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REVISTA DERMATOLÓGICA SEPTIEMBRE 2003-2024, LIQUEN PLANO ORAL
La primera publicación sobre el EL LIQUEN PLANO (LP) que realice, fue en el año 1998, cuando estaba comenzando esta revista dermatológica online, con solo pocas referencias sobre el tema.
Luego en 2017 hice una amplia revisión sobre el mismo con 71 referencias BIBLIOGRÁFICAS donde explico la HISTORIA, NOMBRES QUE SE LE DIO, CLASIFICACIÓN. Y TRATAMIENTOS.
Hoy diciembre 2024, te estoy publicando una actualización del LIQUEN PLANO ORAL (LPO), una de las variantes de esta patología, SU CLASIFICACIÓN y TRATAMIENTOS..
El LIQUEN PLANO ORAL (LPO), es un subtipo del clásico LIQUEN PLANO (LP), que se presenta en la BOCA: LABIOS, ENCÍAS y LENGUA.
Este también tiene su clasificación o subtipos:
CLASIFICACIÓN DEL LIQUEN PLANO ORAL (LPO):
1.) RETICULAR: se observan unas estrías de color blanquecino (estrías de wickham), en el lado interno de las mejillas, y cara interna de labios, es la forma más común.
2.) PLACAS: Se presentan placas gruesas, de color blanco, predominantemente en la lengua y puede confundirse fácilmente con una leucoplasia.
3.) PAPULAR: Similar a la presentación en PLACAS pero las lesiones son pápulas, dolorosas, es una forma poco común en la boca. El liquen plano papular es mas frecuente en el cuerpo.
4.) EROSIVO: Se caracteriza por áreas ulceradas y con erosión, muy dolorosas y esta asociadas a un MAYOR RIESGO DE MALIGNIZACIÓN.
5.) ATRÓFICO: la mucosa oral se presenta con depresiones, adelgazada también acompañada de dolor.
6.) AMPOLLAR o BULOSO: se presenta en la mucosa oral en forma de ampollas dolorosas, es la variante mas rara del liquen plano oral (LPO).
Hay que destacar que el LIQUEN PLANO ORAL (LPO), tiene asociación con cáncer, por su potencial de malignización, sobre todo las variante erosiva.
También está relacionado con enfermedades autoinmunes como el lupus discoide crónico, lupus sistémico, y erupciones liquenoides orales inducidas por MEDICAMENTOS, CONTACTO con prótesis bucales, (aparatología funcional de los maxilares), recordando que estas están elaboradas con materiales metálicos, acrílicos, y cerámica.
Debemos recordar que, el LIQUEN PLANO ORAL, tiene presentación SIMILAR tanto en el hombre como en la mujer en la MUCOSA GENITAL, denominándose LIQUEN PLANO VULVAR, en la mujer y del PENE en el hombre.
Se presenta en adultos entre 50 y 60 años y con variantes tipo: PLACA, EROSIONES y ÚLCERAS, muy dolorosas y pruriginosas, afectando la calidad de vida de los afectados; siendo la variante erosiva al igual que en la boca, la que tiene mayor asociación con MALIGNIZACIÓN.
TRATAMIENTO:
El liquen plano oral es una patología difícil de tratar:
A.- TRATAMIENTOS TÓPICOS:
1.) Corticosteroides tópicos: acetónido de triamcinolona, desonida con clioquinol. clobetasol, betametasona, fluocinolona.
2.) Anestésicos tópicos: para aliviar el dolor.
3.) Pimecrolimus y tacrolimus: eficacia no comprobada.
B.- TRATAMIENTOS SISTÉMICOS:
1.) Corticosteroides: Prednisona y/o prednisolona: a dosis alta pueden aliviar los síntomas y mejorar las lesiones, en combinación con la terapia tópica.
2.) Retinoides sistémicos: el ETRETINATO (derivado de la Vitamina A), en algunos casos ha dado resultados satisfactorios.
