Symptoms Of Oral Lichen Planus Research Articles

Clinical Improvement and P63-Deficiency Correction in OLP Patients After Photobiomodulation.

Background: Oral lichen planus (OLP) is a chronic inflammatory disease associated with the formation of symptomatic lesions in the mouth. P63 is essential for epidermal development and regeneration. Weak expression of this protein has been shown in OLP lesions. Photobiomodulation (PBM) therapy has been reported to reduce OLP symptoms, but its ability to correct the molecular perturbations of the disease has not been studied. This study aimed to evaluate the efficacy of PBM in OLP treatment by evaluating changes in p63 expression and their association with clinical response. Methods: Twenty OLP patients underwent PBM with a diode laser (810 nm), (0.50 W, 30 s, 1.2 J/cm2), 3 times weekly for a month. The treatment efficacy index (EI) was calculated based on pain-level values and clinical scores of lesions before and after therapy. Biopsies were taken before and after therapy, analyzed immunohistochemically for p63 expression, and compared with 10 healthy controls. Results: P63 levels in OLP lesions were significantly lower than those in normal oral mucosa. After treatment, the pain level and clinical scores of the lesions decreased significantly. The calculated EI showed PBM effectiveness in 90% of cases. Increased p63 positivity and staining intensity were observed after therapy. Conclusions: The established p63 deficiency in OLP lesions is likely an important molecular mechanism in the pathogenesis of the disease. Laser irradiation at 810 nm increased p63 expression to a level close to that found in the healthy epithelium and significantly improved the symptoms and clinical signs of OLP. All of this determines the effectiveness of PBM therapy in the management of OLP.

Impact of Topical Fluocinonide on Oral Lichen Planus Evolution: Randomized Controlled Clinical Trial.

To examine the impact of fluocinonide 0.05% gel formulation for the topical treatment of oral lichen planus (OLP). Through an RCT design, 47 patients with OLP were randomly allocated for topical OLP treatment with fluocinonide 0.05% (n = 23) or placebo (n = 24). Patients were examined for OLP symptoms, signs, disease severity, and extension score changes over 6-month follow-up. After 6 months, in comparison with placebo, patients treated with fluocinonide experienced a significant reduction of OLP symptoms (p = 0.024), signs (p = 0.014), and OLP extension score (p = 0.028). The two-way ANOVA estimation models revealed that treatment with fluocinonide determined, at 6 months, a positive significant effect on the reduced OLP signs (p = 0.017), OLP symptoms (p = 0.026), and OLP extension score (p = 0.028). The multivariate regression analysis highlighted that anxiety, stress, and depression were significant predictors of every analyzed OLP outcome (p < 0.05 for each parameter) and that patients who had baseline anxiety, depression, and stress gained more benefits from fluocinonide at 6-month follow-up. Topical fluocinonide 0.05% was more efficacious compared to placebo in reducing OLP outcomes at 6-month follow-up. Anxiety, depression, and stress were significant predictors of OLP outcomes and positively impacted the treatment with fluocinonide at 6 months.

The relationship between clinical symptoms of oral lichen planus and quality of life related to oral health

