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Kirtschig G, Kinberger M. [Genital lichen sclerosus and lichen planus]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:22-29. [PMID: 38133692 DOI: 10.1007/s00105-023-05267-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/23/2023]
Abstract
Lichen sclerosus (LS) and lichen planus (LP) are chronic inflammatory dermatoses of unknown aetiology. They pose the most important differential diagnoses of inflammatory dermatoses in the genital area. There is often a delay in diagnosing LS and LP and subsequently treatment is initiated late in the course of the disease, which will lead to scarring and a decreased quality of life. There is an increased risk of the development of malignancies in the genital area in both diseases; however, early and continuous treatment with potent topical steroids will decrease this risk.
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Affiliation(s)
- Gudula Kirtschig
- Medbase Gesundheitszentrum, Unterer Graben 1, 8500, Frauenfeld, Schweiz.
| | - Maria Kinberger
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
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2
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Serafini G, De Biase A, Lamazza L, Mazzucchi G, Lollobrigida M. Efficacy of Topical Treatments for the Management of Symptomatic Oral Lichen Planus: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1202. [PMID: 36673955 PMCID: PMC9859481 DOI: 10.3390/ijerph20021202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
Oral lichen planus (OLP) is a chronic mucosal inflammatory disease associated with T-cell-mediated immunological dysfunction. Symptomatic OLP is a painful condition, and complete healing is often not achieved. The aim of this systematic review was to assess the effectiveness of topical drugs, medications, and other interventions compared to placebo or to other treatments in pain reduction and clinical resolution in adult patients with symptomatic OLP. A detailed electronic literature search was performed through the MEDLINE (PubMed) database between 1 January 2005 and 30 September 2022. Eligible studies were selected based on the inclusion criteria, and a quality assessment was conducted. From 649 titles, 121 articles were selected as abstracts, 75 papers were assessed as full text, along with 15 other papers obtained through a manual search. A total of 15 RCTs were finally included in the review process. Because of the significant heterogeneity in the study design of the included studies, no meta-analysis of the data could be performed. Topical corticosteroids represent the first-line treatment in the management of symptomatic OLP due to their efficacy and minimal adverse effects. Calcineurin inhibitors seem to be equally effective and are indicated in recalcitrant cases, extensive lesions, patients susceptible to oral candidiasis, or cases unresponsive to corticosteroids. Other treatments, such as aloe vera, chamomile, isotretinoin, ozone, and laser therapy, could be beneficial as adjunct therapies in association with first-line treatments.
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Affiliation(s)
- Giorgio Serafini
- Department of Oral and Maxillo Facial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy
| | | | - Luca Lamazza
- Department of Oral and Maxillo Facial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy
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González-Serrano J, Serrano J, Sanz M, Torres J, Hernández G, López-Pintor RM. Efficacy and safety of a bioadhesive gel containing propolis extract, nanovitamin C and nanovitamin E on desquamative gingivitis: a double-blind, randomized, clinical trial. Clin Oral Investig 2023; 27:879-888. [PMID: 35900605 PMCID: PMC9889524 DOI: 10.1007/s00784-022-04653-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate the efficacy of a gel-containing propolis extract, nanovitamin C, and nanovitamin E as adjuvants to professional plaque removal on desquamative gingivitis (DG). MATERIALS AND METHODS A randomized clinical trial was conducted on patients suffering DG due to mucocutaneous diseases. Patients received professional supragingival prophylaxis with oral hygiene instructions and were randomly assigned to use test or control gels as toothpaste and to apply it on DG lesions 3 times/day for 4 weeks. DG clinical score (DGCS), clinical periodontal variables, and visual analog scale (VAS) for pain and oral health impact profile (OHIP-14) were collected at baseline, 2 and 4 weeks. RESULTS Twenty-two patients were randomly assigned to test (n = 11) or control group (n = 11). Eighteen had diagnosis of oral lichen planus and four of mucous membrane pemphigoid. DGCS statistically decreased in both groups after treatment with no significant differences between groups. Clinical periodontal outcomes decreased in both groups, but no significant differences were observed. Periodontal variables statistically improved only in test group after treatment. VAS and OHIP-14 scores decreased in test and control groups without significant differences. However, only one test group showed a statistically significant decrease in VAS and OHIP-14 scores after treatment. No adverse effects were reported. CONCLUSIONS Test gel may alleviate DG and improve quality of life without side effects. CLINICAL RELEVANCE A gel-containing propolis extract, nanovitamin C, and nanovitamin E as adjuvants to mechanical debridement may improve both clinical and patient related outcomes in DG patients without side effects. CLINICAL TRIAL REGISTRATION The study protocol was registered at clinicaltrials.gov with the following number: NCT05124366 on October 16, 2021.