3.) Inmunosupresores: Azatioprina y ciclosporina: utilizados en casos severos.
4.) Antiparasitarios: LEVAMISOL: (DECARIS). el levamisol es un antiparasitario que se ha demostrado tener efectos inmunomoduladores, y hay varios estudios donde se demostró su efectividad en el tratamiento del liquen plano oral (LPO).
5.) Medicinas naturistas: la curcumina o azafran de la india: hay algunos estudios que demuestran la utilidad de la curcuma en el liquen plano oral (LPO).
C.-) OTROS TRATAMIENTOS:
1.) Controlar el estrés: para evitar el empeoramiento de las lesiones.
2.) Fototerapia: puede ser de utilidad en algunos casos
3.) Cuidado de la salud: evitar comidas calientes, picantes, pasta de dientes diluida para que no provoque irritación, y evitar frutas ácidas.
Te dejo dos enlaces de interés sobre esta patología:
EL LIQUEN PLANO, primera impresión.
EL LIQUEN PLANO BUSCANDO EL ORIGEN (2017) , UNA REVISIÓN COMPLETA DE ESTA PATOLOGÍA: historia, clasificación y tratamiento. Si quieres aprender sobre el Liquen Plano(LP), leer estas tres revisiones.
Saludos,,,
Dr. José Lapenta.
ENGLISH
The first publication on LICHEN PLANUS (LP) that I made was in 1998, when I was starting this online dermatological magazine, with only a few references on the subject.
Then in 2017 I made a comprehensive review on it with 71 BIBLIOGRAPHIC references where I explain the HISTORY, NAMES GIVEN TO IT, CLASSIFICATION. AND TREATMENTS.
Today December 2024, I am publishing an update on ORAL LICHEN PLANUS (LPO), one of the variants of this pathology, ITS CLASSIFICATION and TREATMENTS..
ORAL LICHEN PLANUS (LPO), is a subtype of the classic LICHEN PLANUS (LP), which occurs in the MOUTH: LIPS, GUMS and TONGUE.
This also has its classification or subtypes:
CLASSIFICATION OF ORAL LICHEN PLANUS (OLP):
1.) RETICULAR: whitish streaks (Wickham's streaks) are observed on the inner side of the cheeks and inner side of the lips, it is the most common form.
2.) PLAQUES: Thick, white plaques appear, predominantly on the tongue and can be easily confused with leukoplakia.
3.) PAPULAR: Similar to the PLAQUE presentation but the lesions are papules, painful, it is an uncommon form in the mouth. Papular lichen planus is more frequent in the body.
4.) EROSIVE: It is characterized by ulcerated and eroded areas, very painful and is associated with a GREATER RISK OF MALIGNIZATION.
5.) ATROPHIC: the oral mucosa appears with depressions, thinned also accompanied by pain.
6.) BULLOUS or BLISTER: it appears on the oral mucosa in the form of painful blisters, it is the rarest variant of oral lichen planus (OLP).
It should be noted that ORAL LICHEN PLANUS (OLP) is associated with cancer, due to its potential for malignancy, especially the erosive variant.
It is also related to autoimmune diseases such as chronic discoid lupus, systemic lupus, and oral lichenoid eruptions induced by MEDICINES, CONTACT with oral prostheses, (functional jaw appliances), remembering that these are made of metal, acrylic, and ceramic materials.
We must remember that ORAL LICHEN PLANUS has a SIMILAR presentation in both men and women in the GENITAL MUCOSA, being called VULVAR LICHEN PLANUS in women and PENIS in men.
It occurs in adults between 50 and 60 years of age and with variants such as: PLAQUE, EROSIONS and ULCERS, which are very painful and pruritic, affecting the quality of life of those affected; the erosive variant, as in the mouth, is the one that has the greatest association with MALIGNANCY.