IntroductionOral Lichen Planus (OLP) is a chronic and relatively common mucocutaneous disease that often affects the oral mucosa. Although, OLP is generally not life-threatening, its consequences can significantly impact the quality of life in physical, psychological, and social aspects. Therefore, the aim of this research is to investigate the relationship between clinical symptoms of OLP and oral health-related quality of life in patients using the OHIP-14 (Oral Health Impact Profile-14) questionnaire.Materials and methodsThis descriptive-analytical study has a cross-sectional design, with case–control comparison. In this study, 56 individuals were examined as cases, and 68 individuals were included as controls. After recording demographic characteristics and clinical features by reviewing patients' records, the OHIP-14 questionnaire including clinical severity of lesions assessed using the Thongprasom scoring system, and pain assessed by the Visual Analog Scale (VAS) were completed. The ADD (Additive) and SC (Simple Count) methods were used for scoring, and data analysis was performed using the T-test, Mann–Whitney U test, Chi-Square, Spearman's Correlation Coefficient, and SPSS 24.ResultsNearly all patients (50 individuals, 89.3%) reported having pain, although the average pain intensity was mostly mild. This disease has affected the quality of life in 82% of the patients (46 individuals). The patient group, in comparison to the control group, significantly expressed a lower quality of life in terms of functional limitations and physical disability. There was a statistically significant positive correlation between clinical symptoms of OLP, gender, location (palate), and clinical presentation type (erosive, reticular, and bullous) of OLP lesions with OHIP-14 scores, although the number or bilaterality of lesions and patient age did not have any significant correlation with pain or OHIP scores.ConclusionIt appears that certain aspects of oral health-related quality of life decrease in patients with OLP, and that of the OLP patient group is significantly lower in terms of functional limitations and physical disability compared to the control group. Additionally, there was a significant correlation between clinical symptoms of OLP and pain as well as OHIP scores.

The efficacy of Punica granatum extract gel in the treatment of symptomatic oral lichen planus in an Indian population: A clinical study.

The autoimmune disorder, oral lichen planus (OLP), primarily affects oral mucous membranes. Current drug treatments are only palliative and have serious side effects. Pomegranate has been used as a potential herbal remedy for the treatment of OLP. The study consisted of a sample size of 30 individuals who were diagnosed with symptomatic OLP based on both clinical and histological evidence and were equally assigned to Group A (4% topical Punica granatum seed extract gel, which has been customized for this particular study purpose only) and Group B (0.1% topical steroid). All patients were evaluated for the outcome criteria of pain, burning sensation, and lesion size. In the present study, results were highly statistically significant (P = 0.001) in intragroup observation for both Group A and Group B from baseline to the end of 30 days of follow-up for all three parameters. There was no statistically significant difference between groups for each week of follow-up. P. granatum has been used in very few studies, but this is one of the few where a gel made from P. granatum seed extract is used as an oral gel. In conclusion, it can be said that topical P. granatum extract gel is as good as topical corticosteroids at getting rid of the signs and symptoms of OLP, so it can be used as an alternative treatment.

Analysis of oral lichen planus severity on micro-RNA linked with malignant transformation risks.

The present study evaluated the oral tissue expression of micro-RNA (miRNAs) linked to the potential malignant evolution of oral lichen planus (OLP). Furthermore, the correlation between OLP severity and miRNAs expression was assessed, and possible predictors of miRNAs in OLP patients were identified. The present study enrolled 41 patients with OLP (median age 58 years) and 42 healthy controls (median age 59 years). In each patient, miRNA levels (miR-7a-3p,-7a2-3p,-7a-5p,-21-3p,-21-5p,-100-3p,-100-5p,-125b-2-3p,-125b-5p,-200b-3p,-200b-5p) were assessed and analyzed through reverse transcription polymerase chain reaction. Clinical parameters and the eventual presence of OLP symptoms, signs, and disease severity scores in each patient were reported using an anamnestic questionnaire. In comparison with healthy controls, OLP patients showed significantly higher miR-7a-3p,-7a-2-3p,-21-3p, miR-21-5p and miR-100-5p levels (p < 0.05) and significantly lower miR-125b-2-3p,-125b-5p,-200b-3p, and -200b-5p levels (p < 0.05). Furthermore, OLP symptoms and signs and disease severity scores were significantly correlated and were also predictors of all analyzed miRNAs (p < 0.05). In comparison with healthy subjects, OLP patients exhibited unbalanced oral miRNAs expression linked to the risk of potential malignant evolution of OLP. Furthermore, some miRNAs were correlated with OLP extent and were significant predictors of OLP symptoms, signs, and disease severity scores.

Comparing the Effectiveness of Low-Level Laser Therapy and Topical Steroid Therapy Combination Regimen With Routine Topical Steroid Therapy in the Management of Oral Lichen Planus Symptomatic Patients.

