Therapy For Oral Lichen Planus Research Articles

What can we learn from treatments of oral lichen planus?

Oral lichen planus (OLP), a T-lymphocyte-mediated disease of the oral mucosa, has a complex pathogenesis that involves a number of factors. The disease is characterized by recurrent episodes and requires continuous follow up, and there is no curative treatment available. Erosive lichen planus, among others, has a risk of malignant transformation and requires standardized treatment to control its progression. Different clinical subtypes of oral lichen planus require appropriate treatment. Pharmacological treatments are the most widely available and have the greatest variety of options and a number of novel pharmacological treatments are presented as highlights, including JAK enzyme inhibitors. The second is photodynamic therapy, which is the leading physiological treatment. In addition, periodontal treatment and psychological treatment should not be neglected. In this review, we briefly discuss the most recent developments in therapies for oral lichen planus after summarizing the most widely used clinical treatments, aiming to provide different proposals for future clinical treatment.

Effect of platelet concentrates for pain and symptom management in oral lichen planus: an evidence-based systematic review.

Platelet Concentrate (PC) injection therapy has shown potential as a local therapy for oral lichen planus (OLP). However, its safety and efficacy have not yet been fully established. Our research compared the efficacy of PC with topical steroid treatment in alleviating pain and symptoms related to OLP. We aims to present evidence-based alternatives that dentists can use to improve patient outcomes while reducing potential side effects. We conducted a systematic search of five electronic databases up to April 2023, including Embase, Cochrane Central Register of Controlled Trials, PubMed, OVID Medline, and WanFang, to evaluate PCs' efficacy compared to topical corticosteroid therapy for OLP. The literature quality was assessed using the Cochrane ROB tool. A fixed-effects model was used to determine the Weighted Mean Difference (WMD) and Mean Difference (MD) at a 95% confidence interval (CI) for pain severity and other relevant clinical indicators. The comparison between topical corticosteroid therapy and PCs showed no significant difference for pain relief (WMD = -0.07, CI = 95% -0.34 to 0.19), symptom improvement (MD = -0.21, CI = 95% -0.55 to 0.13), or the severity of included lesions measured by REU scores (MD = -0.25, CI = 95% -0.32 to 0.82). Locally injected PC have been found efficient in managing oral lichen planus, indicating that they are a promising alternative option to steroid therapy for OLP patients, particularly those who have not responded favorably to steroid therapy. However, further research is needed to establish determining the recurrence rate and long-term adverse effects. The systematic review protocol has been registered in advance with the PROSPERO database (CRD42023415372).

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.

Updates on immunological mechanistic insights and targeting of the oral lichen planus microenvironment.

Oral lichen planus (OLP) is a chronic immune inflammatory disease that is an oral potentially malignant disorder (OPMD), occurs in the oral mucosa and affects approximately 0.5% to 4% of the general population. There are usually five types of OLP: reticular/papular, plaque-like, atrophic/erythematous, erosive/ulcerative, and bullous. Furthermore, the chance of causing oral squamous cell carcinoma (OSCC) is 1.4%. Although the etiology of OLP is still unknown, accumulating evidence supports that immune dysregulation may play a vital role in the pathogenesis of OLP, especially the massive production of various inflammatory cells and inflammatory mediators. In this review, we focus on the relationship between OLP and its immune microenvironment. We summarize current developments in the immunology of OLP, summarizing functional cell types and crucial cytokines in the OLP immune microenvironment and the underlying mechanisms of key signaling pathways in the OLP immune microenvironment. We highlight the application potential of targeted immune microenvironment therapy for OLP.

ВЗАИМОСВЯЗЬ ПСИХОЭМОЦИОНАЛЬНОГО СОСТОЯНИЯ И БОЛЕВОГО ФАКТОРА У ПАЦИЕНТОВ С КРАСНЫМ ПЛОСКИМ ЛИШАЕМ РТА

Objectives. To evaluate the correlation between the psycho-emotional state and the pain factor in patients with oral lichen planus (OLP).
 Methodology. Patients (n = 287) with various verified clinical forms of OLP of the oral mucosa (OM) and patients of the control group (without OLP) (n = 32), matched by gender and age, were studied. The levels of anxiety and depression were studied according to the Beck method, the intensity of pain sensations on a visual analog scale using author's computer programs.
 Results. In the structure of the examined patients with OLP, the following clinical forms prevailed: typical form was 39.7% (n = 114), erosive-ulcerative – 31.0% (n = 89), exudative-hyperemic – 21.9% (n = 63 ), other forms – 7.4%, (n = 21).
 Analysis of the correlation between pain and anxiety (BAI) and depression (BDI) revealed positive mean correlations: r = 0.5627 (95% CI 0.4754–0.6390) and r = 0.4349 (95% CI 0, 3330–0.5268), at p < 0.0001, respectively. It is worth noting that the pain factor had a 29% greater influence on the state of anxiety than on the depression factor.
 Conclusion. In the complex therapy of OLP, it is necessary to take into account the psychological profile of patients, pain, understanding that these factors can be either initiating or supporting the pathological state. In view of this, the issue of an interdisciplinary approach and general planning of therapy with the involvement of specialized specialists is especially acute. The applied author's programs have shown convenience for both doctors and patients.

