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Novo VM, Feletti MP, Maifrede SB, da Fonseca JZ, Cayô R, Gonçalves SS, Grão-Velloso TR. Clinical and mycological analysis of colonization by Candida spp. in oral leukoplakia and oral lichen planus. Braz J Microbiol 2024; 55:2693-2703. [PMID: 38913253 PMCID: PMC11405724 DOI: 10.1007/s42770-024-01416-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 06/04/2024] [Indexed: 06/25/2024] Open
Abstract
OBJECTIVE This study aims to analyze the prevalence of Candida spp. colonization in oral leukoplakia and oral lichen planus lesions, verify the influence of systemic and local factors, besides identify and determine the in vitro antifungal susceptibility profile of Candida species. MATERIALS AND METHODS Samples were collected by swabbing from oral lesions and healthy mucosa and cultured on Sabouraud Dextrose and CHROMagar® Candida plates. Species identification was confirmed with MALDI-TOF MS analysis. RESULTS Candida spp. was found in 36.8% of cases of oral leukoplakia and 18.2% of cases of oral lichen planus. Candida albicans was the only species found in oral lichen planus lesions (n = 2, 100%) and the most prevalent in oral leukoplakia (n = 5, 76.4%). Among the non-albicans Candida species found in oral leukoplakia were C. parapsilosis (n = 2, 25.5%) and C. tropicalis (n = 1, 14.1%). Candida isolates were susceptible to all antifungals tested. CONCLUSION C. albicans was the most commonly found species in the studied lesions. No correlation was found between systemic and local factors with positive cases of oral lichen planus. However, smoking and alcohol consumption may be associated with positive cases of oral leukoplakia, especially the non-homogeneous clinical form. In addition, there is a possible predisposition to associated Candida colonization in cases of epithelial dysplasia found in oral leukoplakia. The antifungal medications tested showed excellent efficacy against isolates.
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Affiliation(s)
| | | | | | | | - Rodrigo Cayô
- Federal University of São Paulo, São Paulo, SP, Brazil
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2
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Andabak-Rogulj A, Vindiš E, Aleksijević LH, Škrinjar I, Juras DV, Aščić A, Brzak BL. Different Treatment Modalities of Oral Lichen Planus-A Narrative Review. Dent J (Basel) 2023; 11:dj11010026. [PMID: 36661563 PMCID: PMC9857452 DOI: 10.3390/dj11010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/22/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Oral lichen planus (OLP) is a chronic inflammatory disease of unknown etiology which affects the oral mucosa. OLP varies in its clinical features from a reticular form that is, in most cases, asymptomatic, to atrophic-erosive, and is accompanied by symptoms of burning sensation and pain followed by difficulty in eating. Given the fact that OLP is a disease of unknown etiology, the treatment is symptomatic and involves suppressing the signs and symptoms of the disease using various topical and systemic drugs. The first line of therapy for treating symptomatic OLP is topical corticosteroids, whereas systemic corticosteroids are used for treating persistent lesions that do not respond to local treatment. However, the lack of convincing evidence on the efficacy of previous therapies, including topical corticosteroids, and numerous side effects that have appeared over recent years has resulted in the emergence and development of new therapeutic options. Some of the therapies mentioned are tacrolimus, efalizumab, dapson, interferon, retinoic acid, photochemotherapy with psoralen and ultraviolet A rays (PUVA), aloe vera, antimalarials, antibiotics and others. These therapies only partially meet the properties of efficacy and safety of use, thus justifying the continuous search and testing of new treatment methods.
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Affiliation(s)
- Ana Andabak-Rogulj
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Clinical Hospital Zagreb, 10000 Zagreb, Croatia
| | - Ema Vindiš
- Dental Practice at Healthcare Center Ormož, 2270 Ormož, Slovenia
| | | | - Ivana Škrinjar
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Clinical Hospital Zagreb, 10000 Zagreb, Croatia
| | - Danica Vidović Juras
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Clinical Hospital Zagreb, 10000 Zagreb, Croatia
| | | | - Božana Lončar Brzak
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence:
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3
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Khalighi HR, Anbari F, Mojahedi SM, Forouzani G. Evaluating the Efficacy of the Er,Cr:YSGG Fractional Laser Before Treatment With Triamcinolone NN Ointment in Oral Lichen Planus Lesions. J Lasers Med Sci 2022; 13:e23. [PMID: 35996491 PMCID: PMC9392885 DOI: 10.34172/jlms.2022.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/10/2022] [Indexed: 08/11/2024]
Abstract
Introduction: It has been demonstrated that laser technology can enhance topical drug absorption. This study aimed to determine the effects of Er,Cr:YSGG laser radiation before the application of topical corticosteroids in the healing of oral lichen planus. Methods: In this double-blind split-mouth clinical trial, 32 lesions were chosen from eight patients affected by oral lichen planus (OLP). The oral lesions were randomly categorized into two groups. The first group had topical treatment with triamcinolone NN ointment and the second group had laser radiation (Er,Cr:YSGG) for eight weeks before starting the ointment. For each lesion, the irritating level based on the VAS score, the lesion level based on the Thongprasom scale score, and the healing time were measured, and the collected data were analyzed by the Friedman test and the Wilcoxon's statistical test. Results: The mean healing time based on the verbal analog scale (VAS) score was not significantly different between the two treatment groups (P>0.05). The mean healing time based on Thongprasom scale scores did not show any significant difference between the two treatment groups (P>0.05). Conclusion: The application of the Er,Cr:YSGG laser before treatment with triamcinolone NN ointment did not show any advantage for the average healing time compared to a medicine regimen with only triamcinolone NN ointment.