For symptomatic oral lichen planus (OLP), a wide range of therapeutic approaches have been suggested. To minimize discomfort and symptoms among individuals with symptomatic OLP, extensive therapy is frequently needed. Therefore, finding a new therapeutic approach that may effectively manage OLP's symptoms and signs while having few adverse effects continues to be a difficult task. Recently, low-level laser therapy (LLLT) has become a popular alternative therapy option for OLP with no serious side effects. The present research was designed to compare the effectiveness of a combination regimen of LLLT in addition to topical steroids with routine topical steroid therapy separately in order to manage patients with bothersome OLP with an extended period of follow-up. In our trial, 60 patients were chosen and given sequential numbers as they signed up to take part. The participants were divided randomly into two categories: category A (LLLT plus topical steroids) and category B (only topical steroids). The data were entered into the aforementioned prepared case template after receiving informed consent. The aforementioned prepared case template included the following criteria for evaluating the result of the treatment: pain, recurrence, burning sensation, clinical remission, and size of the lesion. Applying the visual analog scale (VAS), pain, as well as burning sensations, were assessed in both categories. With the aid of the Electronic Digital Vernier Caliper (Mitutoyo, China), these individuals were assessed for the dimension of the lesion. The pain score on day 21 of intervention in category A was 2.5, while it was 4.63 in category B. The difference in findings was significant statistically at day 21 (p = 0.0032). The pain score on day 28 of intervention in category A was 1.3, while it was 3.0 in category B. The difference in findings was significant statistically at day 28 (p = 0.003). The pain score was greater in the control category as compared to the intervention category. The burning sensation score on day 21 of intervention in category A was 2.5, while it was 4.5 in category B. The difference in findings was significant statistically (p = 0.0024). The burning sensation score at the follow-up phase on day 45 of intervention in category A was 1.1, while it was 3.4 in category B. The difference in findings was significant statistically (p = 0.002). Newer therapeutic techniques are becoming accessible to oral specialists for controlling oral mucosal disorders as a result of evolving dental trends. The gold standard for treating people with symptomatic OLP continues to be topical corticosteroids. The therapeutic advantages of topical corticosteroids, however, are considerably outweighed by their complementary effect when paired with newer treatment methods like LLLT.

Effectiveness of photodynamic therapy (PDT) in the management of symptomatic oral lichen planus -A systematic review.

Oral Lichen Planus (OLP) is a chronic mucocutaneous inflammatory disease of unknown aetiology characterized by T cell mediated autoimmune response which trigger apoptosis of basal cells of an oral epithelium. Corticosteroids are the primary therapeutic option for symptomatic OLP however treatment of lesions unresponsive to corticosteroids that tend to recur are becoming challenging for the clinicians. Currently photodynamic therapy (PDT) is being explored as a new curative option for reduction of pain and/or burning sensation associated with OLP lesions. The aim of this systematic review was to analyse studies from literature on the therapeutic effectiveness of PDT in management of symptomatic OLP unresponsive to corticosteroid therapy. The electronic retrieval systems and databases PUBMED [MEDLINE], EMBASE, SCOPUS, WEB OF SCIENCE, GOOGLE SCHOLAR, and SCIENCE DIRECT were searched independently by two authors for relevant articles from January 2015 till July 2021. Primary studies focussed on the role of PDT in treatment of symptomatic OLP and published in English were included. Out of the 370 articles, only ten studies met the selection criteria. Included studies demonstrated PDT as an effective alternative modality to treat symptomatic OLP with no drop outs. In all studies, with PDT reduction in lesion size and VAS score was observed during each follow up sessions and after treatment (approx. 12 weeks) when compared to pre-treatment level (p<0.001). Four studies noted PDT to be more effective than topical corticosteroids in reduction of signs and symptoms of OLP (p=0.001). In the future, long-term studies on larger population should be conducted to establish the clinical effectiveness in PDT in symptomatic OLP. Studies should take into consideration different sources of light and photosensitizers to determine the ideal parameters of PDT treatment for OLP. Wavelength is the most important factor in all types of photo therapies, so the most appropriate wavelength should be selected to obtain better outcome.