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.

Population-based cohort study to assess the gingival lesions in 1319 patients with lichen planus.

Oral lichen planus (OLP) is a chronic immune disease. In this paper, we evaluated the overall characters, clinical presentation, and outcome of gingival lesions in OLP Italian patients. A retrospective cohort study was accomplished: a total of 1319 charts were investigated, of whom 922 were female (69.9%): 617 patients (46.8%) manifested white lesions and 702 red ones (53.2%). While most patients had several oral sites of involvement, the gingiva was the unique location in 103 cases. Symptoms were reported in 480 patients (36.4%): 286 patients with erosive OLP, 103 with atrophic form, and 91 with a white form. Long-lasting surveillance showed that only 40 patients (3.03%) had a total clinical signs remission. Regarding OLP medical treatment provided, patients attending less frequently a dental office underwent more often a specific therapy. To the best of our knowledge, this is the biggest collections of patients with gingival OLP ever described; exclusive gingival lesions are, however, rare and unlikely to undergo a malignant transformation. Moreover, gum lesions seemed to anticipate the appearance of oral lesions and a higher rate of OLP therapy was observed in patients with less frequent dental check-ups and oral hygiene instructions.

PROGNOSTIC ROLE OF THE BIOMARKER FOR SQUAMOUS CELL CARCINOMA ANTIGEN IN ORAL LICHEN PLANUS

Lichen planus refers to chronic dermatoses with manifestation in the oral mucosa. Its clinical manifestations are displayed as disruption of the immune system balance. A prolonged course of lichen planus causes deregulation of the cell growth gene, dysplasia of the epithelium of the oral mucosa and the development of squamous cell carcinoma. Identification of circulating biological markers in blood and saliva enables to detect stable and reliable predictors of clinical significance in the diagnosis and the prognosis of diseases of the oral mucosa, including the onset of tumor transformation. Squamous cell carcinoma (SCC) antigen is one of these cancer markers. Saliva is an "ultrafiltrate of blood plasma", which makes it possible to evaluate biological markers by a safe non-invasive method. The aim of this study is to assess the concentration of squamous cell carcinoma antigen in mixed saliva samples of patients with various forms of lichen planus at the stages of diagnosis and treatment. Materials and methods. 47 women with a clinical diagnosis of "oral lichen planus" were examined and randomized in groups. They described the dental status, identified the causes of chronic injury, and made a comprehensive treatment plan. Monitoring was carried out at the diagnostic stage, after 14 and 90 days. During the first visit and after treatment, unstimulated mixed saliva was collected on an empty stomach. Results. During the diagnosis, the content of SC in the oral fluid of patients with lichen planus was <500 mcg/ml (489 mcg/ml) and a decrease in its concentration after treatment is characteristic of a benign course and susceptibility to therapy. The concentration of the marker >500 mcg/ml (527 mcg/ml) and an increase in the value after the treatment course indicates a severe recurrent nature of the disease and low efficacy of prescribed medications. Conclusion. The study of squamous cell carcinoma (SCC) antigen in oral fluid expands the applications of the biomarker in determining the prognosis of the course and effectiveness of therapy for oral lichen planus.

MiR-155-5p modulates inflammatory phenotype of activated oral lichen-planus-associated-fibroblasts by targeting SOCS1.