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Affiliation(s)
- José González-Serrano
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University of Madrid. Plaza Ramón y Cajal S/N, 28040 Madrid, Spain
| | - Julia Serrano
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University of Madrid. Plaza Ramón y Cajal S/N, 28040 Madrid, Spain
| | - Mariano Sanz
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University of Madrid. Plaza Ramón y Cajal S/N, 28040 Madrid, Spain
| | - Jesús Torres
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University of Madrid. Plaza Ramón y Cajal S/N, 28040 Madrid, Spain
| | - Gonzalo Hernández
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University of Madrid. Plaza Ramón y Cajal S/N, 28040 Madrid, Spain
| | - Rosa María López-Pintor
- grid.4795.f0000 0001 2157 7667Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University of Madrid. Plaza Ramón y Cajal S/N, 28040 Madrid, Spain ,grid.4795.f0000 0001 2157 7667Departamento de Especialidades Clínicas Odontológicas. Facultad de Odontología, Universidad Complutense de Madrid. Plaza Ramón Y Cajal S/N, 28040 Madrid, Spain
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Topical Cyclosporine in Oral Lichen Planus-A Series of 21 Open-Label, Biphasic, Single-Patient Observations. J Clin Med 2021; 10:jcm10225454. [PMID: 34830736 PMCID: PMC8622196 DOI: 10.3390/jcm10225454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
Topical cyclosporine (CSA) has been reported as an alternative treatment in steroid-refractory oral lichen planus (OLP), but evidence is limited and conflicting. An N-of-1 trial setting could be appropriate to evaluate interindividual differences in treatment response. We studied a series of 21 open-label, biphasic single-patient observations. Patients (15 women, 6 men) with OLP recalcitrant to topical steroids received four weeks of CSA mouth rinse (200 mg/twice daily) followed by four weeks of drug withdrawal. Pain (visual analogue scale (VAS) score), disease extent (physicians’ global assessment (PGA) score) and quality of life (Dermatology Life Quality Index (DLQI) score,) were assessed at baseline (T0), after four weeks of treatment (T1) and after another four weeks without treatment (T2). Median age was 58 years (interquartile range/IQR = 52–67) and median disease duration was 18 months (IQR = 12–44). Median baseline VAS score decreased significantly at T1 (p = 0.0003) and increased at T2 (p = 0.032) (T0 = 5 (IQR = 3–6.5); T1 = 2 (IQR = 0.5–3.4); T2 = 3 (IQR = 2–4.8)). Similarly, median baseline PGA score decreased significantly at T1 (p = 0.001) and increased at T2 (p = 0.007) (T0 = 2 (IQR = 1.3–2.5); T1 = 1 (IQR = 1–2); T2 = 2 (IQR = 1–2)). Median baseline DLQI score also decreased significantly at T1 (p =.027) but did not change at T2 (p = 0.5) (T0 = 2.5 (IQR = 1–5.8); T1 = 1 (IQR = 0–3); T2 = 1 (IQR = 1–4)). CSA responders (n = 16) had significantly higher median baseline VAS scores (5.2 (IQR = 5–6.5)) than nonresponders (n =5) (2 (IQR = 2–3.5) (p = 0.02). In our study, pain, disease extent and quality of life of patients with OLP improved significantly during therapy with low-dose CSA mouth rinse and exacerbated after drug withdrawal. Remarkably, patients with high initial VAS scores seemed to profit most.
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Skullerud KH, Gjersvik P, Pripp AH, Qvigstad E, Helgesen ALO. Apremilast for genital erosive lichen planus in women (the AP-GELP Study): study protocol for a randomised placebo-controlled clinical trial. Trials 2021; 22:469. [PMID: 34284808 PMCID: PMC8290211 DOI: 10.1186/s13063-021-05428-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background Genital erosive lichen planus (GELP) is a genital subtype of lichen planus, a chronic autoimmune inflammatory disease of unknown aetiology. In women, GELP is characterised by painful vulvo-vaginal mucosal erosions and scarring, often resulting in poor sexual health and reduced quality of life. Treatment options are limited and often with little effect. Apremilast, a phosphodiesterase 4-inhibitor, has been shown to have a positive effect on psoriasis and other inflammatory skin diseases. We aim to investigate the effect and safety of peroral apremilast in women with GELP in a randomised placebo-controlled double-blinded clinical trial. Methods We will recruit 42 adult women with characteristic clinical and/or histological features of moderate-to-severe GELP from a specialised vulva clinic in Oslo, Norway. The patients will be randomised 1:1 to either apremilast 30 mg BID (with an initial dose titration on days 1–6) or a placebo for 24 weeks. The concomitant use of topical corticosteroids will be allowed. The primary end point will be the mean GELP score, a clinical scoring system, at week 24 in the apremilast-treated patients versus the placebo-treated patients. The secondary end points will include the mean GELP score improvement from weeks 0 to 24, patient-reported use of topical steroids, the pain score on a visual analogue scale and the number of patients with GELP score improvements at weeks 16 and 24. The Physician Global Assessment , Patient Global Assessment and selected quality of life and sexual function assessments will be recorded at weeks 0, 16 and 24. The exploratory endpoints include description of immunohistochemical changes before and after apremilast therapy, assessed in vulvar or vaginal biopsies at weeks 0 and 24. Regular follow-ups for possible adverse events will be conducted. Discussion The study design is based on experience from studies on apremilast in other inflammatory skin diseases using equivalent apremilast doses for approved indications. The trial may provide evidence for the use of apremilast in women with this burdensome genital dermatosis. Trial registration ClinicalTrials.govNCT0365666. Registered on 4 September 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05428-w.