Oral lichen planus clinician reported outcome measure: Development, content validity, and further development.

To establish and test a clinician-reported outcome measure of oral lichen planus (OLP): OLP Investigator global assessment (IGA). OLP IGA scale was tested with retrospective data from clinical practice and a phase II clinical trial. A comparison of the OLP IGA score with patient-reported outcomes was completed. Clinical Practice: The mean (SD) OLP IGA score (0-4) in 107 OLP patients was 1.8 (1.0) with correlation of 0.25-0.48 (p value 0.01 - <0.0001) with symptom scores. There was a significant increase in OLP symptoms based on OLP IGA score. The mean (SD) OLP IGA score in 137 research participants was 2.5 (1.2) with correlation of 0.43-0.52 (all p values <0.0001) with symptoms scores. There was a significant increase in OLP symptoms based on OLP IGA score. Forty-seven (35%) participants in the phase 2 study had an improvement in the OLP IGA score of ≥2. There were significant improvements in all symptoms scores in relation to the change in IGA score. The OLP IGA is designed to assess changes in symptomatic OLP lesions and is appropriate for use across the full range of symptomatic OLP severity and represents a scale with utility in clinical practice and clinical trials.

Vitamin D in the Treatment of Oral Lichen Planus: A Systematic Review.

Oral lichen planus (OLP) is a chronic mucocutaneous condition that affects up to 2% of the general population, and typically presents with long-standing, non-responsive lesions, with episodes of exacerbation and remissions. The etiopathogenesis of OLP is still unclear, although, it has been postulated that it is most likely a T-cell-mediated condition of an unknown antigen. The treatment remains a challenge with no defined treatment strategy. Vitamin D has anti-inflammatory and immunomodulatory properties, along with its regulatory effect on keratinocyte proliferation and differentiation; thus, suggesting its possible role in the treatment of OLP. This systematic review aims to evaluate the therapeutic role of vitamin D in OLP treatment. We searched PubMed/MEDLINE, and Google scholar search engines for studies evaluating vitamin D as a treatment modality in OLP from January 2000 to August 2022. Articles were searched with the combination of Medical Subject Heading (MeSH) terms. A web platform for visualizing risk-of-bias assessment was used in this review, and descriptive statistics were calculated. Out of the seventeen retrieved studies, five articles meeting the inclusion criteria were considered in this systematic review. All the included studies demonstrated significant amelioration in the OLP symptoms in patients who were given vitamin D supplements as an adjuvant to the conventional steroid therapy and or placebo. This systematic review signifies the role of vitamin D as adjuvant therapy for OLP. However, more studies with larger sample size are required to validate these results.

Serum vitamin D level in healthy individuals versus patients with symptomatic and asymptomatic oral lichen planus.

The aetiology of oral lichen planus (OLP) is multifactorial, having variable triggers. A role for vitamin D related to the immune system has been established. Vitamin D modulating effect is on the adaptive and innate immune responses. Our study aimed to compare serum levels of vitamin D in patients having different clinical symptoms of OLP (symptomatic or asymptomatic) with healthy individuals. Also, in this study, for further evaluation, the expression level of interleukin-17A and interleukin-6 (IL-17A and IL-6) was evaluated because the presence of active vitamin D reduces the expression of these pro-inflammatory factors.This study was included three groups with 30 volunteers in each. The first group included asymptomatic oral lichen planus patients (reticular or plaque-like lesions). The second group consisted of symptomatic oral lichen planus patients (atrophic or bullous-erosive lesions). In contrast, the third group consisted of healthy control subjects. The serum 25-hydroxyvitamin D was measured between the three groups and then correlated with clinical manifestation of oral lichen planus, either symptomatic or non-symptomatic. The Real-Time PCR technique was used to evaluate the expression of IL-17A and IL-6. Patients with symptomatic OLP (second group) had statistically significantly lower Vitamin D levels than asymptomatic OLP patients (first group). Healthy Controls (third group) exhibited statistically significantly higher vitamin D levels than OLP groups. The results of IL-17A and IL-6 genes expression showed that the presence of vitamin D had a statistically significant effect on reducing the expression of these two pro-inflammatory cytokines among symptomatic and asymptomatic OLP patients. Also, the results showed that there was a statistically significant difference between OLP patients (group I and II) and the control group (group III). In general, the current study results showed that lack of vitamin D had an important role in initiating or increasing the OLP's severity.