Oral lichen planus (OLP) is a chronic inflammatory oral mucosal disease. Cytokines are closely associated with OLP development. In addition to immune cells, fibroblasts have been reported to induce regional inflammation. MicroRNA(miR)-155-5p is reportedly increased significantly in OLP and is known to regulate inflammation. This study aimed to investigate the role of miR-155-5p in fibroblasts of OLP lesions. Normal mucosal fibroblasts (NFs) and OLP associated-fibroblasts (OLP AFs) were isolated from the oral mucosa of 15 healthy controls and 30 OLP patients. We detected the expression of miR-155-5p and fibroblast activation protein alpha (FAP-α) using quantitative RT-PCR and analyzed their correlation. Interleukin (IL)-6 and IL-8 levels were determined using ELISA. Expression of suppressor of cytokine signaling (SOCS) 1 was analyzed by western blotting. A dual-luciferase reporter assay was performed to investigate the interaction between miR-155-5p and SOCS1. MiR-155-5p and FAP-α were significantly increased and positively correlated in OLP AFs. Overexpression of miR-155-5p in OLP AFs augmented IL-6 and IL-8 release and decreased SOCS1 expression, whereas knockdown of miR-155-5p in OLP AFs decreased IL-6 and IL-8 release. The expression of SOCS1 was downregulated in OLP AFs, and SOCS1 silencing augmented IL-6 and IL-8 production in OLP AFs. Furthermore, miR-155-5p inhibited SOCS1 expression by directly targeting its 3'-UTR in OLP AFs. MiR-155-5p regulates the secretion of IL-6 and IL-8 by downregulating the expression of SOCS1 in activated OLP AFs. Our results provide novel insights into the pathogenesis of OLP and identify a potential new target for OLP therapy.

Clinical responses of patients with systemic diseases to the photodynamic therapy of oral lichen planus

BackgroundOral lichen planus (OLP) is a chronic disease commonly detected in older aged patients with female predominance. Treatment of OLP in diabetic and hypertensive patients usually shows some difficulties which require a more safe and effective treatment modality such as Photodynamic therapy (PDT). The current study aims to evaluate the role of PDT in treating OLP in diabetic and hypertensive patients. MethodsWe evaluated the role of PDT in treating erosive OLP of type 2 diabetic and hypertensive patients. The following parameters were evaluated for each case at the time zero, after2 weeks, and 4 weeks of the study: subjective responses, objective responses, and the size of the lesion. ResultsOur study included 9 diabetic and 7hypertensive patients with an age range of 30:60 years old. There were statistically significant differences between the diabetic and hypertensive patients in the objective response, area of ulceration, and the area of erythema at the end of the 4th week of the study (p<0.05). ConclusionPDT is an effective treatment modality for diabetic and hypertensive patients with no side effects or patient discomfort.

The efficacy of henna (Lawsonia inermis L.) mouthwash versus chlorhexidine gluconate 0.2% mouthwash as adjuvant therapy of oral lichen planus: A randomized double-blind clinical trial

Ethnopharmacological relevanceIn modern medicine, some traditional remedies are introduced to be effective in treatment. Accordingly, the henna plant (Lawsonia inermis L.) is studied more than before. Previous studies have shown many medical properties for henna, such as anti-inflammatory and anti-fungal properties. Aim of the studyOral lichen planus (OLP) is a common mucocutaneous disease with chronic immunomodulatory disruptions. Topical corticosteroids are the first line of OLP treatment. Previous studies have suggested different adjunctive therapies for preventing the side effects of corticosteroids overuse. This study aimed to compare the effects of henna and chlorhexidine mouthwashes as adjunctive therapy. Materials and methodsThis parallel-group, double-blind, randomized controlled study was conducted on forty OLP patients. Luteolin content was determined in Henna mouthwash composed of 2% aqueous extract of henna, 2% ethanol, 10% glycerol, and 0.1% methylparaben distilled water. Henna or chlorhexidine mouthwashes were prescribed twice daily as an adjuvant to the topical corticosteroid treatment. Visual analog scale (VAS) index and Thongprasom rating were used to measure pain intensity and clinical signs of patients at days 0,7, and 14. The collected data were analyzed using SPSS software (version 26.0; SPSS). Ordinal logistic regression was used to investigate the effect of independent variables on Thongprasom and VAS scores. ResultsIn this clinical trial, 82.6% of the participants were women. There was no difference between the two study groups in terms of VAS scores (p = 0.404) and clinical features (p = 0.305) in the second follow-up visit. All drug regimens caused clinical signs and symptoms relief. ConclusionsThere was no significant difference between the groups receiving topical corticosteroid supplementation, neither henna mouthwash nor chlorhexidine mouthwash. The therapeutic effects of henna mouthwash in the main or adjuvant treatment of OLP need more evaluation in future research. Henna mouthwash can be a good alternative to chlorhexidine mouthwash if no side effects are reported.

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.

