Severe oral lichen planus: remission and maintenance with Vitamin A analogues

Abstract

Twenty-five patients with chronic oral lichen planus, usually of the atrophic-erosive type, were treated for 2 months with Etretinate® 0.6 mg/kg b.w./day, followed for 4 months by Etretinate® 0.3 mg/kg/day, or 0.1% Tretinoin® in an adhesive base. Complete resolution or improvement was seen in 85% of the lesions after first treatment. The number of patients with oral soreness and pain was significantly reduced (p< 0.001). During the second treatment, the improvement was maintained or even increased in about 70% of the patients, irrespective of the mode of treatment. Treatment was discontinued in one patient owing to moderately increased serum transaminase levels. The number of drug-related drop-outs was significantly lower than in a previous study utilizing an etretinate dose of about 1 mg/kg/day (p < 0.05). Other adverse effects were minor and tolerable. Retinoids offer an effective mode of therapy for severe oral lichen planus.

Update On Oral Lichen Planus: Etiopathogenesis and Management

“…The use of systemic vitamin A or analogues, which can be effective against OLP (Sloberg et al, 1983), was initially restricted by their toxicity (Stuttgen, 1975). The vitamin A analogue etretinate has been used (Schuppli, 1978;Hersle et al, 1982) because of its greater therapeutic index, and it can be useful where there are cutaneous or genital lesions in addition to OLP (BaudetPommel et al, 1991;Gorsky and Raviv, 1992;Eisen, 1994).…”

“…The main empirical treatments for OLP, shown in Table 10, are mainly immunosuppressive and include particularly the topical corticosteroids in various forms (Mumford and Morgan, 1956;Kovesi and Banoczy, 1973;Randell and Cohen, 1974;Tyldesley and Harding, 1977;Greenspan et al, 1978;Silverman et al, 1985a), cyclosporin (Eisen et al, 1990a,b;Ho et al, 1990;Ho and Conklin, 1991), vitamin A analogues (Gunther, 1973;Sloberg et al, 1979Sloberg et al, , 1983Hersle et al, 1982;Ferguson et al, 1984;Handler, 1984;Stans and Bergfeld, 1984;Zegarelli, 1984;Woo, 1985), and hydroxychloroquine (Eisen, 1993b). However, all of these drugs can have sideeffects, not all have been reliably effective, and recurrences of the lesions are common after the cessation of therapy.…”

Topical Retinoids in Oral Lichen Planus Treatment: An Overview

“…Sixteen studies met the inclusion criteria [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25] and their characteristics are detailed in table 1.…”

“…There were one single case report [22], three case series [10,13,17], three observational studies [14,20,24] and nine controlled clinical trials [11,12,15,16,18,19,21,23,25]. A total of 264 patients were described in these 16 studies: 84 were men, 132 were women (for 48 patients sex was not reported), mean age was 49.7 years.…”

“…A total of 264 patients were described in these 16 studies: 84 were men, 132 were women (for 48 patients sex was not reported), mean age was 49.7 years. Mean duration of OLP signs and symptoms was 3.3 years (data from 9 studies) [11,12,13,15,18,19,20,22,25]; there were no data on duration of OLP in the remaining studies. Seven studies [10,13,16,17,20,21,22] only considered patients affected by reticular OLP, two studies only considered erosive OLP patients [12,19], five studies studied reticular and erosive OLP patients [11,15,18,23,25] and in the remaining two studies the OLP clinical form was not specified.…”