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Affiliation(s)
- Hamid Reza Khalighi
- Department of Oral Medicine, Dental Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Anbari
- Department of Oral Medicine, Dental Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Gelareh Forouzani
- Department of Oral Medicine, Dental Faculty, Aja University of Medical Sciences, Tehran, Iran
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4
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Sandhu S, Klein BA, Al-Hadlaq M, Chirravur P, Bajonaid A, Xu Y, Intini R, Hussein M, Vacharotayangul P, Sroussi H, Treister N, Sonis S. Oral lichen planus: comparative efficacy and treatment costs-a systematic review. BMC Oral Health 2022; 22:161. [PMID: 35524296 PMCID: PMC9074269 DOI: 10.1186/s12903-022-02168-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/11/2022] [Indexed: 12/22/2022] Open
Abstract
Objective To compare the reported efficacy and costs of available interventions used for the management of oral lichen planus (OLP). Materials and methods A systematic literature search was performed from database inception until March 2021 in MEDLINE via PubMed and the Cochrane library following PRISMA guidelines. Only randomized controlled trials (RCT) comparing an active intervention with placebo or different active interventions for OLP management were considered.
Results Seventy (70) RCTs were included. The majority of evidence suggested efficacy of topical steroids (dexamethasone, clobetasol, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus, cyclosporine), topical retinoids, intra-lesional triamcinolone, aloe-vera gel, photodynamic therapy, and low-level laser therapies for OLP management. Based on the estimated cost per month and evidence for efficacy and side-effects, topical steroids (fluocinonide > dexamethasone > clobetasol > triamcinolone) appear to be more cost-effective than topical calcineurin inhibitors (tacrolimus > pimecrolimus > cyclosporine) followed by intra-lesional triamcinolone. Conclusion Of common treatment regimens for OLP, topical steroids appear to be the most economical and efficacious option followed by topical calcineurin inhibitors. Large-scale multi-modality, prospective trials in which head-to-head comparisons interventions are compared are required to definitely assess the cost-effectiveness of OLP treatments. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02168-4.
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Affiliation(s)
- Shaiba Sandhu
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA. .,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA. .,Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Brittany A Klein
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Malak Al-Hadlaq
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Prazwala Chirravur
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Amal Bajonaid
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Yuanming Xu
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Rossella Intini
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Mai Hussein
- Harvard Medical School, Boston, MA, USA.,Ministry of Health and Population, Cairo, Egypt
| | - Piamkamon Vacharotayangul
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Herve Sroussi
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Stephen Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
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5
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Eita AAB, Zaki AM, Mahmoud SA. Serum 8-isoprostane levels in patients with resistant oral lichen planus before and after treatment with lycopene: a randomized clinical trial. BMC Oral Health 2021; 21:343. [PMID: 34266435 PMCID: PMC8281687 DOI: 10.1186/s12903-021-01711-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background Oral lichen planus is an autoimmune disease in which topical steroids are the first line of treatment. The adverse effects of systemic corticosteroids prescribed for resistant oral lichen planus cases advocate alternative modalities. Lycopene is an antioxidant with a wide range of beneficial properties. This trial aimed to evaluate the effect of pure lycopene as compared to systemic corticosteroids (Prednisolone) on the symptoms, signs and oxidative stress in patients with erosive oral lichen planus recalcitrant to topical steroids. Methods Twenty patients were randomly divided into the test (lycopene) and control (corticosteroids) groups. Numeric rating scale and Escudier et al. (Br J Dermatol 4:765–770, 2007. 10.1111/j.1365-2133.2007.08106.x) lesion scores were assessed at baseline and weeks 4 and 8 from baseline. Serum levels of 8-isoprostane were measured in all patients at baseline and at the end of treatment (week 8). Results There was a significant reduction in signs and symptoms after the end of treatment in each group. However, no significant difference was found between the lycopene and the corticosteroids group. Moreover, a significant reduction in 8-isoprostane levels was observed in the lycopene group from baseline and as compared to the control group. Conclusions Based on the study results, lycopene is a safe and effective therapeutic modality for resistant oral lichen planus. 8-isoprostane is a biomarker of lipid peroxidation that can be reduced by lycopene. Trial registration ID: PACTR202003484099670. 'Retrospectively registered on 11/3/2020'. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01711-z.