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Affiliation(s)
- Kristin Helene Skullerud
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Petter Gjersvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Erik Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Anne Lise Ording Helgesen
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway.,Department of Dermatology, Oslo University Hospital, Oslo, Norway
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Kalaskar AR, Bhowate RR, Kalaskar RR, Walde SR, Ramteke RD, Banode PP. Efficacy of Herbal Interventions in Oral Lichen Planus: A Systematic Review. Contemp Clin Dent 2020; 11:311-319. [PMID: 33850395 PMCID: PMC8035840 DOI: 10.4103/ccd.ccd_320_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/24/2020] [Accepted: 09/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: Oral lichen planus (OLP) is a chronic autoimmune condition requiring prompt treatment to alleviate the signs and symptoms. There is weak evidence emphasizing the efficacy of any one therapy. Steroids, of all the therapies, have proved to be effective and hence considered as the standard care for OLP. However, the complications associated with it further worsen the patient's condition. Alternative safe approaches such as herbal interventions (HIs) have been tried in OLP. Their efficacies could only be evaluated from properly designed research protocols such as randomized controlled trials (RCTs). The present systematic review aims to assess the efficacy of HIs compared to steroids in RCTs involving OLP. Materials and Methods: An extensive search for HIs in OLP was conducted in PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, and gray literature. Eight studies fulfilled the eligibility criteria. Results: In all the studies, clinical severity was significantly reduced in within-group comparisons, whereas between-group comparisons showed nonsignificant results, except for total glucosides of paeony capsules. Conclusion: Efficacy of herbal therapy in OLP should be weighed against the high bias in the studies.
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Affiliation(s)
- Ashita R Kalaskar
- Department of Oral Medicine and Radiology, Government Dental College and Hospital, Nagpur, Maharashtra, India
| | - Rahul R Bhowate
- Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, DMIMS (DU), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Ritesh R Kalaskar
- Department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Nagpur, Maharashtra, India
| | - Sheelpriya R Walde
- Department of Quality Assurance, Gurunanak College of Pharmacy, Nagpur, Maharashtra, India
| | - Rachana D Ramteke
- Department of Kaumar Hritya, Shri Ayurvedic College and Hospital, Nagpur, Maharashtra, India
| | - Priyanka P Banode
- Department of Periodontology, Sharad Pawar Dental College, DMIMS DU, Sawangi (Meghe), Wardha, Maharashtra, India
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Veneri F, Bardellini E, Amadori F, Conti G, Majorana A. Efficacy of ozonized water for the treatment of erosive oral lichen planus: a randomized controlled study. Med Oral Patol Oral Cir Bucal 2020; 25:e675-e682. [PMID: 32683383 PMCID: PMC7473429 DOI: 10.4317/medoral.23693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 06/14/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Management of erosive Oral Lichen Planus (eOLP) is challenging. Currently, topical corticosteroids are widely used as first-line therapy, but they might be associated with side-effects and incomplete clinical response. Among non-pharmacological strategies, ozone at low medical concentration has proven to induce a mild activation of protective anti-oxidant pathways, thus exerting therapeutic effects in many inflammatory diseases. The aim of this randomized controlled study was to investigate the effectiveness of ozonized water in association with conventional topical corticosteroids for the treatment of eOLP. MATERIAL AND METHODS Fifty-one patients were included in the study and randomized into 2 groups: study group (n=26) included patients receiving ozonized water treatment; control group (n=25) included patients receiving placebo treatment (i.e. double-distilled water). Treatment protocol consisted of 1-minute oral rinses, repeated for 4 times, twice a week for 4 weeks. All patients received conventional corticosteroid topical therapy (betamethasone soluble tablets, 2 rinses/day for 4 weeks). Assessment of size of lesions, sign and pain scores was performed before treatment, after 2 weeks of treatment (T1) and at the end of 4-week treatment (T2). Efficacy Index (EI) of treatment, candidiasis and relapse rates were also recorded. RESULTS All patients experienced significant improvement of sign and pain scores with a higher rate of improvement in ozone-treated group (T1 improvement rates: Thongprasom 92.2% vs 28%; VAS pain 76.9% vs 32%; p<0.05). Pain and size reduction were significantly higher in ozone-treated group both at T1 and T2 (p<0.05). Ozone-treated group showed a higher EI at every time point (T0-T2: 72.77% vs 37.66%, p<0.01). Candidiasis (32% vs 11.5%) and relapse (40% vs 34.6%) rates were higher in control group, however the differences were not statistically significant. CONCLUSIONS Within the limitations of this study, ozonized water seems to be effective as an adjunct therapy, in combination with topical corticosteroids, for the treatment of eOLP.
