Effect of adjunctive systemic vitamin E on clinical parameters and salivary total antioxidant capacity in symptomatic oral lichen planus patients: Randomized controlled clinical trial

Abstract

Background: Most of the available therapeutics of oral lichen planus are associated with adverse effects and there is no sufficient evidence to support the effectiveness of these modalities over placebo or over each other. Micronutrients including antioxidants modify the immune system function and are considered promising alternatives in management of OLP with negligible side effects. The current trial assessed the effect of adjunctive use of systemic vitamin E in symptomatic oral lichen planus patients. Methods: This randomized controlled clinical trial includes 30 symptomatic (erosive and atrophic ) oral lichen planus patients in two parallel groups (interventiontopical triamcinolone acetonide adhesive paste and vitamin E, control -topical triamcinolone acetonide adhesive paste and placebo), with allocation ratio 1:1. Outcome measures were pain intensity, clinical improvement and salivary level of total antioxidant capacity. Results: Mean amount of pain reduction and clinical improvement were greater in the experimental group with statistically significant difference. Mean amount of total antioxidant capacity upregulation was greater in the control group with no statistical difference. Conclusion: Adjunctive use of systemic vitamin E has shown promising results in management of OLP with no side effects.

Oral lichen planus and its recent management: A review

“…At present, topical and systemic immuno-suppressants are typically administered to relieve clinical symptoms, but most of the cases of OLP tend to be more persistent and more resistant to treatment despite of many treatment modalities like topical and systemic steroids, anti-inflammatory coating gels, topical calcineurin inhibitors, retinoids and immunosuppressants. While some of these leave significant side effects such as dysgeusia, tachyphylaxis, oral mucosa thinning, adrenal suppression ,systemic absorption and secondary candidiasis up on long term management 3,5,6,10,11 . Hence numerous studies are being carried out throughout the world to find alternative treatments for OLP using non-pharmacological approaches and other therapeutic strategies.Topical steroids are considered as the first line of treatment as well as the gold standard in OLP treatment for decades 3,5,6,10,11 .…”

“…While some of these leave significant side effects such as dysgeusia, tachyphylaxis, oral mucosa thinning, adrenal suppression ,systemic absorption and secondary candidiasis up on long term management 3,5,6,10,11 . Hence numerous studies are being carried out throughout the world to find alternative treatments for OLP using non-pharmacological approaches and other therapeutic strategies.Topical steroids are considered as the first line of treatment as well as the gold standard in OLP treatment for decades 3,5,6,10,11 . In mild cases of OLP, topical steroids can be used but systemic corticosteroids must be given in cases where topical corticosteroid doesn't work, such as in recalcitrant, erosive and erythematous OLP.…”

“…In case of isolated plaques and non healing erosive OLP, surgical excision is recommended 5 . In clustered erosive and symptomatic OLP, free gingival grafts were used, indicating a complete eradication of the disease after 3.5 years 5 Micronutrients, like antioxidants, modify the role of the immune system and are perceived appealing substitutes of negligible side effects while handling OLP 11 .Oral lichen planus being hypothesized to be an autoimmune disease, several researches have been carried out to treat lichen planus by micronutrients including antioxidants that modify the immune system function. Such studies involve the impact of vitamins A, D, E 3,11 Vitamin A : Topical retinoids like tretinoin, isotretinoine or fenretinide have been reported to induce transient reversal of white striae in OLP.…”

“…Website: https://www.banglajol.info/index.php/UpDCJ epithelium the at penetration lymphocyte Prominent connective tissue interface, hyperparakeratosis, cytoid bodie, acanthosis and hydropic epithelial layer transition are some histopathologic characteristics of OLP 2,9 So far, OLP appears to be an incurable disease, and most clinical practice focuses on inflammation control and reduction 9,11 . Despite multiple treatment modalities, most cases of OLP appear to be more resistant to treatment, such as topical steroids(considered as the first line of treatment), systemic steroids, retinoids, calcineurin inhibitors, lasers, phototherapy, immunosuppressants, natural agents such as curcumin, aloe vera, vitamin A, laser biomodulation.Although there are many proposed treatment modalities, a permanent cure is not yet available.…”

“…Despite multiple treatment modalities, most cases of OLP appear to be more resistant to treatment, such as topical steroids(considered as the first line of treatment), systemic steroids, retinoids, calcineurin inhibitors, lasers, phototherapy, immunosuppressants, natural agents such as curcumin, aloe vera, vitamin A, laser biomodulation.Although there are many proposed treatment modalities, a permanent cure is not yet available. Unfortunately, most of the therapeutic modalities are associated with adverse effects; some of them are serious, which limits their use 11 . The main aim of this article is to combine the latest information and findings regarding oral lichen planus…”