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Affiliation(s)
- Aliaa Abdelmoniem Bedeir Eita
- Oral Medicine, Periodontology, Diagnosis and Radiology Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Azza Mohamed Zaki
- Oral Medicine, Periodontology, Diagnosis and Radiology Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Sabah Abdelhady Mahmoud
- Medical Biochemistry Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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6
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Hesse J, Schmalfuss A, Kvaal SI. Photodynamic therapy of oral lichen planus. Photochem Photobiol Sci 2021; 19:1271-1279. [PMID: 32945823 DOI: 10.1039/d0pp00249f] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Oral lichen planus (OLP) is a chronic inflammatory and immune-mediated disease affecting the oral mucosa. OLP presents with asymptomatic, lacelike white stripes and/or symptomatic red, ulcerated mucous membranes. Eating, drinking and oral hygiene procedures may be painful resulting in reduced quality of life (QOL). The histopathological picture is a zone of cellular infiltrate, mainly CD8+ cells, in the superficial layer of the connective tissue and signs of liquefaction degeneration of the basal membrane. Conventional treatment is corticosteroids. Local and systemic side effects are common, and patients may develop drug resistance. The intention with this article is to demonstrate the heterogeneity in photodynamic therapy (PDT) of OLP. A search in PubMed, Embase (Ovid) and Medline (Ovid) identified seventeen clinical studies investigating PDT of OLP. Only five were randomised controlled studies and the study groups varied from 5 to 50 patients. Five different photosensitisers or precursors were tested. Both broadband spectrum lamps, lasers and light-emitting-diodes (LEDs), with wavelengths from 420 nm to 682 nm, were used. The number of treatment sessions varied from one to ten. The patients were followed up for 0 to 48 months, but in thirteen studies the post treatment observation time was ≤6 months. Single arm studies demonstrated improvement of OLP except in one study. In all controlled studies except for one, PDT was superior or equal to conventional treatment. The majority of patients experienced a slight burning sensation during light activation, but no serious adverse events were reported. Only few studies examined the effect of PDT on a cellular level.
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Affiliation(s)
- Juliane Hesse
- University of Oslo, Faculty of Dentistry, Institute of Clinical Dentistry, Department of Oral Surgery and Oral Medicine, Oslo, Norway. and Public Dental Health Service Competence Centre of Northern Norway, Tromsø, Norway
| | - Andreas Schmalfuss
- UiT, The Arctic University of Norway, Faculty of Health Science, Department of Clinical Dentistry, Tromsø, Norway
| | - Sigrid I Kvaal
- University of Oslo, Faculty of Dentistry, Institute of Clinical Dentistry, Department of Oral Surgery and Oral Medicine, Oslo, Norway.
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7
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Rogulj AA, Z. Alajbeg I, Brailo V, Škrinjar I, Žužul I, Vučićević-Boras V, Alajbeg I. Topical NAVS naphthalan for the treatment of oral lichen planus and recurrent aphthous stomatitis: A double blind, randomized, parallel group study. PLoS One 2021; 16:e0249862. [PMID: 33831097 PMCID: PMC8031371 DOI: 10.1371/journal.pone.0249862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
AIM To evaluate the effectiveness of non-aromatic very rich in steranes (NAVS) naphthalan in the treatment of oral lichen planus (OLP) and recurrent aphthous stomatitis (RAS). Null hypothesis was that there would be no difference between NAVS and topical steroids in the treatment of OLP and RAS. METHODS The study consisted of two sub-trials conducted as randomized, double-blind controlled studies: first included OLP patients and second patients with RAS. Patients received either NAVS or 0.05% betamethasone dipropionate. Primary outcomes were activity score (OLP patients), No of lesions and lesion diameter (RAS patients) and pain intensity (VAS) while secondary outcome included the impact of the disease on quality of life assessed by Oral health impact profile (OHIP 14). RESULTS No significant differences in terms of OLP clinical signs (p = 0.84, η2 = 0.001) and responses on the OHIP-14 (p = 0.81, η2 = 0.002) or on VAS (p = 0.14, η2 = 0.079) between NAVS and betamethasone groups were observed. In RAS patients, no significant differences between the groups in terms of lesion number (at days 3 and 5, p = 0.33 and p = 0.98, respectively), lesion diameter (days 3 and 5, p = 0.24 and p = 0.84, respectively) were observed. However, in NAVS group a significant reduction of lesions diameter was observed on the 3rd day, while in betamethasone group a significant reduction in lesions diameter was evident only after the 5th day. No significant differences in VAS (p > 0.05) and the OHIP-14 (p > 0.05) between groups were found. CONCLUSION No evidence of differences between the two compared interventions was found. REGISTRATION Retrospective registration of this trial was conducted in ClinicalTrials.gov on September 30, 2016; trial registration number: NCT02920658. https://clinicaltrials.gov/ct2/show/NCT02920658?term=NAVS&draw=2&rank=4.