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Affiliation(s)
| | - E Bardellini
- Dental Clinic, p.le Spedali Civili n.1 25133 Brescia
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Rotaru DI, Sofineti D, Bolboacă SD, Bulboacă AE. Diagnostic Criteria of Oral Lichen Planus: A Narrative Review. Acta Clin Croat 2020; 59:513-522. [PMID: 34177062 PMCID: PMC8212651 DOI: 10.20471/acc.2020.59.03.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/27/2018] [Indexed: 01/29/2023] Open
Abstract
Oral lichen planus (OLP) is a disease with unclear etiology or pathogenesis, categorized by the World Health Organization as oral lichenoid lesions (OLL; interface mucositis or lichenoid mucositis) into a group of potentially malignant disorders. The diagnosis of OLP is challenging because the clinical and histopathologic features are frequently seen in OLP, OLL and/or other mucosal diseases with lichenoid characteristics. Furthermore, OLP has a dynamic nature. Finally, an early and precise diagnosis can play a decisive role, allowing timely treatment and thus improving the patient quality of life. This article summarizes the state-of-the-art regarding OLP and OLL and discusses the challenges faced on making an accurate diagnosis, aiming to provide a practical guideline for the postgraduates and oral physicians in reaching the diagnosis of these lesions.
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Dunaway S, Tyler K, Kaffenberger J. Update on treatments for erosive vulvovaginal lichen planus. Int J Dermatol 2020; 59:297-302. [PMID: 31631346 DOI: 10.1111/ijd.14692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/02/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022]
Abstract
Vulvovaginal lichen planus (VVLP) is a debilitating disease that causes significant pain and psychological distress. Management is made difficult by the chronic course of the disease and its resistance to treatment. While topical steroids have been accepted as the first-line treatment, they fail to achieve symptomatic control in approximately 40% of patients. Second-line therapies include other topical treatments such as calcineurin inhibitors, systemic therapies including oral steroids, methotrexate, mycophenolate mofetil, biologics, and tacrolimus, and procedural options including surgery and dilation, photodynamic therapy, and ultrasound. This review provides an overview of the current treatments and explores the level of evidence supporting each of them.
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Affiliation(s)
- Spencer Dunaway
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kelly Tyler
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jessica Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Photodynamic therapy in oral lichen planus: A prospective case-controlled pilot study. Sci Rep 2020; 10:1667. [PMID: 32015380 PMCID: PMC6997407 DOI: 10.1038/s41598-020-58548-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/09/2020] [Indexed: 12/21/2022] Open
Abstract
Oral lichen planus (OLP) is a common, chronic relapsing inflammatory disorder of the mucous membranes, which causes major discomfort. Current treatment includes topical/systemic glucocorticoids, immune modulators and systemic immunosuppressants, which may lead to considerable side-effects. The aim of this study was to determine the clinical and immunological efficacy of photodynamic therapy (PDT) in OLP as an alternative, easy-to-use, safe and non-invasive treatment. Twenty patients with OLP were treated with PDT in a prospective case-controlled pilot-study. PDT was performed on the most extensive oral lesion in 4 sessions (day 1, 3, 7, 14). Peripheral blood and lesional T cells were analysed before (day 1) and after PDT treatment (day 28). PDT led to a statistically significant reduction of clinical parameters (lesion size, ABSIS, Thongprasom-score) and improvement of all evaluated quality-of-life (QOL) items. The clinical improvement was accompanied by a significant decrease of the relative number of CD4+ and CD8+ T cells in mucosal OLP-lesions. Furthermore, CXCL10 plasma levels were decreased and the number of activated peripheral CD4 + CD137+ and CD8 + CD137+ T cells and IL-17-secreting T cells was diminished. PDT treatment in OLP leads to lesion reduction and improvement of QOL, and induces local and systemic anti-inflammatory effects. The study identifies PDT as a novel therapeutic option in OLP.
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Mi L, Zhang H, Zhang D, Zhang M. Lichen planus with multiple system involvement including the mouth, vagina, urethra, and scalp: a case report. ACTA ACUST UNITED AC 2019; 52:e8823. [PMID: 31618369 PMCID: PMC6787949 DOI: 10.1590/1414-431x20198823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/02/2019] [Indexed: 01/03/2023]
Abstract
This is a case report of lichen planus (LP) with multiple system involvement. A 35-year-old female patient was admitted in November 2014 with a 5-year history of painful/difficult sexual intercourse and loss of oral mucosa, and an 8-year history of focal hair loss. Earlier, the patient had been unable to adhere to corticosteroid therapy because of severe adverse side effects. In September 2014, labia minora mucosa defects and stricture of the urethral orifice (with dysuria), vaginal orifice, and vagina were identified. Biopsy was performed and a diagnosis of erosive LP was made. The patient was treated with an oral immunosuppressant (cyclosporine A) and urethral/vaginal dilatation. Urine flow rate and sex life were improved after 6 months and she discontinued medication. Four years later, the patient reported a good overall treatment efficacy. LP can involve multiple systems and should be considered in patients with dyspareunia. Immunosuppressive agents can achieve a satisfactory effect in patients with contraindication to corticosteroid.