TREATMENT:
Oral lichen planus is a difficult pathology to treat:
A.- TOPICAL TREATMENTS:
1.) Topical corticosteroids: triamcinolone acetonide, desonide with clioquinol. clobetasol, betamethasone, fluocinolone.
2.) Topical anesthetics: to relieve pain.
3.) Pimecrolimus and tacrolimus: unproven efficacy.
B.- SYSTEMIC TREATMENTS:
1.) Corticosteroids: Prednisone and/or prednisolone: at high doses they can relieve symptoms and improve lesions, in combination with topical therapy.
2.) Systemic retinoids: ETRETINATE (derived from Vitamin A), has given satisfactory results in some cases.
3.) Immunosuppressants: Azathioprine and cyclosporine: used in severe cases.
4.) Antiparasitics: LEVAMISOL: (DECARIS). Levamisole is an antiparasitic that has been shown to have immunomodulatory effects, and there are several studies where its effectiveness in the treatment of oral lichen planus (OLP) has been demonstrated.
5.) Naturopathic medicines: curcumin or Indian saffron: there are some studies that demonstrate the usefulness of turmeric in oral lichen planus (OLP).
C.-) OTHER TREATMENTS:
1.) Control stress: to avoid the worsening of the lesions.
2.) Phototherapy: can be useful in some cases
3.) Health care: avoid hot, spicy foods, diluted toothpaste so that it does not cause irritation, and avoid acidic fruits.
I leave you two links of interest about this pathology:
LICHEN PLANUS, first impression.
LICHEN PLANUS LOOKING FOR THE ORIGIN (2017), A COMPLETE REVIEW OF THIS PATHOLOGY: history, classification and treatment. If you want to learn about Lichen Planus (LP), read these three reviews.
Greetings...
Dr. José Lapenta R.
4.) Hydroxychloroquine sulfate (Plaquenil) improves oral lichen planus: An open trial
5.) Management of recalcitrant ulcerative oral lichen planus with topical tacrolimus.
7.) [Simvastatin-induced lichen planus pemphigoides]
8.) Topical tacrolimus and pimecrolimus: future directions.
10.) The efficacy of cyclosporin for topical use in oral lichen planus]
12.) Efficacy of fluocinolone acetonide gel in the treatment of oral lichen planus.
C.- The Management of Oral Lichen Planus.2020
E.- A Clinical Study of 205 Patients With Oral
Lichen Planus.
F.- Oral Lichen Planus: An Update on Diagnosis and
Management.2024
I.- Therapeutic Strategies for Oral Lichen Planus:
State of the Art and New Insights.2022
K.- Is Curcumin a Safe and Effective Therapeutic in
the Treatment Against Oral Lichen Planus?.2022
M.- Levamisole monotherapy for oral lichen
planus.
C.- The Management of Oral Lichen Planus.2020
E.- A Clinical Study of 205 Patients With Oral Lichen Planus.
F.- Oral Lichen Planus: An Update on Diagnosis and Management.2024
I.- Therapeutic Strategies for Oral Lichen Planus: State of the Art and New Insights.2022
K.- Is Curcumin a Safe and Effective Therapeutic in the Treatment Against Oral Lichen Planus?.2022
M.- Levamisole monotherapy for oral lichen planus.
1.) Treatment of chronic erosive oral lichen planus with low concentrations of topical tacrolimus: an open prospective study.
Arch Dermatol. 2002 Oct;138(10):1335-8.
Olivier V, Lacour JP, Mousnier A, Garraffo R, Monteil RA,
Ortonne JP.
Department of Dermatology, Hopital Archet-2, BP 3079, 06202
Nice CEDEX, France.