The expression of membrane-bound complement regulatory proteins CD46, CD55 and CD59 in oral lichen planus

ObjectiveTo investigate the expression levels of membrane-anchored complement regulatory proteins (mCRPs), CD46, CD55 and CD59 in oral lichen planus (OLP), and evaluate the activation status of complement. DesignThirty-seven cases of OLP patients (20 non-erosive OLP and 17 erosive OLP) and twenty healthy controls were recruited in this study. The proteins and mRNA expression levels of CD46, CD55 and CD59 in OLP tissues were detected by western blotting and RT-qPCR respectively, and the expression levels of complement C3 and sC5b-9 in OLP patients’ saliva were detected by ELISA to evaluate the activation status of complement. In addition, mucosa tissues of another 3 non-erosive OLP patients and another 3 healthy controls were collected, and the epithelial layer of two groups were separated to culture primary keratinocytes in vitro. Immunofluorescence was used to further detect the expression of mCRPs at the cellular level. ResultsThe levels of CD46, CD55 and CD59 in OLP tissues and cells were significantly decreased compared with those of the healthy control group, and the level of complement C3 in the patients’ saliva was significantly decreased, while the level of sC5b-9 was increased. ConclusionsThese results suggest that the reduced expression of mCRPs keeps the complement system in a continuously active state, which may be the reason of the persistent local immune inflammatory state in OLP. This study aimed to provide new insights for the etiology and therapy of OLP.

Stepwise approach in the management of oral lichen planus

Lichen planus is a chronic inflammatory disease in the skin, hair, nails, and mucous membranes. Like in other sites, oral lichen planus (OLP) includes asymptomatic and flare-up or symptomatic periods. The symptomatic period is characterized by erosive, ulcerative, or painful symptoms. In addition, some lesions may have potentially malignant transformation. Despite many molecular-based studies, the OLP etiology is still unclear. Hence, there is no gold-standard therapy for OLP so far. The management of symptomatic lesions is based on each individual’s clinical features, and treatment outcomes are often unpredictable. That explains why most dentists are not confident in dealing with this disease. Nevertheless, there is a consensus among the majority of authors that the pathogenesis of OLP, as an immune-mediated disease, is related to T-lymphocyte immunological dysfunction. Medical treatment, using immunosuppressant therapies or immunomodulators, aims (1) to alleviate painful symptoms, (2) to heal the ulcerative and atrophic lesions, (3) to reduce the risk of malignant transformation, and (4) to prolong the symptom‑free intervals. This review article aims to synthesize current literature evidence and integrate the authors’ experience in suggesting a stepwise approach to manage OLP patients.

Effects of cold physical plasma on oral lichen planus: An in vitro study (Effects of CAP on OLP).

In the search for more effective and safe treatment avenues, we investigated cold physical plasma as a new treatment modality for therapy of oral lichen planus (OLP). Healthy and diseased human mucosal tissue samples with a size of 3mm in diameter obtained from OLP patients were subjected to plasma treatment ex vivo or were left untreated. Tissue sections were quantified for immune-infiltration of CD4+ , CD8+ , CD45RA+ , and CD45R0+ T cells. Moreover, the tissues' inflammatory profile was assessed by analyzing 12 different cytokines in the surrounding media. A significantly increased infiltrate of CD8+ and CD45-R0+ T cells was detected in OLP tissue samples when compared to healthy tissue. A higher concentration of interleukin (IL) 1β, IL6, IL8, and granulocyte macrophage-colony stimulating factor (GM-CMF) was detected in OLP samples compared to healthy mucosal tissue. For all cytokines and chemokines investigated, 23 out of 24 comparisons showed a decrease in tendency (significant for IL1β, IL2, IL10, and GM-CSF) in response to plasma treatment. In ex vivo-treated tissue, a decrease of T-cell infiltrate in OLP lesions compared with healthy tissue was observed. Our findings suggest cold physical plasma can be a promising therapeutic option for OLP that requires further validation in vivo.

Efficacy evaluation of photodynamic therapy for oral lichen planus: a systematic review and meta-analysis

BackgroundPhotodynamic therapy (PDT) is a new option for oral lichen planus (OLP) management; however, there are different opinions on the efficacy of PDT for OLP. The aim of this study was to comprehensively assess the efficacy of PDT in the treatment of OLP and compare PDT with steroid therapy.MethodsA systematic review and meta-analysis were conducted to assess the curative effect of PDT. Five electronic databases were searched, PubMed, Web of Science, the Cochrane Library, Embase, and EBSCO up to 1 December, 2019. Random and fixed effects models for pooled estimates calculation were used and the Meta package of R was applied.ResultsPooled estimates revealed that, after PDT, the lesion size decreased by 1.53 cm2 (95% confidence interval (CI): 0.71–2.35) after PDT and the partial response (PR) was 0.77 (95% CI: 0.65–0.85). The visual analogue scale (VAS) score decreased by 3.82 (95% CI: 2.80–4.85) and the Thongprasom sign score decreased by 1.33 (95% CI: 0.56–2.10) after PDT. Subgroup analyses revealed that the 5-aminolevulinic acid (5-ALA) was more effective than methylene blue (MB), with a PR of 0.87 (95% CI: 0.80–0.91). The topical use of 5-ALA yielded a better response than gargling methylene blue. In terms of VAS, the diode laser showed a better clinical PR in the treatment of OLP. In terms of changes in lesion size, the efficacy of the semiconductor laser was higher than that of the diode laser. PDT had a similar efficacy to topical corticosteroids, as shown by pooled estimates of five randomised controlled trials with 139 lesions.ConclusionThis systematic review indicates that PDT is an effective treatment modality for the management of OLP. PDT is as effective as topical corticosteroid in the treatment of OLP and could be used for cases resistant to steroids or when steroids are contraindicated.