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Affiliation(s)
- Lan Mi
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Hong Zhang
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Dai Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Miao Zhang
- Department of Obstetrics and Gynecology, Beijing Aiyuhua Hospital for Women and Children, Beijing, China
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Help for Future Research: Lessons Learned in Trial Design, Recruitment, and Delivery From the "hELP" Study. J Low Genit Tract Dis 2019; 22:405-408. [PMID: 29975332 PMCID: PMC6161816 DOI: 10.1097/lgt.0000000000000407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gobbo M, Rupel K, Zoi V, Perinetti G, Ottaviani G, Di Lenarda R, Bevilacqua L, Woo SB, Biasotto M. Scoring systems for Oral Lichen Planus used by differently experienced raters. Med Oral Patol Oral Cir Bucal 2017; 22:e562-e571. [PMID: 28809373 PMCID: PMC5694178 DOI: 10.4317/medoral.21833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Indexed: 01/30/2023] Open
Abstract
Background Scoring systems have been widely used to evaluate the severity and activity of oral lichen planus (OLP). The aim of the present study was to compare two existing (one modified) scoring systems in the evaluation of OLP severity and correlation with pain. Three differently experienced raters were involved. Material and Methods Consecutive patients with OLP were assessed for pain using the Visual Analogue Scale and examined at 10 intraoral sites before starting (T0) and three weeks after (T1) steroid therapy (Clobetasol). Three differently experienced raters evaluated photographs using two scoring systems designated White-Erosive-Atrophic (WEA) modified from an older WEA system (WEA-MOD) and Reticular-erythematous-Ulcerative (REU) systems. WEA-MOD Kendall’s W and interclass correlation coefficient were calculated and correlation between REU/WEA-MOD and pain was calculated using Spearman coefficient. Results Most patients showed lesions on buccal mucosa (85-93,5%) and maxillary/mandibular gingivae (31,8-31,2%), predominantly reticular. At T0, Kendall-W coefficients of 0.89 and 0.74 were obtained for the REU and WEA respectively. At T1, Kendall-W coefficients of 0.83 and 0.58 were obtained for the REU and WEA respectively. Interclass correlation coefficient ranged from 0.87 to 0.90 for REU and from 0.58 to 0.87 for WEA. REU and WEA scores significantly decreased after therapy (p<0.000) as well as VAS (p<0.05). REU score showed correlation with VAS. Conclusions All the raters achieved comparable measures using REU whereas WEA and WEA-MOD seem less reproducible. REU seems to correlate to disease activity and pain. Key words:Oral lichen planus, scoring system, VAS, REU, WEA, rater.
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Affiliation(s)
- M Gobbo
- Division of oral medicine and pathology, Dental Science Department, Ospedale Maggiore, 34100, Trieste, Italy,
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Topical application of morphine for wound healing and analgesia in patients with oral lichen planus: a randomized, double-blind, placebo-controlled study. Clin Oral Investig 2017; 22:305-311. [PMID: 28353022 DOI: 10.1007/s00784-017-2112-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the effect of topical morphine on erosive/ulcerative lesions in patients with oral lichen planus (OLP). Previous studies reported on an enhanced remission of skin wounds when morphine was applied topically. MATERIALS AND METHODS This was single-center, prospective, double-blind, placebo-controlled, randomized, multi-arm (3), phase II study (RCT). Patients diagnosed with erosive and/or ulcerative OLP applied 0.2 or 0.4 mg morphine dissolved in glycerine, three times a day for 5 days. The primary outcome was the extent of healing. Secondary outcomes were as follows: (1) effect on pain, (2) presence and severity of opioid-related central and local side effects, (3) whether patients required 'rescue medication' for treatment of pain, and (4) total intake of test substance. RESULTS A total of 123 patients were screened for eligibility, 45 patients were recruited into the study, and 43 completed it. Patients applied a solution of either placebo or 0.2 or 0.4% morphine in groups of n = 12, n = 15, and n = 16, respectively. Extent of healing was similar in the three groups. Severity of pain was minor pre-treatment and throughout the course of the study. Only minor adverse events were reported (dry mouth, burning sensation). CONCLUSION Morphine did not enhance wound healing compared to placebo-treated patients. Healing was observed in all groups, which may be attributed to an effect of glycerine or to the natural course of the disease. Patients experienced only mild levels of pain, rendering the model insensitive for assessing pain. CLINICAL RELEVANCE OLP is a chronic disease and current treatment options are limited. Healing occurred in all three study groups, an effect we attribute to the carrier.