Is oral lichen planus a potential malignant disorder?: A critical appraisal.

Dear Editor, “The difficulty lies not in new ideas, but in escaping old ones” - John Keynes Oral lichen planus (OLP) is a chronic inflammatory oral mucosal disease of unknown etiology.[1] One of the most controversial aspects of OLP is its potentially malignant nature.[2] Numerous studies on OLP have reported varying malignant transformation rates of OLP from very high to almost negligible giving rise to conflicting findings.[23] Recent studies have reported malignant transformation of OLP ranging between 0.44 and 2.28%.[456] In this letter, we would like to put forth our views regarding the malignant transformation of OLP and its inclusion in oral potential malignant disorders (OPMDs). GLOBOCAN in 2018 reported the estimated average age-standardized rate of oral cancers worldwide as 4 per 100 000 (range between 0.4 and 20.4 per 100 000). So, based on the estimated worldwide prevalence of OLP, 5–20 OLP patients per 100 000 of the general population will develop oral cancer within 5 years. On comparing the global cancer prevalence rate with OLP, it shows that most oral squamous cell carcinoma (OSCC) cases have apparently developed from OLP, which seems questionable.[7] In most of the systematic reviews and meta-analyses, after application of strict criteria to the clinical appearance of the affected site and transformed location, histopathological presentation, habits, comorbid conditions, age, and gender, it is evidenced that the malignant transformation rate of OLP is exaggerated due to insufficient diagnostic criteria, inaccurate follow-up and/or average quality of investigation.[8] The diagnosis of OLP requires the presence of both clinical and histopathological features.[9] Unfortunately, many times diagnosis is solely based on clinical judgement without biopsy. It is quite possible that OSCC may clinically present as OLP and the clinician may institute topical/systemic steroid therapy without histopathological examination. Subsequent biopsy of those unresponsive lesions turns out to be OSCC, resulting in an inadvertent increase in the malignant transformation rate of OLP in studies. Topical/systemic steroid treatment results in decreased local immunity, providing a potential cause for conversion to cancer that cannot be ignored.[31011] Systemic condition like diabetes causes disturbances in cellular and humoral immune functions, reducing the immunity in OLP-affected patient which may lead to malignant transformation.[12] Association of tobacco and/or alcohol may also play a role in mucosal alteration at the microscopic level, increasing the likelihood of malignant transformation.[3] Though the investigators have supported the potentially malignant nature of OLP, a small but significant number of OSCC occur in non-smokers and non-drinkers with a range of 3–24%. Even with this finding the overall malignant transformation rate of OLP remains lower compared to the occurrence of OSCC in non-smokers and non-drinkers (OLP—2.28% vs OSCC in non-smokers and non-drinkers 3–24%).[6131415] Based on the above observations, it is high time for us to rethink whether OLP should still be considered as an OPMD? Once diagnosed with OLP, informing the patient about possible malignant transformation induces cancerophobia, causing stress and disturbing their emotional status further aggravating the signs and symptoms of OLP.[16] Until then, based on the literature reporting the potentially malignant nature of OLP, we suggest the need for psychological counseling for all OLP patients. This will definitely serve to alleviate their anxiety, thus making them more receptive to treatment. We hope our letter will generate a healthy discussion among the readers to arrive at a common consensus by putting forth their views on this topic. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Evaluation of Ayurvedic Treatment Modalities for Oral Lichen Planus – A Systematic Review

