Is Topical Application of Hyaluronic Acid in Oral Lichen Planus Effective? A Randomized Controlled Crossover Study

Abstract

Hyaluronic acid (HA) has anti-inflammatory and anti-edematous effects and, thus, could be promising in the treatment of oral lichen planus (OLP). The aim of the study was to evaluate the effects of topical hyaluronic acid, compared to placebo, on salivary levels of calprotectin, interleukin-6 (IL-6), and bacteria, as well as clinical and subjective parameters. Fourteen patients with confirmed OLP were included. After random selection, patients started with either 0.2% hyaluronic acid or a placebo gel for 6 weeks. Following a wash-out period, the groups changed the application. Whole saliva, clinical parameters, and questionnaires were evaluated before and after the intervention, as well as after the crossover phase. Salivary calprotectin, IL-6, and inflammation-related bacteria were determined by ELISA and PCR, respectively. There were no significant differences in clinical or subjective outcome parameters, salivary levels of IL-6, calprotectin, or bacteria after the application of hyaluronic acid, compared to placebo. However, only nine patients completed the study, as five out of seven patients starting with placebo were lost to follow-up. Significant effects of HA on inflammatory mediators and clinical parameters in OLP patients could not be proven, although a trend in clinical severity improvement could be observed.

Effectiveness of hyaluronic acid in the management of oral lichen planus: a systematic review and meta-analysis

“…Five studies reported a high risk of bias [ 6 14 15 18 19 ] due to one or more risks owing to performance, detection, attrition, and reporting bias. Two other studies reported an unclear risk of bias in selection, performance, and detection [ 13 20 ].…”

“…A total of 199 participants from 6 studies were included in the analysis of OLP lesion symptoms [ 6 13 15 18 19 20 ]. The pooled overall mean difference was 0.65 [95% CI: -1.80 to 3.09] which was not statistically significant (Z = 0.52, P = 0.60).…”

“…It can be used in all grades of oral ulceration [ 10 11 12 ]. HA plays an important role in various biological processes, such as cell signalling, morphogenesis, matrix organization, tissue hydration, lubrication, wound healing, regulating gene expression, and cell proliferation [ 8 13 14 15 ]. HA is commercially available as sodium hyaluronate combined with polyvinylpyrrolidone (PVP) and glycyrrhetinic acid.…”

“…However, despite HA showing promising properties, data for its usage in OLP remain scarce and conflicting [ 6 15 18 19 20 ]. Previous systematic reviews have compared the efficacy of topical HA with only steroids/placebo [ 21 ].…”

The Use of Herbal Mouthwash Therapy in Oral Lichen Planus: A Systematic Review

“…There is evidence that topical use of corticosteroids can be absorbed and cause systemic side effects [10]. The most reported side effects of topical corticosteroids are the presence of acute candidiasis, burning sensation, mucosal atrophy, and dry mouth [11]. Another side effect that can occur is hypogeusia and systemic effects such as suppression of the hypothalamic-pituitary-adrenal axis and Cushing's syndrome.…”