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Simpson RC, Murphy R, Bratton DJ, Sydes MR, Wilkes S, Nankervis H, Dowey S, Thomas KS. Systemic therapy for vulval Erosive Lichen Planus (the 'hELP' trial): study protocol for a randomised controlled trial. Trials 2016; 17:2. [PMID: 26729245 PMCID: PMC4698814 DOI: 10.1186/s13063-015-1133-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Erosive lichen planus affecting the vulva (ELPV) is a relatively rare, chronic condition causing painful raw areas in the vulvovaginal region. Symptoms are pain and burning, which impact upon daily living. There is paucity of evidence regarding therapy. A 2012 Cochrane systematic review found no randomised controlled trials (RCTs) in this field. Topically administered corticosteroids are the accepted first-line therapy: however, there is uncertainty as to which second-line treatments to use. Several systemic agents have been clinically noted to show promise for ELPV refractory to topically administered corticosteroids but there is no RCT evidence to support these. The 'hELP' study is a RCT with an internal pilot phase designed to provide high-quality evidence. METHODS/DESIGN The objective is to test whether systemic therapy in addition to standard topical therapy is a beneficial second-line treatment for ELPV. Adjunctive systemic therapies used are hydroxychloroquine, methotrexate, mycophenolate mofetil and prednisolone. Topical therapy plus a short course of prednisolone given orally is considered the comparator intervention. The trial is a four-armed, open-label, pragmatic RCT which uses a blinded independent clinical assessor. To provide 80 % power for each comparison, 96 participants are required in total. The pilot phase aims to recruit 40 participants. The primary clinical outcome is the proportion of patients achieving treatment success at 6 months. 'Success' is defined by a composite measure of Patient Global Assessment score of 0 or 1 on a 4-point scale plus improvement from baseline on clinical photographs scored by a clinician blinded to treatment allocation. Secondary clinical outcomes include 6-month assessment of: (1) Reduction in pain/soreness; (2) Global assessment of disease; (3) Response at other affected mucosal sites; (4) Hospital Anxiety and Depression Scale scores; (5) Sexual function; (6) Health-related quality of life using 'Short Form 36' and 'Skindex-29' questionnaires; (7) Days of topical steroid use; (8) Treatment satisfaction; (9) Discontinuation of medications due to treatment failure; (10) Per participant cost of intervention in each treatment group. Adverse events will also be reported. DISCUSSION 'hELP' is the first RCT to address second-line treatment of ELPV. The trial has encountered unique methodological challenges and has required collaborative efforts of the UK Dermatology Clinical Trials Network alongside expert clinicians. TRIAL REGISTRATION CURRENT CONTROLLED TRIALS ISRCTN 81883379 . Date of registration 12 June 2014.
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Affiliation(s)
- Rosalind C Simpson
- Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Lenton Lane, NG7 2NR, Nottingham, UK.
| | - Ruth Murphy
- Nottingham University Hospitals, Queen's Medical Centre Campus, Derby Road, Nottingham, NG7 2UH, UK.
| | - Daniel J Bratton
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Aviation House, 125, Kingsway, London, WC2B 6NH, UK.
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Aviation House, 125, Kingsway, London, WC2B 6NH, UK.
| | - Sally Wilkes
- Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Lenton Lane, NG7 2NR, Nottingham, UK.
| | - Helen Nankervis
- Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Lenton Lane, NG7 2NR, Nottingham, UK.
| | - Shelley Dowey
- Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Lenton Lane, NG7 2NR, Nottingham, UK.
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Lenton Lane, NG7 2NR, Nottingham, UK.
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Garcovich S, Garcovich M, Capizzi R, Gasbarrini A, Zocco MA. Cutaneous manifestations of hepatitis C in the era of new antiviral agents. World J Hepatol 2015; 7:2740-2748. [PMID: 26644817 PMCID: PMC4663393 DOI: 10.4254/wjh.v7.i27.2740] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/23/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
The association of chronic hepatitis C virus (HCV) infection with a wide spectrum of cutaneous manifestations has been widely reported in the literature, with varying strength of epidemiological association. Skin diseases which are certainly related with chronic HCV infection due to a strong epidemiological and pathogenetic association are mixed cryoglobulinemia, lichen planus and porphyria cutanea tarda. Chronic pruritus and necrolytic acral erythema are conditions that may share a possible association with HCV infection, while several immune-mediated inflammatory skin conditions, such as psoriasis, chronic urticaria and vitiligo, have been only anecdotally reported in the setting of chronic HCV infection. Traditional interferon-based treatment regimens for HCV infection are associated with substantial toxicity and a high-risk of immune-related adverse events, while the advent of new direct-acting antivirals with sustained virological response and improved tolerability will open the door for all-oral, interferon-free regimens. In the new era of these direct acting antivirals there will be hopefully a renewed interest in extra-hepatic manifestations of HCV infection. The aim of the present paper is to review the main cutaneous HCV-related disorders - mixed cryoglobulinemia, lichen planus, porphyria cutanea tarda and chronic pruritus - and to discuss the potential impact of new antiviral treatments on the course of these extra-hepatic manifestations of chronic HCV infection.
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Rivas-Tolosa N, Requena C, Llombart B, Alcalá R, Serra-Guillén C, Calomarde L, Nagore E, Guillén C, Sanmartín O. Antimalarial Drugs for the Treatment of Oral Erosive Lichen Planus. Dermatology 2015; 232:86-90. [DOI: 10.1159/000439588] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/20/2015] [Indexed: 11/19/2022] Open
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Mustafa MB, Porter SR, Smoller BR, Sitaru C. Oral mucosal manifestations of autoimmune skin diseases. Autoimmun Rev 2015; 14:930-51. [PMID: 26117595 DOI: 10.1016/j.autrev.2015.06.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023]
Abstract
A group of autoimmune diseases is characterised by autoantibodies against epithelial adhesion structures and/or tissue-tropic lymphocytes driving inflammatory processes resulting in specific pathology at the mucosal surfaces and the skin. The most frequent site of mucosal involvement in autoimmune diseases is the oral cavity. Broadly, these diseases include conditions affecting the cell-cell adhesion causing intra-epithelial blistering and those where autoantibodies or infiltration lymphocytes cause a loss of cell-matrix adhesion or interface inflammation. Clinically, patients present with blistering, erosions and ulcers that may affect the skin as well as further mucosal surfaces of the eyes, nose and genitalia. While the autoimmune disease may be suspected based on clinical manifestations, demonstration of tissue-bound and circulating autoantibodies, or lymphocytic infiltrates, by various methods including histological examination, direct and indirect immunofluorescence microscopy, immunoblotting and quantitative immunoassay is a prerequisite for definitive diagnosis. Given the frequency of oral involvement and the fact that oral mucosa is the initially affected site in many cases, the informed practitioner should be well acquainted with diagnostic and therapeutic aspects of autoimmune dermatosis with oral involvement. This paper reviews the pathogenesis and clinical presentation of these conditions in the oral cavity with a specific emphasis on their differential diagnosis and current management approaches.