Oral lichen planus (OLP), a chronic inflammatory disease that affects the oral mucosa, may cause pain or discomfort along with increased burning sensation. There are numerous treatment modalities available that have several side effects. The aim of this study was to determine the effectiveness of Ayurvedic management for oral Lichen Planus. Two sources of Internet were used to search appropriate articles which satisfied the purpose of study including PubMed and Google scholar. Studies which were done on Indian population, PubMed search including articles that were published between January 1, 2000 and October 31, 2019, Studies published in English or which could be translated to English, randomized clinical trials, controlled clinical trials and longitudinal studies with essential data on Ayurvedic approach were included. Patients having Oral Lichen Planus where ayurvedic approach was used for treatment. Out of 09 articles, included in systematic review, in almost all the studies improvement in pain, erythema and burning sensation were reported in score scale. Administration of topical herbal antioxidants and topical application of herbal medicines prove to be effective approach in minimizing the signs and symptoms of Oral Lichen Planus. Long-term use of steroids has many side effects while the herbal medicines almost have none. So, herbal medicines can be used for better efficacy with least side effects for OLP.

Abstracts from the World Federation for Laser Dentistry—Asia Pacific Division Virtual Conference July 16–17, 2021

Abstracts from the World Federation for Laser Dentistry—Asia Pacific Division Virtual Conference July 16–17, 2021

Eficacia del ácido hialurónico tópico para el liquen plano oral sintomático: Revisión Sistemática

Background: Oral lichen planus (OLP) is a chronic inflam-matory disorder with a potential of malignant transformation. Despite the extensive research on the topic, the management of OLP is still quite challenging, with no definitive cure. Objective: The present systematic review assessed the efficacy of topical hyaluronic acid in the management of OLP. Material and Methods: A comprehensive search of PubMed, Scopus, Web of Science and Google Scholar was carried out by two independent investigators. All randomized clinical trials that compared the efficacy of hyaluronic acid with other interventions and/or placebo in the management of OLP and fulfilled the following criteria were included: 1) OLP diagnosis was confirmed clinically and histopathologically, 2) the study included systemically healthy patients aged 15 years and older, 3) a minimum sample size of 10, and 4) reporting the main outcomes including pain, erythema, and ulcer size. Case reports, case series, reviews, animal studies, uncontrolled trials were excluded. Results: Four clinical trials involving 234 patients were included. Two studies compared hyaluronic acid with a topical corticosteroid, and two studies compared it with placebo. Only one of the four included studies was at low risk of bias. Overall, topical hyaluronic acid showed good efficacy in alleviating the signs and symptoms of OLP. Two studies found hyaluronic acid significantly more effective in reducing pain and improving clinical signs of OLP compared to placebo. Compared to topical corticosteroids, one study reported comparable results; and one study found hyaluronic acid to be superior to triamcinolone in reducing pain but inferior to triamcinolone in improving the healing time. Conclusion: The limited available evidence suggests that hyaluronic acid may have some benefits in the management of OLP. Further well-designed studies with adequate follow-up periods are highly recommended.

The Effect of Mouthrinse with 0.05% Dexamethasone Solution on the Oral Bacterial Community of Oral Lichen Planus Patients: Prospective Pilot Study

Few studies have already been performed to assess oral bacteria during steroid therapy for oral lichen planus (OLP). Thus, the aim of our study was to analyze the effect of dexamethasone mouthrinse treatment on the oral bacteria of OLP patients. This prospective study was conducted on patients who were diagnosed with OLP and treated with 0.05% dexamethasone mouthrinse twice per day for 4 weeks. Using unstimulated saliva of the patients before and after treatment, the qualitative and quantitative changes in oral bacteria were analyzed using quantitative real-time polymerase chain reaction (qPCR). The qPCR results were analyzed using Wilcoxon signed-rank test to the quantitative changes with dexamethasone mouthrinse. The statistical significance was considered at a level of 0.05. In total, 20 patients were enrolled in this study, wherein all were noted to show improved symptoms of OLP. Fifteen patients (75%) had a qualitative change in the oral microbial species and an improved relative periodontitis risk score (from 26.1 ± 10.7 to 20.9 ± 9.2; p = 0.008). However, quantitative changes in all species were determined to be not statistically different before and after the treatment. Most OLP patients had a changed microbial community composition after 0.05% dexamethasone mouthrinse for 4 weeks. In particular, the composition of the periodontopathic bacteria was improved after the treatment.

