aware of this comorbidity in order to apply suitable measures and make referrals if hypertension is suspected, although further research is needed.

Treatment of Oral Lichen Planus: A Systematic Review

Objective: Oral Lichen Planus (OLP) treatment or clinical management is challenging. This systematic review aims to discuss the main therapy used in the management of OLP and the efficacy of every type of treatment to improve the quality of patient life. Methodology: We discussed the publications on the clinical management of oral lichen planus on the PubMed database. Only randomized controlled trials (RCT) conducted in humans were considered. We included randomized controlled trials (RCT) published from 2005/1/1 to 2021/5/28 with symptomatic, clinically, or histologically diagnosed OLP. We compared different active treatments or between active treatment and placebo. Results: Twenty randomized controlled trials involving 931 patient samples were included in the analysis. For the short time treatment (on average 2-8 weeks) of OLP, TCI, including Tacrolimus, pimecrolimus, and Ciclosporin, were similar to TCS, including Clobetasol, triamcinolone in efficacy. Tacrolimus–Triamcinolone resulted in similar outcomes. In addition, Tacrolimus and Ciclosporin showed a statistically higher incidence of local adverse events than triamcinolone and Clobetasol. A few systemic adverse events occurred in the tacrolimus and ciclosporin groups, but they were not serious. Conclusion: Triamcinolone acetonide 0.1% should be the first drug of choice when selecting TCS, and Tacrolimus 0.1% should be the drug of choice when selecting TCI. J Bangladesh Coll Phys Surg 2023; 41: 219-233

CO2 laser vaporisation in treating oral lichen planus: A split-mouth randomised clinical trial.

This study aimed to compare the effectiveness of carbon dioxide (CO2 ) laser vaporisation versus intralesional injection of triamcinolone acetonide (TA) in the management of oral lichen planus (OLP). A randomised clinical trial with a split-mouth design was conducted on 16 patients with bilateral symptomatic OLP lesions. One side was treated with CO2 laser vaporisation, and the counterpart was treated with TA intralesional injection. The reticular-erythematous-ulcerative (REU) score, Thongprasom sign scoring (TSS), visual analogue scale (VAS) and lesion area were used to evaluate the lesions at weeks 0, 4 and 9. All participants were followed up for 9 months. Reduction in the REU, TSS scores and lesion area from baseline to the end of treatment was significantly greater in the CO2 group than in the TA group (p values were 0.001, 0.002 and 0.048 respectively). However, the reduction in VAS score did not differ between the two groups (p = 0.54). The recurrence rate was significantly higher in the TA group than in the CO2 group (75% vs. 31.1%; p = 0.016). CO2 laser vaporisation was more effective than TA intralesional injection in managing OLP and decreased recurrence rates.

Comparative Study on Efficacy of Topical Application of Triamcinolone Acetonide and Curcumin in Management of Oral Lichen Planus

Introduction: Oral lichen planus (OLP) is a chronic inflammatory and immune mediated disease that affects the mucous membranes. OLP is cell-mediated, immune damage to basal keratinocytes that are recognized as being antigenically foreign or altered. Many treatment modalities have been tried since the time immemorial, steroids being the mainstay of the treatment, with more benefits than adversities, but now-a-days alternative/ herbal medicines are used keeping in view the chronicity of disease and long term treatment required to cure it. Curcuminoids, the major constituent of turmeric, has anti-inflammatory, antioxidant and anticancer properties. Natural / herbal product has minimal adversities so this can be more helpful for patients in the upcoming time. Aim: The study was conducted to compare the efficacy of conventional topical corticosteroid, triamcinolone acetonide 0.1% with 1% curcumin gel in OLP patient and to assess reduction in burning sensation, regression of size and ulcero-erosive appearance of lesion. Materials and Methods: An intervention study was conducted on 40 patients diagnosed with OLP which were divided into two groups. Group A was provided with Ointment 0.1% triamcinolone acetonide while Group B was provided with 1% curcuma longa extracts gel for local application on the affected regions The results were analysed using Students t-test,discrete (categorical) data were summarised in number (n) and percentage (%) and compared by chi-square (χ2) test. Groups were also compared by two factor (groups and periods) repeated measure (RM) analysis of variance (ANOVA). Results: Intragroup comparison showed statistically significant reduction in burning sensation, size and extension of lesion (p&lt;0.001) as well as erythema and ulceration (p&lt;0.001) in both the groups. In inter-group comparison, Group A showed reduction in burning sensation (97.3%), size and extension of lesion (100%), reduction in erosive pattern (94.7%) and reduction in ulcerative .......

Ozone therapy, a promising adjunct modality in the management of oral lichen planus: A review

A chronic inflammatory condition of the oral mucosa with an unclear cause, oral lichen planus (OLP) affects 2% of the population. The management of OLP has been considered from a variety of therapeutic angles. It is difficult to utilize a single, set therapy approach since disease activity is changing. Due to the disease’s refractory nature, the currently available medicines are still unable to totally cure it. Because of its potent oxidizing properties and excellent antibacterial activity (against bacteria, viruses, yeasts, and protozoa), ozone therapy has attracted significant attention in the medical and dentistry fields. Studies have shown that low O3 concentrations promote cell defensive pathways without causing cell harm. Various forms of ozone such as ozonized water, gaseous ozone, and ozonized olive oil have been tried clinically to cure OLP. This paper presentation is review of all the forms of ozone therapy for the management of OLP.