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Affiliation(s)
- Mayson B Mustafa
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; Oral medicine section, Department of Oral and Maxillofacial Surgery, University of Khartoum, Faculty of Dentistry, Khartoum, Sudan
| | | | - Bruce R Smoller
- Department of Pathology, University of Rochester, School of Medicine and Dentistry, USA
| | - Cassian Sitaru
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; BIOSS Centre for Biological Signalling Studies, Signalhaus Freiburg, Schänzlestr. 18, 79104 Freiburg, Germany.
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Cheng H, Oakley A, Rowan D, Lamont D. Diagnostic criteria in 72 women with erosive vulvovaginal lichen planus. Australas J Dermatol 2015; 57:284-287. [DOI: 10.1111/ajd.12355] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 04/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Harriet Cheng
- Department of Dermatology; Waikato Hospital; Hamilton New Zealand
| | - Amanda Oakley
- Department of Dermatology; Waikato Hospital; Hamilton New Zealand
| | - Darion Rowan
- Department of Gynaecology Oncology; National Womens Health; Auckland New Zealand
| | - Duncan Lamont
- Department of Pathology; Waikato Hospital; Hamilton New Zealand
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Stone SJ, Heasman PA, Staines KS, McCracken GI. The impact of structured plaque control for patients with gingival manifestations of oral lichen planus: a randomized controlled study. J Clin Periodontol 2015; 42:356-62. [DOI: 10.1111/jcpe.12385] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Simon J. Stone
- School of Dental Sciences; Newcastle University; Newcastle upon Tyne UK
| | - Peter A. Heasman
- School of Dental Sciences; Newcastle University; Newcastle upon Tyne UK
| | - Konrad S. Staines
- School of Oral and Dental Sciences; University of Bristol; Bristol UK
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Oral medicine: off-label cream use. Br Dent J 2014; 217:660-1. [PMID: 25524996 DOI: 10.1038/sj.bdj.2014.1107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Clinical guidelines for gynecologic care after hematopoietic SCT. Report from the international consensus project on clinical practice in chronic GVHD. Bone Marrow Transplant 2014; 50:3-9. [PMID: 25347009 DOI: 10.1038/bmt.2014.242] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 09/05/2014] [Accepted: 09/17/2014] [Indexed: 12/13/2022]
Abstract
Despite similarities relevant age- and gender-specific issues exist in the care of patients after allogeneic hematopoietic SCT (HSCT). Female genital chronic GVHD (cGVHD) has been markedly underreported in the past but has a significant impact on the patients' health and quality of life. Data on prevention and treatment of this complication are still limited. Here we present a comprehensive review summarizing the current knowledge, which was discussed during several meetings of the German, Austrian and Swiss Consensus Project on clinical practice in cGVHD. In this report, we provide recommendations for post-transplant gynecological care of cGVHD manifestations agreed upon by all participants. This includes guidelines for diagnosis, prevention, and therapeutic options and topical treatments in female patients with genital cGVHD and hormonal replacement treatment of premature ovarian failure for adult and pediatric patients and underlines the necessity for regular gynecological care and screening programs for women after HSCT.
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Ryan K, Hegarty AM, Hodgson T. Aetiology, diagnosis and treatment of oral lichen planus. Br J Hosp Med (Lond) 2014; 75:492-6. [DOI: 10.12968/hmed.2014.75.9.492] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Anne M Hegarty
- Consultant in Oral Medicine in the Department of Oral Medicine, Charles Clifford Dental Hospital, Sheffield S10 2SZ
| | - Tim Hodgson
- Consultant in Oral Medicine, Eastman Dental Hospital UCLH Foundation Trust and Eastman Dental Institute UCL, London
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Abstract
BACKGROUND Mucosal lichen planus (MLP) is a chronic mucosal disorder that often poses a therapeutic challenge to dermatologists, dentists, and gynecologists. To relieve patients' pain and discomfort, improve their quality of life, and achieve clinical improvement, various therapeutic approaches can be considered for this disease. Based on the current literature it is difficult to define any particular treatment as the main therapeutic modality. OBJECTIVE We aimed to systematically review the current literature for the effectiveness of available treatment modalities for MLP. METHODS All of the randomized controlled trials and systematic reviews of MLP were collected by searching Pubmed, EMBASE, the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, and China National Knowledge Infrastructure. Meta-analysis was performed, if possible. RESULTS Topical betamethasone valerate, clobetasol-17-propionate, and fluocinonide are effective in the treatment of oral lichen planus (OLP) when compared with placebo. Calcineurin inhibitors and topical retinoids are also beneficial treatment options. LIMITATIONS The review does not include therapies with a lower level of evidence. CONCLUSION Topical corticosteroids are the mainstay of therapy for OLP. High-quality evidence is lacking for the treatment of lichen planus.
