Topical Therapies for Oral Lichen Planus Management and their Efficacy: A Narrative Review

Abstract

Oral Lichen Planus (OLP) is a chronic inflammatory condition implicating T cell-mediated cytotoxicity, and involving oral mucosal surfaces. Several therapeutic regimens have been evaluated to treat OLP and pain related, but often without high level of evidence. Topical formulations are the favourite for the majority of cases; bioadhesive formulations have been considered very useful and practical for local drug delivery in oral mucosa, due to the increased residence time on the oral mucosa of the dosage forms and better therapeutic efficacy.In this narrative review, authors try to illustrate the current topical managements for OLP from the accessible literature on this topic. Steroids are very helpful in discomfort and making better quality of life: they are considered the first-line treatment even if they could cause secondary candidosis, and sometimes bad taste, nausea, dry mouth, sore throat or swollen mouth.Other substances or devices by topical administration are adopted especially when the first line approach is refractory. This is the case when retinol with its synthetic and natural analogues (retinoids), hyaluronic acid, or Aloe Vera are chosen.Recent topical applications for OLP therapy include phototherapy and low/high energy pulsing light; the treatment with extracorporeal photochemotherapy is also reasonable and promising.Finally, calcineurin inhibitors (i.e. cyclosporine, tacrolimus and pimecrolimus), antioxidant and biologics (i.e alefacept, efalizumab, basiliximab, TNF-inhibitors -infliximab, rituximab) may be alternative approaches when OLP does not respond to the standard protocols.In this scenario, there are several studies on molecules different from glucocorticosteroids, but not sufficient or statistically adequate to justify their evidence-based use in OLP; large randomized placebo controlled trials are required to evaluate the safety and effectiveness of these non conventional therapies.In conclusion, since OLP is a chronic disease and requires long-term management, the dental/medical practitioner, who treats OLP patients, needs to know the natural history of OLP, how to monitor, and how to treat, taking in account all of the available modalities conventional and not, with pros and cons.

The efficacy of aloe vera in management of oral lichen planus: a systematic review and meta‐analysis

“…Bagan et al () advised dentists to consider all the existing treatment alternatives with their advantages and drawbacks. Keenan and Ferraiolo () asked the dentists to be aware of the available alternatives with comparable palliative effect as steroids but without adverse effects.…”

Hyaluronan-Phosphatidylethanolamine Polymers Form Pericellular Coats on Keratinocytes and Promote Basal Keratinocyte Proliferation

“…Application of HA to aged mouse skin partially restores permeability barrier homeostasis and epidermal thickness [41, 42]. Topical or injected HMW HA products have had variable effects in restoring a sustained physiological and hydrated microenvironment of youthful skin required for optimizing tissue repair and rejuvenation [4, 62, 64, 65]. Transepidermal or dermal HA delivery modalities, although promising, have similarly failed to reliably replenish sustained high levels of native HMW HA in the epidermis or dermis of aged skin [66–68].…”

Papillon‐Lefèvre or Haim‐Munk Syndrome? Report on Two Sisters in a Consanguineous Family

“…Nazzaro et al 32 reported that teeth that erupted during retinoid therapy were free from periodontopathy. Topical retinoid is available for the treatment of many conditions, including PLS, 33 and it was used in the oral cavity for the treatment of oral lichen planus 34 . It could be an option in the future to use topical retinoids as subgingival medication for the treatment of conditions such as PLS.…”