BACKGROUND: Chronic erosive oral lichen planus (EOLP) is a
severe form of lichen of the buccal mucosa that is often
resistant to systemic or topical therapies. OBJECTIVE: To
evaluate the efficacy and safety of topical tacrolimus, 0.1 mg
per 100 mL of water, in treating EOLP. DESIGN: Open-label,
prospective, noncomparative study, with 6 months of treatment
and 6 months of follow-up. SETTING: Dermatology department at
a university hospital in Nice, France. PATIENTS: Ten patients
with histologically proved EOLP that was refractory to
treatment. Two patients were withdrawn because of
noncompliance; findings in 8 were available for evaluation.
INTERVENTIONS: Mouthwashes with tacrolimus, 0.1 mg per 100 mL
of distilled water, 4 times daily for 6 months. MAIN OUTCOME
MEASURES: Efficacy was assessed using a calculated score that
combined the intensity of spontaneous and meal-triggered pain
and the surface area of erosions. Safety assessment included
the monitoring of adverse effects, clinical laboratory values,
and blood concentrations of tacrolimus. RESULTS: Among the 8
patients evaluated, 1 had no improvement and 7 were improved.
The mean score decreased from 7.00 at baseline to 5.43 (a
22.43% decrease) at 1 month, 4.14 (a 40.86% decrease) at 2
months, 3.00 (a 57.14% decrease) at 3 months, 2.43 (a 65.29%
decrease) at 4 months, 2.57 (a 63.29% decrease) at 5 months,
and 3.43 (a 51.00% decrease) at 6 months. A decrease of
symptoms was reported by the 7 responding patients as soon as
the first month of treatment. No severe adverse effects were
observed. All patients had whole-blood concentrations of
tacrolimus below the detection limit of the assay (1.5 ng/mL)
at all intervals. At 9 months, 6 patients had had a relapse
within a mean of 38.6 days. At 12 months, all patients had had
a relapse and required treatment with topical corticosteroids
or systemic hydroxychloroquine sulfate. CONCLUSION: Results of
our study suggest a rapid and important palliating effect of
low concentration of topical tacrolimus in distilled water in
patients with EOLP.
2.) Treatment of severe erosive gingival lesions by topical application of clobetasol propionate in custom trays.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Jun;95(6):688-92.
Gonzalez-Moles MA, Ruiz-Avila I, Rodriguez-Archilla A, Morales-Garcia P, Mesa-Aguado F, Bascones-Martinez A, Bravo M.
University of Granada, Jaen General Hospital, and University Complutense of Madrid, Spain. magonzal@ugr.es
OBJECTIVE: We sought to describe the response of patients with severe erosive gingival lesions to treatment with clobetasol propionate in Orabase paste administered in trays. The adverse effects were also recorded. STUDY DESIGN: A descriptive pretest/posttest clinical study with no control group (33 patients total) was developed. All patients received repeated applications of 0.05% clobetasol propionate plus 100,000 IU/cc of nystatin in Orabase paste. Over the 48-week period, the pain levels, ulcerations, presence of atrophy, and the patients' daily activities were recorded, and Likert scales were used to classify each outcome as either a complete recovery, excellent, good, poor, or failed. The presence of any adverse effect was also noted. RESULTS: At the end of the study period, the pain and ulceration had disappeared (complete response) in 100% of the sample (33/33; 95% confidence interval = 89.4%-100%), and there was a complete recovery of daily activities and remission of atrophy in 93.9% (31/33; 95% confidence interval = 79.8%-99.3%) and 21.2% (7/33; 95% confidence interval = 9.0%-38.9%) of the patients, respectively. No adverse effects related to the treatment were observed. CONCLUSIONS: The application of an Orabase paste of 0.05% clobetasol 17-propionate plus 100,000 IU/cc of nystatin by means of a tray appears to be an efficacious treatment for severe erosive gingival lesions.
3.) Oral erosive/ulcerative lichen planus: preliminary
findings in an open trial of sulodexide compared with
cyclosporine (ciclosporin) therapy.
Int J Dermatol. 2003 Apr;42(4):308-11.
Femiano F, Gombos F, Scully C.
