Interventions for treating oral lichen planus: corticosteroid therapies

Abstract

Background Oral lichen planus (OLP) is a relatively common chronic T cell-mediated disease, which can cause significant pain, particularly in its erosive or ulcerative forms. As pain is the indication for treatment of OLP, pain resolution is the primary outcome for this review. This review is an update of a version last published in 2011, but focuses on the evidence for corticosteroid treatment only. A second review considering non-corticosteroid treatments is in progress. Objectives To assess the e ects and safety of corticosteroids, in any formulation, for treating people with symptoms of oral lichen planus. Search methods Cochrane Oral Health's Information Specialist searched the following databases to 25 February 2019: Cochrane Oral Health's Trials Register, CENTRAL (2019, Issue 1), MEDLINE Ovid, and Embase Ovid. ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. There were no restrictions on language or date of publication. Selection criteria We considered randomised controlled clinical trials (RCTs) of any local or systemic corticosteroid treatment compared with a placebo, a calcineurin inhibitor, another corticosteroid, any other local or systemic (or both) drug, or the same corticosteroid plus an adjunctive treatment. Data collection and analysis Three review authors independently scanned the titles and abstracts of all reports identified, and assessed risk of bias using the Cochrane tool and extracted data from included studies. For dichotomous outcomes, we expressed the estimates of e ects of an intervention as risk ratios (RR), with 95% confidence intervals (CI). For continuous outcomes, we used mean di erences (MD) and 95% CI. The statistical unit of analysis was the participant. We conducted meta-analyses only with studies of similar comparisons reporting the same outcome measures. We assessed the overall certainty of the evidence using GRADE. Main results We included 35 studies (1474 participants) in this review. We assessed seven studies at low risk of bias overall, 11 at unclear and the remaining 17 studies at high risk of bias. We present results for our main outcomes, pain and clinical resolution measured at the end of Interventions for treating oral lichen planus: corticosteroid therapies (Review)

Effect of personality traits on the oral health-related quality of life in patients with oral lichen planus undergoing treatment

“…A recent Cochrane review [ 21 ] quoted that the impact of pain on physical, emotional, and social functions required multidimensional qualitative tools and health-related quality of life instruments that are uncommonly used in OLP trials. Due to the chronic nature of OLP and the impact of this condition on quality of life, the use of patient-reported outcome measures in assessing the treatment of chronic oral mucosal diseases is of great importance.…”

Treatment of oral lichen planus with mucoadhesive mycophenolate mofetil patch: A randomized clinical trial

“…As topical steroids are first line treatment of OLP, recent placebo controlled trials on different types of steroids like clobetasol propionate 0.05% mixed with 4% hydroxyethyl cellulose gel (Lodi, Manfredi, Mercadante, Murphy, & Carrozzo, 2020), triamcinolone paste and tacrolimus ointment (Lodi et al, 2020) showed significant reduction of clinical signs of OLP against orabase and 4% hydroxyethyl cellulose gel alone (considered as placebo) in symptomatic OLP patients (Lodi et al, 2020). Our results are comparable to these studies, but unlike these studies, the drug effect durability of MMF patch on OLP is not evaluated and needs more investigation.…”

“…Lichen planus (LP) is a common inflammatory disease of the skin, mucous membranes, nail, and hair follicles (Nazemi, Esmaeli, Sedaghat, & Mostafa, 2006), in which autoreactive T lymphocytes are directed against basal layer antigens. The lesions can vary from a mild inflammation to destruction of the epithelium with painful wounds (Glick, 2015).…”

Familial oral lichen planus in a 3-year-old boy: a case report with eight years of follow-up

“…According to an updated review about OLP treatment, the aims of therapeutic management are eliminating painful symptoms, promoting healing of erosive lesions, reducing the risk of malignant transformation, and prolongating symptom free periods [15]. For erosive OLP, corticosteroids were recommended as first-line treatment in consensus guidelines [15,16]. However, systemic or topical application of corticosteroids present various adverse effects, containing oral candidiasis, a smarting sensation in the mouth, gingival tenderness, insomnia, mood swings, fatigue, and water retention [16][17][18].…”

“…For erosive OLP, corticosteroids were recommended as first-line treatment in consensus guidelines [15,16]. However, systemic or topical application of corticosteroids present various adverse effects, containing oral candidiasis, a smarting sensation in the mouth, gingival tenderness, insomnia, mood swings, fatigue, and water retention [16][17][18]. Moreover, there is no definitive protocol of corticosteroid therapy for children aged three.…”