Clinical impact of direct-acting antiviral treatment on patients with hepatitis C virus–related oral lichen planus

<h3>Objectives</h3> Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disease. It has been related to hepatitis C virus (HCV) infection as one of the extrahepatic pathologic manifestations. The current treatment for HCV infection with direct-acting antivirals (DAAs) is highly effective and safe. This study aimed to evaluate the impact of HCV eradication on OLP clinical manifestations. <h3>Methods</h3> Patients with a histologic diagnosis of OLP and HCV chronic infection were recruited from the oral medicine and internal medicine units of the University of Campania "Luigi Vanvitelli." All patients received DAA treatment and were monitored at baseline and during and after treatment for liver function and antiviral response. Patients underwent an oral clinical examination before receiving DAAs (T0) and 8 weeks after the end of treatment (T1), and they were observed periodically in follow-up (FU). Statistical analysis was performed using Mann-Whitney and Wilcoxon tests, chi-square tests, and Fisher exact tests. <h3>Results</h3> Eighteen patients (13 females and 5 males; median age, 75 years) with chronic HCV infection of different genotypes were enrolled. All patients cleared HCV RNA with a sustained virologic response at FU. No adverse events were reported. The median FU was 92 weeks at T2. At T0, 5 patients presented with reticular and bilateral white lesions; 7 patients presented with erosive OLP; and 6 patients presented with a mixed form. The mean percentages of oral sites involved were 30% (±13.9) at T0, 20.8% (±12.9) at T1, and 16.2% (±15.2) at T2, showing improvement from T0 to T1 (<i>P</i> = .007) and T2 (<i>P</i> = .005). One patient developed oral cancer during the treatment and was excluded. Oral lesions have improved in 9 cases (52.9%) at T1 and in 10 cases (55.6%) at FU (T2); among these, 6 (60%) showed complete remission. However, statistical analysis did not reveal a significant correlation between oral improvement and HCV genotype (<i>P</i> = .64), viral load (<i>P</i> = .27), liver status (<i>P</i> = .60), isolated HBcAb positivity (<i>P</i> = .633), and type of DAA received (<i>P</i> = .103). <h3>Conclusions</h3> DAA treatment leading to HCV eradication can improve OLP symptoms. However, a causative relationship between HCV infection and OLP pathogenesis is difficult to establish. Further studies are necessary.

Novel neem leaves extract mouthwash therapy for oral lichen planus

Oral lichen planus (OLP) is a potentially malignant, chronic inflammatory condition affecting the oral cavity. Most of the patients have associated systemic conditions like hypertension, diabetes mellitus and hyperthyroidism. Patients experience severe burning pain in the oral cavity. Although, the standard treatment for this condition is a corticosteroid, the associated side effects limit its prolonged use. Chronic topical use can lead to mucosal atrophy, secondary candidal infection and burning pain which could ultimately lead to dietary disturbance, psychological problems and negative impact on the quality of life. Therefore, an alternative approach like herbal therapy including neem tree leaves was tried in OLP patients. Aqueous neem leaves extract has anti-inflammatory, immunomodulatory, antifungal and anticancer agents in addition to various antioxidants, which could prove to be beneficial in treating OLP. This paper presents an herbal therapeutics case series of a novel aqueous neem leaves extract mouthwash therapy which was successful in resolving the signs and symptoms of OLP in four patients.

Predictors of symptomatic oral lichen planus.