Stomatology Clinic, University of Medicine and Surgery, Naples, Italy. femiano@libero.it
OBJECTIVE: To study the effect of the heparinoid sulodexide systemically, compared with topical cyclosporine (ciclosporin), on chronic oral erosive/ulcerative lichen planus. STUDY DESIGN: An open nonrandomized trial was conducted in two groups of 10 Italian patients with lichen planus, with subjective assessment of pain and assessment of ulceration amelioration by nonblinded clinicians. RESULTS: Comparable pain relief and amelioration of erosions/ulcers were seen in patients on sulodexide and in those on ciclosporin, but with faster healing in those on sulodexide. CONCLUSIONS: Sulodexide appears to be as effective, and perhaps more effective, than topical ciclosporin in the therapy of oral lichen planus, and is less expensive, but full double-blind placebo-controlled studies are required.
4.) Hydroxychloroquine sulfate (Plaquenil) improves oral
lichen planus: An open trial.
J Am Acad Dermatol. 1993 Apr;28(4):609-12.
Dermatology Associates of Cincinnati, Inc., OH 45230.
BACKGROUND: Oral lichen planus is chronic and can be debilitating. Topical corticosteroids are most frequently used for treatment, but they are not always effective. OBJECTIVE: Hydroxychloroquine sulfate (Plaquenil), an antimalarial agent, was evaluated in an open trial (10 patients) for its ability to improve oral lichen planus. METHODS: Patients received hydroxychloroquine, 200 to 400 mg daily, as a monotherapy for 6 months. Patients were assessed at baseline and every 4 to 8 weeks during treatment. Baseline ophthalmologic examinations were performed, and laboratory values were monitored before and during treatment. RESULTS: Nine of ten patients had an excellent response to therapy. Three of six patients with erosions at baseline had complete healing. Pain relief and reduced erythema were usually observed after 1 to 2 months of therapy, but erosions required 3 to 6 months of treatment before they resolved. There were no adverse effects. CONCLUSION: Hydroxychloroquine may be useful in the treatment of oral lichen planus.
5.) Management of recalcitrant ulcerative oral lichen planus with topical tacrolimus.
J Am Acad Dermatol. 2002 Jan;46(1):35-41.
Kaliakatsou F, Hodgson TA, Lewsey JD, Hegarty AM, Murphy AG,
Porter SR.
Unit of Oral Medicine, Eastman Dental Institute for Oral
Health Care Sciences, University College London, United
Kingdom
OBJECTIVE: Our purpose was to investigate the efficacy and
safety of 0.1% topical tacrolimus in erosive or ulcerative
oral lichen planus. METHODS: This was an open-label,
noncomparative study conducted in an outpatient oral medicine
unit in London, United Kingdom. The study covered an 8-week
period with a 22-week follow-up after cessation of therapy.
Nineteen patients, aged 28 to 87 years with biopsy-proven oral
lichen planus refractory to, or dependent on, systemic
immunosuppressive agents, were enrolled. Seventeen patients
(89%) completed the study. Application of 0.1% tacrolimus was
administered to all symptomatic oral mucosal lesions. Clinical
review took place 1, 3, 5, 7, and 8 weeks after commencing
therapy. Alleviation of symptoms was evaluated by using a
visual analogue scale as well as the McGill Pain and Oral
Health Impact profile questionnaires. The extent of the oral
mucosal erosion or ulceration was directly measured by the
same clinician at all visits. Safety assessments included
monitoring of adverse events, complete blood cell count, renal
and hepatic clinical chemistry, and tacrolimus blood
concentrations. RESULTS: Tacrolimus caused a statistically
significant improvement in symptoms within 1 week of
commencement of therapy. A mean decrease of 73.3% occurred in
the area of ulceration over the 8-week study period. Local
irritation (in 6 subjects, 35%) was the most commonly reported
adverse effect. Laboratory values showed no significant
changes with time. Therapeutic levels of tacrolimus were
demonstrated in 8 subjects but were unrelated to the extent of
oral mucosal involvement. Thirteen of 17 patients suffered a
relapse of oral lichen planus within 2 to 15 weeks of
cessation of tacrolimus therapy. CONCLUSION: Topical
tacrolimus is effective therapy for erosive or ulcerative oral
lichen planus.