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.

Treatment trends in oral lichen planus and oral lichenoid lesions (Review).

Oral lichen planus (OLP) is a chronic inflammatory disease, associated with altered cell-mediated immunological function. It has long-term evolution, repeated exacerbations, sometimes painful and resistant to treatment, even all of these, OLP significantly affects patient's life quality. Not least, OLP is accompanied by an increased risk of malignant transformation. A wide spectrum of therapeutic options is available, but none are curative. In this review, 58 structured studies on the clinical symptomatology and treatment strategy of OLP were analyzed. The literature research was performed according to the criteria of the PRISMA system. This study summarizes current knowledge regarding management of OLP and oral lichenoid lesions, discusses the challenges of choosing an adequate treatment and, in attempt to improve the quality of patient life, trying to describe a therapeutic algorithm that takes into consideration the clinical features of the disease. Current OLP therapy aims at eliminating all mucosal-related lesions, reduce symptomatology and decrease the risk of oral cancer and include corticosteroids, immunomodulatory agents, retinoids, ultraviolet irradiation and/or laser therapy.

Photodynamic therapy of oral lichen planus.

Oral lichen planus (OLP) is a chronic inflammatory and immune-mediated disease affecting the oral mucosa. OLP presents with asymptomatic, lacelike white stripes and/or symptomatic red, ulcerated mucous membranes. Eating, drinking and oral hygiene procedures may be painful resulting in reduced quality of life (QOL). The histopathological picture is a zone of cellular infiltrate, mainly CD8+ cells, in the superficial layer of the connective tissue and signs of liquefaction degeneration of the basal membrane. Conventional treatment is corticosteroids. Local and systemic side effects are common, and patients may develop drug resistance. The intention with this article is to demonstrate the heterogeneity in photodynamic therapy (PDT) of OLP. A search in PubMed, Embase (Ovid) and Medline (Ovid) identified seventeen clinical studies investigating PDT of OLP. Only five were randomised controlled studies and the study groups varied from 5 to 50 patients. Five different photosensitisers or precursors were tested. Both broadband spectrum lamps, lasers and light-emitting-diodes (LEDs), with wavelengths from 420 nm to 682 nm, were used. The number of treatment sessions varied from one to ten. The patients were followed up for 0 to 48 months, but in thirteen studies the post treatment observation time was ≤6 months. Single arm studies demonstrated improvement of OLP except in one study. In all controlled studies except for one, PDT was superior or equal to conventional treatment. The majority of patients experienced a slight burning sensation during light activation, but no serious adverse events were reported. Only few studies examined the effect of PDT on a cellular level.

Omega-3 polyunsaturated fatty acids: a promising approach for the management of oral lichen planus.

Oral lichen planus (OLP) is a T-cell-mediated inflammatory disease with a risk of malignant transformation. Although the etiology of OLP is still uncertain, growing evidence suggests that oral microbiota, antigen-specific, and non-specific mechanisms are involved in the pathogenesis of OLP. Antigen-specific mechanisms include antigen presentation, T-cell activation, nuclear factor-kappa B signaling pathway, and cytokine secretion, while non-specific mechanisms consist of matrix metalloproteinases (MMP)-9 upregulation, psychological pressure, oxidative damage, aberrant expression of microRNAs (miRNAs), and autophagy. Till now, there is no cure for OLP, and the main purpose of OLP therapy is symptomatic control. Seafood and its derivative omega-3 polyunsaturated fatty acids (n-3 PUFAs) can suppress antigen presentation, T-cell activation, and nuclear factor-kappa B signaling pathway, modulate the overexpressed inflammatory cytokines, inhibit the expression of MMP-9, as well as regulate the expression of miRNAs and autophagy. And they are possible agents for ameliorating psychological disorder and oxidative damage. Moreover, n-3 PUFAs supplementation has a beneficial effect on preventing tumorigenesis. n-3 PUFAs consumption may provide a non-toxic, inexpensive administration for OLP.