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Affiliation(s)
- Ana Andabak Rogulj
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Iva Z. Alajbeg
- Department of Dentistry, Clinical Hospital Center Zagreb, Zagreb, Croatia
- Department of Removable Prosthodontics, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Vlaho Brailo
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
- Department of Dentistry, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Ivana Škrinjar
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
- Department of Dentistry, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Ivona Žužul
- Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Vanja Vučićević-Boras
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
- Department of Dentistry, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Ivan Alajbeg
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
- Department of Dentistry, Clinical Hospital Center Zagreb, Zagreb, Croatia
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8
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Said Z, Murdoch C, Hansen J, Siim Madsen L, Colley HE. Corticosteroid delivery using oral mucosa equivalents for the treatment of inflammatory mucosal diseases. Eur J Oral Sci 2021; 129:e12761. [PMID: 33645844 PMCID: PMC8048628 DOI: 10.1111/eos.12761] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/14/2022]
Abstract
Oral lichen planus (OLP) is an immune‐mediated disease of the oral mucosa with idiopathic aetiology. It is frequently treated with topical corticosteroids (applied as gels, mouthwashes, or sprays); however, the mucosal exposure times of topical corticosteroids are short because of removal by the constant flow of saliva and mechanical forces. In this study we used cell monolayers, as well as oral mucosal equivalents (OMEs) containing activated T‐cells, to examine corticosteroid potency and delivery of clobetasol‐17‐propionate from a novel electrospun mucoadhesive patch. The OMEs displayed tight junctions, desmosomes, hemidesmosomes, and an efficient permeability barrier. Following application of corticosteroids to cells cultured as monolayers, the degree of cytotoxicity measured correlated to the level of potency recognized for each corticosteroid; by contrast, OMEs were largely unaffected by corticosteroid treatment. Permeation of clobetasol‐17‐propionate into and through the OMEs was time‐ and dose‐dependent, regardless of whether this corticosteroid was delivered in liquid form or from a mucoadhesive patch, and both liquid‐ and patch‐delivered clobetasol‐17‐propionate significantly reduced the secretion of interleukin‐2 by activated T‐cells. This study confirms that OMEs are more suitable models than cell monolayers for evaluating toxicity and drug delivery. After topical exposure, clobetasol‐17‐propionate accumulated in OMEs at a higher level than betamethasone‐17‐valerate and hydrocortisone‐17‐valerate, and exerted its immunosuppressive actions following application via the patch delivery system, highlighting the efficacy of this mode of drug delivery to treat OLP.
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Affiliation(s)
- Zulfahmi Said
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK.,Faculty of Dentistry, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Craig Murdoch
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | | | | | - Helen E Colley
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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9
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Mucoadhesive Poloxamer-Based Hydrogels for the Release of HP-β-CD-Complexed Dexamethasone in the Treatment of Buccal Diseases. Pharmaceutics 2021; 13:pharmaceutics13010117. [PMID: 33477667 PMCID: PMC7831945 DOI: 10.3390/pharmaceutics13010117] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
Abstract
Oral lichen planus (OLP) is an ongoing and chronic inflammatory disease affecting the mucous membrane of the oral cavity. Currently, the treatment of choice consists in the direct application into the buccal cavity of semisolid formulations containing a corticosteroid molecule to decrease inflammatory signs and symptoms. However, this administration route has shown various disadvantages limiting its clinical use and efficacy. Indeed, the frequency of application and the incorrect use of the preparation may lead to a poor efficacy and limit the treatment compliance. Furthermore, the saliva clearance and the mechanical stress present in the buccal cavity also involve a decrease in the mucosal exposure to the drug. In this context, the design of a new pharmaceutical formulation, containing a steroidal anti-inflammatory, mucoadhesive, sprayable and exhibiting a sustained and controlled release seems to be suitable to overcome the main limitations of the existing pharmaceutical dosage forms. The present work reports the formulation, optimization and evaluation of the mucoadhesive and release properties of a poloxamer 407 thermosensitive hydrogel containing a poorly water-soluble corticosteroid, dexamethasone acetate (DMA), threaded into hydroxypropyl-beta-cyclodextrin (HP-β-CD) molecules. Firstly, physicochemical properties were assessed to ensure suitable complexation of DMA into HP-β-CD cavities. Then, rheological properties, in the presence and absence of various mucoadhesive agents, were determined and optimized. The hydration ratio (0.218-0.191), the poloxamer 407 (15-17 wt%) percentage and liquid-cyclodextrin state were optimized as a function of the gelation transition temperature, viscoelastic behavior and dynamic flow viscosity. Deformation and resistance properties were evaluated in the presence of various mucoadhesive compounds, being the sodium alginate and xanthan gum the most suitable to improve adhesion and mucoadhesion properties. Xanthan gum was shown as the best agent prolonging the hydrogel retention time up to 45 min. Furthermore, xanthan gum has been found as a relevant polymer matrix controlling drug release by diffusion and swelling processes in order to achieve therapeutic concentration for prolonged periods of time.
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10
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Santonocito S, Polizzi A, De Pasquale R, Ronsivalle V, Lo Giudice A, Isola G. Analysis of the Efficacy of Two Treatment Protocols for Patients with Symptomatic Oral Lichen Planus: A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E56. [PMID: 33374791 PMCID: PMC7794703 DOI: 10.3390/ijerph18010056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
Oral lichen planus (OLP) is a chronic, inflammatory, immune-mediated disease, which can alter the quality of life of patients. The aim of this randomized clinical trial was to compare the therapeutic efficacy of clobetasol oral gel 0.05% versus an anti-inflammatory in oral solution (mouthwash) in the management of patients suffering from symptomatic OLP. The secondary objective was to analyze which one of the two treatments induced a greater risk of developing side effects. Forty patients were assigned (20 patients for group), through a randomized design, to receive clobetasol gel 0.05% or an anti-inflammatory mouthwash, which contains calcium hydroxide, hyaluronic acid, umbelliferone and oligomeric pro-anthocyanidins) for three months. At baseline (T0) and after 3 months (T1), patients underwent dental and dermatological examinations to assess their symptoms (Numerical Pain Scale (NRS) score) and signs (Thongprasom score). Data were calculated using T-test for the dependent variable, Wilcoxon test and Mann-Whitney u test. Both clobetasol and anti-inflammatory resulted in a statistically significant reduction of signs, (p < 0.001 and p = 0.02, respectively) and symptoms (p < 0.001 for clobetasol and p = 0.02 for anti-inflammatory). In conclusion, the results evidenced that, compared to clobetasol, the anti-inflammatory was less effective in determining the reduction of signs and symptom in OLP patients.