6.) Dramatic response to levamisole and low-dose
prednisolone in 23 patients with oral lichen planus: a
6-year prospective follow-up study.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995 Dec;80(6):705-9.
Lu SY, Chen WJ, Eng HL.
Department of Dentistry, Ghang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China.
The purpose of this prospective study was to evaluate the short-term and long-term clinical efficacy of levamisole used with low-dose prednisolone in patients with refractory oral lichen planus. Twenty-three patients with OLP who had been treated unsuccessfully with other modalities were given 150 mg/day levamisole and 15 mg/day prednisolone for 3 consecutive days each week. Twelve patients showed dramatic remission of signs and symptoms within 2 weeks, whereas 11 had partial remission. All 23 reported significant pain relief and showed no evidence of erosive oral lichen planus after 4 to 6 weeks of treatment. All 23 also remained free from symptoms for 6 to 9 months after the treatment ended. There were few side effects from this treatment besides minor skin rash, headache, and insomnia from the levamisole in three cases. We conclude that the addition of levamisole to prednisolone may produce improved results in the management of erosive oral lichen planus.
7.) [Simvastatin-induced lichen planus pemphigoides]
Ann Dermatol Venereol. 2003 Feb;130(2 Pt 1):187-90.
[Article in French]
Stoebner PE, Michot C, Ligeron C, Durand L, Meynadier J,
Meunier L.
Service de Dermatologie-Allergologie-Photobiologie, Hopital
Saint-Eloi, 80, avenue Augustin Fliche, 34295 Montpellier
Cedex 5. p-stoebner@chu-montpellier.fr
INTRODUCTION: Simvastatin is a competitive inhibitor of the
3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase
which is effective in the treatment of various
hyperlipidemia. We report a case of lichen planus
pemphigoides induced by simvastatin treatment. CASE REPORT:
A 63-year-old man was treated for two months with
simvastatin for hypercholesterolemia. One month later he
developed a pruriginous and bullous lichenoid eruption.
Histological and direct immunofluorescent features were
consistent with the diagnosis of lichen planus pemphigoides.
The Western blot analysis revealed antibodies directed
against BP 180 kDa antigens. All the lesions progressively
disappeared after treatment was discontinued. DISCUSSION:
Lichen planus pemphigoides may be due to the intake of drugs
such as cinnarizine, captopril, ramipril and furosemide.
Simvastatin may induce various drug eruptions such as
pruritus, eczematous rash, cheilitis, angio-oedema and
urticaria, porphyria cutanea tarda, lupus-like syndrome,
dermatomyositis and lichenoid eruption. With the increasing
use of HMG-CoA reductase inhibitors, an association between
simvastatin and lichen planus pemphigoides should be kept in
mind.
8.) Topical tacrolimus and pimecrolimus: future
directions.
Semin Cutan Med Surg. 2001 Dec;20(4):268-74.
Ling MR.
Emory University School of Medicine, Atlanta, GA, USA.
Topical tacrolimus ointment and pimecrolimus cream represent the first members of a new class of medications. Topical immunomodulators have been developed for the treatment of atopic dermatitis. Their superb safety profiles and excellent efficacy as anti-inflammatory agents make them attractive candidates to treat a host of other skin disorders. This article reviews published experiences that use them for psoriasis, seborrheic dermatitis, lichen planus, pyoderma gangrenosum and other diseases. Possible modifications to these compounds and novel untested applications are discussed.
9.) [The topical treatment of atrophic-erosive oral lichen planus with fluocinonide in a bioadhesive gel, chlorhexidine and miconazole gel. A totally open trial]
Minerva Stomatol. 1996 Mar;45(3):61-8.