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Affiliation(s)
- Parastoo Davari
- Department of Dermatology, University of California, Davis, 3301 C Street, Suite 1400, Sacramento, CA, 95816, USA
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Dillenburg CS, Martins MAT, Munerato MC, Marques MM, Carrard VC, Sant'Ana Filho M, Castilho RM, Martins MD. Efficacy of laser phototherapy in comparison to topical clobetasol for the treatment of oral lichen planus: a randomized controlled trial. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:068002. [PMID: 24887747 DOI: 10.1117/1.jbo.19.6.068002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 04/30/2014] [Indexed: 06/03/2023]
Abstract
Oral lichen planus (OLP) is a relatively common chronic mucocutaneous inflammatory disease and a search for novel therapeutic options has been performed. We sought to compare the efficacy of laser phototherapy (LPT) to topical clobetasol propionate 0.05% for the treatment of atrophic and erosive OLP. Forty-two patients with atrophic/erosive OLP were randomly allocated to two groups: clobetasol group (n=21): application of topical clobetasol propionate gel (0.05%) three times a day; LPT group (n=21): application of laser irradiation using InGaAlP diode laser three times a week. Evaluations were performed once a week during treatment (Days 7, 14, 21, and 30) and in four weeks (Day 60) and eight weeks (Day 90) after treatment. At the end of treatment (Day 30), significant reductions in all variables were found in both groups. The LPT group had a higher percentage of complete lesion resolution. At follow-up periods (Days 60 and 90), the LPT group maintained the clinical pattern seen at Day 30, with no recurrence of the lesions, whereas the clobetasol group exhibited worsening for all variables analyzed. These findings suggest that the LPT proved more effective than topical clobetasol 0.05% for the treatment of OLP.
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Affiliation(s)
- Caroline Siviero Dillenburg
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Marco Antonio Trevizani Martins
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Medicine, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Maria Cristina Munerato
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Medicine, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Márcia Martins Marques
- University of São Paulo, School of Dentistry, Department of Dentistry, São Paulo, São Paulo 05508-000, Brazil
| | - Vinícius Coelho Carrard
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Manoel Sant'Ana Filho
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Rogério Moraes Castilho
- University of Michigan, School of Dentistry, Laboratory of Epithelial Biology, Department of Periodontics and Oral Medicine, Ann Arbor, Michigan 48109-1078
| | - Manoela Domingues Martins
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
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Edwards SK, Bunker CB, Ziller F, van der Meijden WI. 2013 European guideline for the management of balanoposthitis. Int J STD AIDS 2014; 25:615-26. [DOI: 10.1177/0956462414533099] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/16/2014] [Indexed: 01/13/2023]
Abstract
Balanoposthitis can be caused by a disparate range of conditions affecting the penile skin. This guideline concentrates on a selected group of conditions and offers recommendations on the diagnostic tests and treatment regimens needed for the effective management of balanoposthitis.
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Affiliation(s)
- SK Edwards
- Department of Genitourinary Medicine, Cambridgeshire Community Services, Bury St Edmunds, UK
| | - CB Bunker
- Department of Dermatology, University College Hospital, London, UK
| | - Fabian Ziller
- Department of Dermatology, DRK Hospital Chemnitz-Rabenstein, Chemnitz, Germany
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Kolios AGA, Marques Maggio E, Gubler C, Cozzio A, Dummer R, French LE, Navarini AA. Oral, esophageal and cutaneous lichen ruber planus controlled with alitretinoin: case report and review of the literature. Dermatology 2013; 226:302-10. [PMID: 23948733 DOI: 10.1159/000349980] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 02/07/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Therapy-resistant lichen planus (LP) can be a challenging condition for dermatologists. There are some case reports about successful treatments with alitretinoin of cutaneous and oral, but not of esophageal LP. OBJECTIVE We present the unique case of a patient with cutaneous, oral and esophageal LP which was refractory to classical treatment options (topical clobetasol propionate and pimecrolimus, intramuscular triamcinolone acetonide); because of systemic side effects the patient did not tolerate systemic acitretin dosed up to 25 mg daily. METHODS Oral alitretinoin was used at a dose of 30 mg daily. RESULTS Both oral and skin changes as well as dysphagia completely resolved within 4 weeks without any severe side effects and the drug was used for 6 months. No papules, intraoral striae or dysphagia recurred during the 6 months of treatment. After 4 months the patient relapsed with mucosal patches so that a second cycle was initiated for 6 months where oral LP lesions resolved after 4 weeks also (with sporadic mild headache). CONCLUSION Further studies are needed to better understand the impact of alitretinoin in LP. Our observation suggests alitretinoin as a new, well-tolerated treatment option for esophageal LP after failed response to conventional treatments.
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Affiliation(s)
- Antonios G A Kolios
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
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