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Affiliation(s)
- Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Rocco De Pasquale
- Department of General Surgery and Surgical-Medical Specialties, Unit of Dermatology, University of Catania, 95124 Catania, Italy;
| | - Vincenzo Ronsivalle
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
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11
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Rotaru D, Chisnoiu R, Picos AM, Picos A, Chisnoiu A. Treatment trends in oral lichen planus and oral lichenoid lesions (Review). Exp Ther Med 2020; 20:198. [PMID: 33123228 PMCID: PMC7588785 DOI: 10.3892/etm.2020.9328] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022] Open
Abstract
Oral lichen planus (OLP) is a chronic inflammatory disease, associated with altered cell-mediated immunological function. It has long-term evolution, repeated exacerbations, sometimes painful and resistant to treatment, even all of these, OLP significantly affects patient's life quality. Not least, OLP is accompanied by an increased risk of malignant transformation. A wide spectrum of therapeutic options is available, but none are curative. In this review, 58 structured studies on the clinical symptomatology and treatment strategy of OLP were analyzed. The literature research was performed according to the criteria of the PRISMA system. This study summarizes current knowledge regarding management of OLP and oral lichenoid lesions, discusses the challenges of choosing an adequate treatment and, in attempt to improve the quality of patient life, trying to describe a therapeutic algorithm that takes into consideration the clinical features of the disease. Current OLP therapy aims at eliminating all mucosal-related lesions, reduce symptomatology and decrease the risk of oral cancer and include corticosteroids, immunomodulatory agents, retinoids, ultraviolet irradiation and/or laser therapy.
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Affiliation(s)
- Doina Rotaru
- Department of Odontology, Endodontics and Oral Pathology, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania
| | - Radu Chisnoiu
- Department of Odontology, Endodontics and Oral Pathology, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania
| | - Alina Monica Picos
- Department of Prosthodontics, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Andrei Picos
- Department of Prevention in Dental Medicine, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400089 Cluj-Napoca, Romania
| | - Andrea Chisnoiu
- Department of Prosthodontics, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
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12
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Luo Y, Kuai L, Chen J, Sun X, Liu L, Luo Y, Ru Y, Xing M, Ding X, Zhou M, Li B, Li X. Efficacy and safety of
Tripterygium wilfordii
Hook. f. for oral lichen planus: Evidence from 18 randomized controlled trials. Phytother Res 2020; 34:2180-2191. [PMID: 32180273 DOI: 10.1002/ptr.6672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/06/2020] [Accepted: 03/01/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Yue Luo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
- Institute of Dermatology Shanghai Academy of Traditional Chinese Medicine Shanghai China
| | - Le Kuai
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
- Institute of Dermatology Shanghai Academy of Traditional Chinese Medicine Shanghai China
| | - Jia Chen
- Department of Dermatopathology, Shanghai Dermatology Hospital Tongji University Shanghai China
| | - Xiaoying Sun
- Institute of Dermatology Shanghai Academy of Traditional Chinese Medicine Shanghai China
| | - Liu Liu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
| | - Ying Luo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
| | - Yi Ru
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
| | - Meng Xing
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
| | - Xiaojie Ding
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
| | - Mi Zhou
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
| | - Bin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
- Institute of Dermatology Shanghai Academy of Traditional Chinese Medicine Shanghai China
- Department of Dermatology Shanxi TCM Hospital Xian China
| | - Xin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
- Institute of Dermatology Shanghai Academy of Traditional Chinese Medicine Shanghai China
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13
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Characterization of dexamethasone loaded collagen-chitosan sponge and in vitro release study. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2019.101449] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Carrozzo M, Porter S, Mercadante V, Fedele S. Oral lichen planus: A disease or a spectrum of tissue reactions? Types, causes, diagnostic algorhythms, prognosis, management strategies. Periodontol 2000 2019; 80:105-125. [PMID: 31090143 DOI: 10.1111/prd.12260] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Oral lichen planus and lichenoid lesions comprise a group of disorders of the oral mucosa that likely represent a common reaction pattern to 1 or more unknown antigens. The coexistence of hyperkeratotic striation/reticulation, varying degrees of mucosal inflammation from mild erythema to severe widespread ulceration, and a band-like infiltrate of mononuclear inflammatory cells including activated T lymphocytes, macrophages, and dendritic cells, are considered suggestive of oral lichen planus and lichenoid lesions. Several classification systems of oral lichen planus and lichenoid lesions have been attempted, although none seem to be comprehensive. In this paper, we present a classification of oral lichen planus and lichenoid lesions that includes oral lichen planus, oral lichenoid contact lesions, oral lichenoid drug reactions, oral lichenoid lesions of graft vs. host disease, discoid lupus erythematosus, and systemic lupus erythematosus, lichen planus-like variant of paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome, chronic ulcerative stomatitis, lichen planus pemphigoides, solitary fixed drug eruptions, and lichen sclerosus. We present the clinical and diagnostic aspects of oral lichen planus and lichenoid lesions, and discuss related treatment options.
