The management of oral lichen planus

Abstract

OBJECTIVE: To review the current literature regarding the medical treatment of oral lichen planus (OLP). DATA SOURCES: PubMed on‐line Medline data searches were carried out for the years 1966–1998 to identify reports on therapy of OLP. METHODS OF STUDY SELECTION: Single case reports or open trials were included if they covered new therapeutic approaches or suggested significant modifications of known treatment modalities. Review papers were limited to those dealing with the topic. DATA EXTRACTION AND SYNTHESIS: Every paper was critically examined. Because of the great heterogeneity of the response criteria, many data could not be directly compared. Stronger weight was given to therapies that have proven to be effective under placebo‐controlled research protocols. Attention was also drawn to potential and effective adverse effects of every drug used. CONCLUSIONS: Among the various medications advocated for the treatment of OLP, several lack conclusive findings from adequately controlled trials. Mainly high‐potency topical corticosteroids in an adhesive medium appear at present the safest and most efficacious. Adjuvant agents as antimycotics may be useful in topical steroid treatment. Systemic corticosteroids may be occasionally indicated for severe recalcitrant erosive OLP or for diffuse mucocutaneous involvement. Topical cyclo‐sporine should be considered in steroid‐unresponsive cases considering that its efficacy in OLP could be related to a systemic effect and its high cost. Classical PUVA therapy seems to have too many side effects; topical application of psoralen is promising but still experimental. Topically and systemically delivered retinoids combined with topical corticosteroids could improve the efficacy of these agents whereas complete remission is difficult to achieve with retinoids alone and they frequently cause adverse effects. Finally, there are only few data concerning the long‐term effect of the medical treatments upon the course of OLP and we do not know if therapy influences the malignant evolution of OLP.

Clinical variants of lichen planus

“…There have also been reports of successful use of topical calcineurin inhibitors (e.g. tacrolimus or pimecrolimus [10,[72][73][74][75][76][77][78] ( Table 5). In the event of exanthematous distribution, additional phototherapy with UVA, UVA1 or UVB can be helpful.…”

“…Tacrolimus [73][74][75] Pimecrolimus [78] Cyclosporine [72,76,77] Retinoid [10,81] Systemic Corticosteroids (e.g. prednisolone 0.5-1 mg/kg daily orally) [81] Alternative, if indicated in combination with:…”

Vulvo-vaginal-gingival syndrome – a

“…Najczęściej występuje liszaj płaski jamy ustnej (ang. oral LP), który dotyczy 0,5-2,2% dorosłej populacji i występuje dwukrotnie częściej u kobiet [1,2]. Wśród kobiet z objawami LP jamy ustnej u około 20% stwierdza się zmiany w obrębie błon śluzowych narządów płciowych [3].…”

Clinical and Genetic Aspects of Oral Lichen Planus

“…[70] 66 to 100% of treated patients respond at least partially to topical corticosteroids, with variation in efficacy mostly due to the different potency of the corticosteroids. [71] Intralesional injections of hydrocortisone, dexamethasone, triamcinolone acetonide, and methylprednisolone have also been used with short-term success. [72] 7.2 Nondrug Therapies 7.2.1 Ultraviolet Irradiation UV radiation has been used with apparent success in oral lichen planus in a number of studies.…”