[Article in Italian]
Carbone M, Carrozzo M, Broccoletti R, Mattea A, Gandolfo S.
Istituto policattedra di Clinica, Universita degli Studi, Torino.
To evaluate the efficacy and long-term course of topical steroids treatment in oral lichen planus (OLP), an open trial has been carried out in 30 patients with atrophic-erosive or symptomatic varieties of OLP confirmed histologically with relative contraindications for systemic steroid treatment (namely, liver disease, peptic ulcer, diabetes, blood hypertension or osteoporosis). The treatment was the following: Fluocinonide (Topsyn) 0.025% in 4% idrossiethylcellulose gel applied 3 times/daily for two months, 2 times/daily for the next 2 months and 1 times/daily for other 2 months. Moreover, chlorhexidine (Plakout) 0.12%, 3 mouthwashes/daily and miconazole gel (Micotef) applied 1 times/daily were used for the entire period of the steroid therapy as antimycotics. The clinical evaluation of signs and symptoms was assessed on a scale of 0 to 5 and of 0 to 3, respectively. Twenty patients concluded the entire therapeutical scheme, whereas 5 (17%) interrupted the treatment for the appearance of side-effects (namely, gastroesophageal disturbances, mucosal bleeding and pruritus), 1 interrupted voluntarily the treatment and 4 cases did not present at the controls. No cases of oral candidiasis were seen. Eighteen patients (90%) had improvements of oral lesions with significant statically reductions in the scores of signs (p < 0.002) and of symptoms (p < 0.02) (Wilcoxon test). We emphasize also that in 61% of the responders the oral conditions were stable after 6 months of follow-up. In conclusion our results suggest the following: a) fluocinonide is an effective and safe drug for the treatment of OLP, especially in addition with chlorehixidine and miconazole; b) the stability of our results demonstrates that probably an adequate steroid therapeutical scheme is more useful than continuous steroid administration in the treatment of OLP.
ugh a blood transfusion.
10.) [The efficacy of cyclosporin for topical use in oral lichen planus]
Source: http://www.hairsite2.com/
[The efficacy of cyclosporin for topical use in oral lichen
planus]
Minerva Stomatol. 1994 Apr;43(4):129-32.
[Article in Italian]
Pacor ML, Biasi D, Urbani G, Lombardo G, Lunardi C.
Clinica Medica, Universita degli Studi di Verona.
Oral lichen planus is a disease characterized by long
symptomatic phases unresponsive to the usual therapy. Many
groups have used different drugs in the treatment of lichen
planus: topically applied retinoic acid, temarotene,
antimycotic agents corticosteroids and immunosuppressive
agents, with unsatisfactory results. Recently it has been
suggested that topical cyclosporine might improve the lesions
of oral lichen planus. The aim of this study was to evaluate
the usefulness of this therapy in our patients. Fourteen
patients, 6 males and 8 females, mean age 47 years, with oral
lichen planus were enrolled in the study. All the patients
were instructed to swish 5 ml of solution (500 mg) of
cyclosporine in the mouth three times a day for three months.
Clinical evaluation was performed before therapy and every two
weeks afterwards. At each visit serum levels of cyclosporine,
creatinine, total and direct bilirubin and complete blood
count were performed. No side effects or blood test
alterations were detected in any patient and cyclosporine
serum level was always undetectable. Symptoms and oral lesions
had a beneficial effect already after one month of therapy.
Our results confirm that cyclosporine is useful in the
treatment of oral lichen planus.
Levamisole and/or Chinese medicinal herbs can modulate the serum level of squamous cell carcinoma associated antigen in patients with erosive oral lichen planus.
J Oral Pathol Med. 2001 Oct;30(9):542-8.
Sun A, Chiang CP.
School of Dentistry, College of Medicine, National Taiwan University, No. 1 Chang-Te Street, Taipei, Taiwan.