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Affiliation(s)
- Marco Carrozzo
- Centre for Oral Health Research, Oral Medicine Department, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Porter
- UCL Eastman Dental Institute, University College London, London, UK
| | | | - Stefano Fedele
- UCL Eastman Dental Institute, University College London, London, UK.,NIHR University College London Hospitals Biomedical Research Centre, London, UK
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15
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Husein‐ElAhmed H, Gieler U, Steinhoff M. Lichen planus: a comprehensive evidence‐based analysis of medical treatment. J Eur Acad Dermatol Venereol 2019; 33:1847-1862. [DOI: 10.1111/jdv.15771] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/21/2019] [Indexed: 12/15/2022]
Affiliation(s)
- H. Husein‐ElAhmed
- Department of Dermatology and Venereology Hospital de Baza Granada Spain
- Translational Research Institute Academic Health System Medical School Hamad Medical Corporation Doha Qatar
| | - U. Gieler
- Translational Research Institute Academic Health System Medical School Hamad Medical Corporation Doha Qatar
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
| | - M. Steinhoff
- Translational Research Institute Academic Health System Medical School Hamad Medical Corporation Doha Qatar
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
- College of Medicine Weill Cornell Medicine‐Qatar Doha Qatar
- Medical School Qatar University Doha Qatar
- College of Medicine Weill Cornell University New York NY USA
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16
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Ghalayani Esfahani A, Altomare L, Varoni EM, Bertoldi S, Farè S, De Nardo L. Electrophoretic bottom up design of chitosan patches for topical drug delivery. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:40. [PMID: 30919137 DOI: 10.1007/s10856-019-6242-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Abstract
Clobetasol propionate (CP) is a high-potency corticosteroid, representing the standard of care for the symptomatic treatment of different skin disorders as well as oral mucosal diseases. Several topical delivery systems are available for treating oral lesions, but the ideal one is still lacking. In this work, we propose a novel class of chitosan (CS) patches, loaded with CP, for the topical treatment of inflammatory chronic oral diseases. Chitosan patches have been fabricated via electrophoretic deposition (EPD), by using a one-pot approach in order to load controlled quantity of CP. Optimized structures showed a water uptake in the range of 200-360% and mechanical properties that allow the design of flexible patches in wet state (E = 0.6 MPa and σbr = 0.55 MPa). Ultraviolet-visible (UV-Vis) spectroscopy was used for the evaluation of both loading and release profile of CP in CS patches. The CP loading has been tuned by adjusting CP concentration in deposition bath-in the range 0.002-0.12 mg cm-2-while releasing curves show an in vitro CP burst of about 80% in the first two hours. Overall, the obtained properties paved the way for the application of this new class of patches for the local oral release of CP.
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Affiliation(s)
- Arash Ghalayani Esfahani
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Miiano, Piazza Leonardo da Vinci 32, Milano (Ml), Italy.
| | - Lina Altomare
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Miiano, Piazza Leonardo da Vinci 32, Milano (Ml), Italy
| | - Elena M Varoni
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Via Beldiletto 1, Milano (MI), Italy
| | - Serena Bertoldi
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Miiano, Piazza Leonardo da Vinci 32, Milano (Ml), Italy
| | - Silvia Farè
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Miiano, Piazza Leonardo da Vinci 32, Milano (Ml), Italy
| | - Luigi De Nardo
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Miiano, Piazza Leonardo da Vinci 32, Milano (Ml), Italy
- Consorzio Interuniversitario Nazionale per la Scienza e Tecnologia dei Materiali (INSTM), Local Unit Politecnico di Milano, Via Giusti 9, 50121, Firenze (Fl), Italy
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17
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Abstract
In many mucocutaneous disorders, corticosteroids therapy is currently central. Systemic therapy is restricted to severe disorders whereas topical applications are considered as the first-line treatment. The oral cavity environment, the medication form and other factors related to the delivery method are key factors for the therapy efficiency and effectiveness. Current marketed medications are not able to avoid wrong drug exposure and scarce patients' compliance. Innovative in situ delivery systems are able to prolong the drug retention time on the mucosa and to avoid the drawbacks of conventional formulations. This review is intended to give a general overview of oral mucocutaneous pathologies and highlight the potential of new technologies in designing innovative delivery systems able to release corticosteroids in situ for the treatment of various oral cavity disorders.