Assessment of 5% Amlexanox, 0.1% Triamcinolone Acetonide and 0.03% Tacrolimus in the Management of Oral Lichen Planus.

Compare 5% amlexanox, 0.1% triamcinolone acetonide, and 0.03% tacrolimus in the management of oral lichen planus (OLP). A received 0.03% tacrolimus, group B received 0.1% triamcinolone acetonide and group C received topical 5% amlexanox. All patients were evaluated for pain on visual analog scale (VAS) and erosive area on day 1, 7, and 15. There was decrease in visual analogue score (VAS) for pain in all tested group after 15 days. There was significant decrease in erosive area in left and right buccal mucosa in all groups after 15 days for inter and intra group comparison. All the drugs used were effective in management of patients with OLP and thus it can be advised to consider these agents as alternatives.

Efficacy of Aloe Vera and Clobetasol Propionate in the Management of Oral Lichen Planus: A Randomized Parallel Clinical Trial.

Objectives: The purpose of this randomized parallel clinical trial was to assess and compare the efficacy of 97% Aloe Vera (AV) gel and 94.7% AV juice against an active control (0.05% Clobetasol Propionate) in the treatment of oral lichen planus (OLP). Materials and Methods : Age and sex matched patients with histologically proven OLP were divided into two groups. One group received 97% AV gel for topical application and 10ml 94.7% AV juice to consume twice daily. The active control group received topical 0.05% Clobetasol Propionate ointment twice daily. Treatment lasted two months followed by four months of observation. Monthly evaluation of various clinical features of OLP was done using the OLP disease scoring criteria. Burning sensation was evaluated using Visual Analog Scale (VAS). Mann Whitney-U (followed by Bonferroni adjustment) and Wilcoxon's signed-rank tests were used for intergroup and intragroup comparisons, respectively. Interclass correlation-coefficient test was applied to assess the intra-observer variation (P<0.05). Results: In total, 41 females and 19 males participated in this study. The most common site was the buccal mucosa followed by the gingivobuccal vestibule. The reticular variant was most frequently encountered. Wilcoxon's signed-rank test showed significant differences in both groups between baseline and end-of-treatment for VAS, site-score, reticular/plaque/papular score, erosive/atrophic score and OLP disease score (P<0.05). Mann-Whitney revealed significant difference between both groups in the 2nd, 3rd and 4th months (P<0.0071). Conclusion: Clobetasol Propionate is more effective for OLP management but in our study AV proved to be a safe treatment alternative for OLP management.

Review: recent trends in management of oral lichen planus

Oral lichen planus (OLP) is a chronic mucocutaneous inflammatory disease, associated with altered cell‐mediated immunological function. It has been characterised by long‐term evolution, repeated exacerbations, sometimes painful and resistant to treatment, or even all of these. OLP significantly affects quality of patient's life. There is a higher risk of malignant transformation accompanied with OLP and similar appearing oral lichenoid lesions. Current OLP therapy aims at eliminating all mucosal‐related lesions reduce symptomatology and decrease the risk of oral cancer. This review summarizes recent treatment modalities used in the management of OLP which includes corticosteroids, immunomodulatory agents, retinoids, ultraviolet irradiation and/or laser therapy, herbal remedies. In addition, focus is also given upon adopting holistic approach in such patients by emphasizing on stress management.

Expanding Patient-Centered Outcome Measures in Oral Lichen Planus Management

Expanding Patient-Centered Outcome Measures in Oral Lichen Planus Management

Single session of laser photobiomodulation for symptom management of oral lichen planus: a retrospective study

This study aimed to evaluate the effectiveness of a single session of laser photobiomodulation (PBM) with flat top handpiece in reducing painful symptoms in patients with Oral Lichen Planus (OLP). The clinical charts of 20 patients of the Dental Clinic of University of Padua (Italy) who underwent a single laser PBM to manage OLP symptomatology were retrospectively analyzed. A 980 nm diode laser and a flat top handpiece with a 1-cm2 spot area were employed to perform the PBM with a single session protocol. VAS pain scores were assessed before and after the laser PBM, the day after, and on the 7th and 30th days after the treatment. No adverse effects occurred within 30 days after treatment. The mean VAS-pain score was 3.8 (SD 2.3) before PBM; 2.6 (SD 2.0) after PBM; 1.9 (SD 2.2) on day 1; 2.0 (SD 2.3) on day 7; and 1.5 (SD 2.2) on day 30. VAS pain decreased significantly over time (p < 0.0001). A single session of laser PBM may be safe and effective in reducing pain for symptomatic OLP patients. Further investigations are required to include placebo or topical corticosteroids as comparators.

A Challenging Case of Oral Lichen Planus: A Comprehensive Review

Abstract Oral lichen planus (OLP) is a chronic mucocutaneous disorder affecting the oral mucosa. This case report presents a comprehensive assessment of a 64-year-old male patient with OLP, detailing the clinical presentation, diagnosis, and management. The patient’s chief complaint was a persistent burning sensation in the oral cavity for several months. Furthermore, he expressed the need to replace missing teeth. The patient was treated with a combination of topical corticosteroids, multivitamins, and systemic steroids, which yielded significant improvement in symptoms. This case highlights the importance of early diagnosis and effective management of Oral Lichen Planus,emphasizing the need for proper understanding and treatment of this oral condition.

The Efficacy of Topical Coconut cream Versus Topical Triamcinolone in The Management of Oral Lichen Planus

The Efficacy of Topical Coconut cream Versus Topical Triamcinolone in The Management of Oral Lichen Planus