The aim of this study was to determine the prevalence and the factors associated with symptomatic oral lichen planus (OLP). Patients with OLP seen for an initial visit were assessed retrospectively. Initial visit data included demographic characteristics; social, medical, and OLP treatment histories; medications; chief complaints, 0 to 10 pain level; OLP duration and symptoms; OLP type and location; total OLP lesion size (mm2); total ulcer size (mm2); and fungal infection and its management. Follow-up data included 0 to 10 pain level and total lesion and ulcer sizes. We assessed 205 patients: 154 (75%) were women, and the mean (standard deviation [SD]) age was 62.5 (11.5) years. The mean (SD) current pain level was 1.6 (2.2) at the initial visit. A total of 125 patients (61%) were classified as symptomatic, including 85 (41%) patients reporting a pain level of 1 or greater and another 40 patients (20%) who had symptoms not described as pain at the initial visit. The following increased the odds of OLP symptoms at the initial visit: tongue location (× 2.3), erosive/erythematous type (× 2.3), female sex (× 2.9), topical steroid use before initial visit (× 2.1), and number of medical conditions (× 1.2). Most patients with OLP in the present cohort were symptomatic at the initial visit, with location, type, sex, steroid use and medical conditions being predictors of symptomatic OLP. Despite improvement in OLP symptoms in most patients over time, 25% of patients who are asymptomatic at the initial visit present with symptomatic OLP at a future visit.

Clinical research of Lishi-Jianpi-Quyu decoction combined with conventional western medicine for the patients with oral lichen planus

Objective To evaluate the therapeutic effect of Lishi-Jianpi-Quyu decoction combined with conventional western medicine for the oral lichen planus (OLP). Methods A total of 80 OLP patients who met the inclusion criteria were divided into two groups by random number table method, 40 in each group. The control group was treated with conventional medicine, while the research group were treated with Lishi-Jianpi-Quyu decoction on the basis of control group. Two groups were treated for 4 weeks. The severity of oral mucosal lesions was assessed by REU scale, and oral discomfort was assessed by VAS scale. The serum tumor necrosis factor-α (TNF-α), IL-6 and IL-8 levels were detected by ELISA, peripheral blood CD3+, CD4+ levels were detected by flow cytometry, and the ratio of CD4+/CD8+ was calculatedand the clinical efficacy was evaluated. Results The effective rate of research group was 82.5% (33/40), while the control group was 62.50% (25/40), and the difference between two groups was statistically significant (χ2=9.031, P=0.003). After treatment, TNF-α (1.19 ± 0.28 μg/L vs. 3.59 ± 0.72 μg/L, t=19.807), IL-6 (11.14 ± 2.04 ng/L vs. 16.34 ± 3.20 ng/L, t=8.666), IL-8 (1.15 ± 0.61 ng/L vs. 2.04 ± 0.76 ng/L, t=5.776) of research group were significantly lower than the control group (P<0.01). The serum CD3+ (64.02% ± 5.16% vs. 58.07% ± 4.85%, t=5.314), CD4+ (41.26% ± 3.61% vs. 37.15% ± 3.04%, t=5.508), CD4+/CD8+ (1.60 ± 0.43 vs. 1.31 ± 0.40, t=3.668) of research group were significantly higher than those of the control group (P<0.01). After treatment, the REU score and VAS score in the research group were significantly lower than that in the control group (t=10.980, 11.146, P<0.01). Conclusions The Lishi-Jianpi-Quyu decoction combined with conventional western medicine can improve the clinical symptoms of OLP, reduce the level of serum inflammatory cytokines, and enhance the body's immunity and improve the curative effect. Key words: Lichen Planus, Oral; Lishi-Jianpi-Quyu decoction; Tumor necrosis factor-alpha; Interleukin; Immune reconstitution

Low level laser Therapy in Management of Oral Lichen Planus (OLP)

Oral lichen planus (OLP) is a chronic state of inflammatory condition with immunological behavior ofunknown etiology, Laser application on different lesions has been suggested as new treatment modalitieswithout significant adverse effects. Eighteen females subjected from OLP with mean age (37.9) years;without signs and symptoms for any medical diseases, these patients treated with low level laser (Epic X10 diode laser for soft tissues). The symptoms of oral lichen planus can be treated by 630-980 nm low levellasers to reducing both the pain and mouth soreness with no adverse effects. The action of laser in this fieldby; convert the pro-inflammatory state to anti-inflammatory condition and progression in collage repair, cellproliferation and finally tissue regeneration.