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18
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Jana A, Thomas J, Ghosh P. P-glycoprotein expression in oral lichen planus. Braz Oral Res 2017; 31:e95. [DOI: 10.1590/1807-3107bor-2017.vol31.0095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 10/05/2017] [Indexed: 11/21/2022] Open
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19
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Torres-Sánchez C, Montoya-Salazar V, Torres-Lagares D, Gutierrez-Pérez JL, Jimenez-Castellanos E. Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: A randomized, crossover, double-blind clinical trial. J Prosthet Dent 2017; 117:614-620. [DOI: 10.1016/j.prosdent.2016.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 09/10/2016] [Accepted: 09/12/2016] [Indexed: 12/17/2022]
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20
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Reply to: Details of the participants and medical intervention used in the study evaluating the effect of a mouth exercising device on burning sensation in oral submucous fibrosis. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:735-737. [PMID: 28412237 DOI: 10.1016/j.oooo.2017.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/20/2022]
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21
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González-Moles MA, Scully C. Vesiculo-erosive Oral Mucosal Disease—Management with Topical Corticosteroids: (1) Fundamental Principles and Specific Agents Available. J Dent Res 2016; 84:294-301. [PMID: 15790732 DOI: 10.1177/154405910508400401] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Vesiculo-erosive diseases of the oral mucosa pose a major challenge in oral medicine, because they are chronic, painful, and interfere with the daily activities and quality of life of the patients, including disturbing eating, drinking, talking, and personal relationships. Many are autoimmune diseases, and corticosteroid therapy is currently central to their treatment. These diseases present with inflammation and alterations to epithelial integrity, through cell and/or humoral immunity-mediated attack on epithelial-connective tissue targets. Until recently, despite their serious adverse effects, it was necessary to prescribe systemic corticosteroids to control severe erosive oral diseases. Now, however, many of these diseases can be controlled by high-potency topical corticosteroids, which have proved to be highly efficacious and to cause fewer adverse effects compared with systemic corticosteroids. Nevertheless, although topical corticosteroids are still the most widely used drugs in the practice of oral medicine, the scientific body of evidence for their use in the oral cavity is virtually non-existent, and therefore many of the protocols followed are, of necessity, drawn from experience of their use in a dermatological setting. This review aims to set out the key aspects of the use of topical corticosteroids in oral medicine. The issues covered include the indications and basic rules for their use, the types of corticosteroids, the drug selection, and the specific formulations.
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Affiliation(s)
- M A González-Moles
- Departamento de Medicina Oral, Facultad de Odontología, Universidad de Granada, Campus de Cartuja sn, 18071, Granada, Spain.
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22
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González-Moles MA, Scully C. Vesiculo-erosive Oral Mucosal Disease—Management with Topical Corticosteroids: (2) Protocols, Monitoring of Effects and Adverse Reactions, and the Future. J Dent Res 2016; 84:302-8. [PMID: 15790733 DOI: 10.1177/154405910508400402] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although topical corticosteroids (TCs) are the most widely used drugs in oral medicine, and specifically in the treatment of vesiculo-erosive oral mucosal disease, there are few evidence-based data for the correct use of these drugs. In this review, we outline the most widely used protocols, the most common reasons for treatment failure, and the adverse effects documented in the literature.
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Affiliation(s)
- M A González-Moles
- Professor of Oral Medicine, Departamento de Medicina Oral, School of Dentistry, Facultad de Odontología, Universidad de Granada, Campus de Cartuja sn, 18071, Granada, Spain.
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23
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Tejani S, Sultan A, Stojanov I, Woo SB. Candidal carriage predicts candidiasis during topical immunosuppressive therapy: a preliminary retrospective cohort study. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:448-54. [DOI: 10.1016/j.oooo.2016.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/05/2016] [Accepted: 06/11/2016] [Indexed: 12/14/2022]
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25
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Belal MH. Management of symptomatic erosive-ulcerative lesions of oral lichen planus in an adult Egyptian population using Selenium-ACE combined with topical corticosteroids plus antifungal agent. Contemp Clin Dent 2015; 6:454-60. [PMID: 26681847 PMCID: PMC4678540 DOI: 10.4103/0976-237x.169837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aim: Oral lichen planus (OLP) is a chronic mucocutaneous disease with an immunological etiology. This study was conducted to evaluate the effect of selenium combined with Vitamins A, C & E (Selenium-ACE) in the treatment of erosive-ulcerative OLP as an adjunctive to topical corticosteroids plus antifungal agent. Subjects and Methods: Thirty patients with a confirmed clinical and histopathologic diagnosis of OLP participated in this clinical trial. Patients were randomly allocated into one of three groups and treated as follows: (I) Topical corticosteroids, (II) topical corticosteroids plus antifungal, and (III) SE-ACE combined with topical corticosteroids plus antifungal. The patients were followed for 6 weeks. The pain and severity of the lesions were recorded at the initial and follow-up visits. All recorded data were analyzed using paired t-test and ANOVA test. A P ≤ 0.05 was considered significant. Results: The experimental groups showed a marked reduction in pain sensation and size of lesions, particularly in the final follow-up period, but there was no significant difference between the first two Groups I and II. However, healing of lesions and improvement of pain sensation was effective in Group III since a significant difference was found favoring Group III over both Groups I and II. Conclusion: No significant difference was found in treating erosive-ulcerative lesions of OLP by topical corticosteroids alone or combined with antifungal. However, when using SE-ACE in combination with topical corticosteroids plus antifungal, this approach may be effective in managing ulcerative lesions of OLP; but more research with a larger sample size and a longer evaluation period may be recommended.