The serum levels of squamous cell carcinoma associated antigen (SCCA) were determined by a microparticle enzyme immunoassay in a group of patients with stage I oral squamous cell carcinoma (OSCC), major or minor type erosive oral lichen planus (EOLP), recurrent aphthous stomatitis (RAS), Behcet's disease (BD), oral leukoplakia (OL), or oral submucous fibrosis (OSF), and in normal control subjects. About 97% of the normal control subjects and the patients with minor type EOLP, RAS, BD, OL or OSF had a serum level of SCCA within the normal limit of 1.2 ng/ml. However, 6 of the 12 (50%) patients with stage I OSCC and 14 of the 31 (45.2%) patients with major type EOLP had a serum level of SCCA greater than 1.2 ng/ml. The mean serum level of SCCA in stage I OSCC patients (1.38+/-1.16 ng/ml) or in major type EOLP patients (1.32+/-1.23 ng/ml) was significantly higher than that in normal control subjects (P<0.001) and that in the patients with minor type EOLP (P<0.001), RAS (P<0.001), BD (P<0.05), OL (P<0.05), or OSF (P<0.05). Either major or minor type EOLP patients could obtain a significant mean reduction of the serum SCCA level of 0.34-0.63 ng/ml after treatment with levamisole and/or Chinese medicinal herbs for 1-30 months. Combination therapy with levamisole plus Chinese medicinal herbs could achieve a shorter duration of treatment to get complete remission than the single therapy with either levamisole only or Chinese medicinal herbs only. We conclude that levamisole and/or Chinese medicinal herbs can modulate the serum SCCA level in EOLP patients. SCCA may be a useful marker in evaluating therapeutic effects and in monitoring the disease status of EOLP. For EOLP patients, the combination therapy is superior to the single therapy of levamisole or of Chinese medicinal herbs.
12.) Efficacy of fluocinolone acetonide gel in the treatment of oral lichen planus.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
2000 Jan;89(1):42-5.
Buajeeb W, Pobrurksa C, Kraivaphan P.
Department of Oral Medicine, Mahidol University, Bangkok,
Thailand.
OBJECTIVE: The purpose of this study was to compare the
efficacy of fluocinolone acetonide gel 0.1% in 2 base forms
(numbers 1 and 2) with fluocinolone acetonide in an oral
base 0.1%. STUDY DESIGN: Forty-eight patients with
histologically confirmed oral lichen planus were enrolled in
the study. Lesions were scored ranging from 0 (no lesion) to
5 (large erosion) according to the severity. Patients were
randomly given fluocinolone acetonide in an oral base,
fluocinolone acetonide gel no. 1 or no. 2. They were asked
to apply the medication on dried lesions 4 times a day. The
lesions were evaluated after 2 and 4 weeks of treatment. The
severity scores were analyzed by the Kruskal-Wallis k-sample
test. RESULTS: Patients who received fluocinolone acetonide
in an oral base and those who received fluocinolone
acetonide gel no. 1 and no. 2 improved from the average
score of 3.0, 3.0, and 2.9 to 1.5, 1.5, and 1.6,
respectively. There were no statistically significant
differences in score changes noted in the 3 groups. The
results indicate that fluocinolone acetonide gel no. 1 and
no. 2 and fluocinolone acetonide in an oral base provide
similar efficacy in the treatment of oral lichen planus.
CONCLUSION: Fluocinolone acetonide gel 0.1% is a safe and
effective alternative therapy to fluocinolone acetonide in
an oral base 0.1% in the treatment of oral lichen planus.
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DATA-MÉDICOS/ JOURNAL/SEPTEMBER 2.003-2024/ DR. JOSE
LAPENTA R.
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Produced by Dr. José Lapenta R. Dermatologist
Venezuela
1.998-2.024
Producido por Dr. José Lapenta R. Dermatólogo Venezuela 1.998-2.0024
Tlf: 0414-2976087 - 04127766810