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Affiliation(s)
- Mahmoud Helmy Belal
- Department of Oral Medicine, Periodontology, Oral Diagnosis and Radiology, Faculty of Dentistry, Damanhour University, Damanhour, Egypt
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26
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Ní Ríordáin R, Shirlaw P, Alajbeg I, Al Zamel GY, Fung PL, Yuan AD, McCreary C, Stoopler ET, De Rossi SS, Lodi G, Greenberg MS, Brennan MT. World Workshop on Oral Medicine VI: Patient-reported outcome measures and oral mucosal disease: current status and future direction. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:152-60.e11. [DOI: 10.1016/j.oooo.2015.01.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/26/2014] [Accepted: 01/14/2015] [Indexed: 02/08/2023]
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27
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Chamani G, Rad M, Zarei MR, Lotfi S, Sadeghi M, Ahmadi Z. Efficacy of tacrolimus and clobetasol in the treatment of oral lichen planus: a systematic review and meta-analysis. Int J Dermatol 2015. [DOI: 10.1111/ijd.12925] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Goli Chamani
- Orofacial Pain Clinic; Department of Oral Medicine; Dental School; Kerman Iran
| | - Maryam Rad
- Oral and Dental Diseases Research Center; Kerman University of Medical Sciences; Kerman Iran
| | - Mohammad Reza Zarei
- Orofacial Pain Clinic; Department of Oral Medicine; Dental School; Kerman Iran
| | - Sodabeh Lotfi
- Orofacial Pain Clinic; Department of Oral Medicine; Dental School; Kerman Iran
| | - Masoumeh Sadeghi
- Research Center for Modeling in Health; Kerman University of Medical Sciences; Kerman Iran
| | - Zahra Ahmadi
- Oral and Dental Diseases Research Center; Kerman University of Medical Sciences; Kerman Iran
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28
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Soylu Özler G. Silver nitrate cauterization: A treatment option for aphthous stomatitis. J Craniomaxillofac Surg 2014; 42:e281-3. [DOI: 10.1016/j.jcms.2013.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/23/2013] [Accepted: 10/08/2013] [Indexed: 10/26/2022] Open
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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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30
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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: 51] [Impact Index Per Article: 5.1] [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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31
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Vijayabala GS, Kalappanavar AN, Annigeri RG, Sudarshan R, Shettar SS. Single application of topical doxycycline hyclate in the management of recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 116:440-6. [PMID: 24035110 DOI: 10.1016/j.oooo.2013.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 06/08/2013] [Accepted: 06/14/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Although tetracyclines are used for topical therapy in recurrent aphthous stomatitis (RAS) patients, there are few clinical trials that have used doxycycline. Hence, we evaluated the therapeutic efficacy of topical doxycycline hyclate in RAS. STUDY DESIGN A single-blinded placebo-controlled trial comprising 50 RAS subjects divided into group A and group B with 25 subjects in each group was performed. Patients in group A received topical application of crushed doxycycline hyclate tablet with denture adhesive and few drops of saline solution once at the initial visit. Group B received placebo similarly. Treatment response was assessed by measures of pain reduction, ulcer duration, and adhesive retention time. Data were analyzed using the Student t test. RESULTS Participants treated with doxycycline hyclate had significantly less pain by day 1 (P < .001) and healed faster (P < .001) compared with placebo. CONCLUSION A single application of doxycycline hyclate decreased pain and speeded recovery.
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Affiliation(s)
- G Sree Vijayabala
- Assistant Professor, Department of Dentistry, ESIC Medical College & PGIMSR, KK Nagar, Chennai, Tamilnadu, India.
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33
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The Efficacy of Sucralfate and Chlorhexidine as an Oral Rinse in Patients with Recurrent Aphthous Stomatitis. Adv Med 2014; 2014:986203. [PMID: 26556433 PMCID: PMC4590976 DOI: 10.1155/2014/986203] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/16/2014] [Accepted: 08/04/2014] [Indexed: 11/17/2022] Open
Abstract
Aim. In this study, we compared the efficacy of sucralfate suspension with chlorhexidine as an oral rinse in patients with recurrent aphthous stomatitis (RAS) in terms of pain relief and healing time. Materials and Methods. The subjects with a complaint of recurrent oral aphthous ulcers less than 1 cm in diameter on the first day of the occurrence of the ulcer and between 20 and 40 years were included in the study. Seventy patients completed the study. The patients were randomized into two groups as SCH group and CHX group. Changes in pain scores, healing time, and side effects of the treatments were evaluated. Results. The mean value of pain scores on the days after the treatment from the first day to the seventh day was significantly higher in CHX group than SCH group (P ≤ 0.05). On the seventh day after the treatment, the ulcers were completely reepithelialized in 23 patients in SCH group and in 19 patients in CHX group. The difference was statistically significant (P ≤ 0.05). In SCH group, the mean healing time of ulcers was 1.97 ± 1.56 days whereas it was 2.80 ± 3.00 days in CHX group. The difference was statistically significant (P ≤ 0.05). No side effects were recorded in either of the groups. Conclusion. Topical sucralfate suspension is an easy, safe, inexpensive, and effective treatment option for RAS to obtain pain relief and shorten the healing time of oral ulcers.
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Kudur MH, Hulmani M. Rebamipide: A Novel Agent in the Treatment of Recurrent Aphthous Ulcer and Behcet's Syndrome. Indian J Dermatol 2013; 58:352-4. [PMID: 24082178 PMCID: PMC3778773 DOI: 10.4103/0019-5154.117298] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Rebamipide is an amino acid analog of 2 (1H)-quinolinone. It is being introduced and used since 1980 for the treatment of peptic ulcer. Its therapeutic use in recurrent aphthous ulcer was not known. It acts by the decrease in oxygen radicals, increase in blood flow and production of protective prostaglandins in ulcer mucosa, which accelerates the process of healing. In this article, we focus on the pharmacodynamics, pharmacokinetics, side-effects and other therapeutic uses of Rebamipide. It will be a new and effective drug in the dermatologists’ drug armamentarium for the treatment of aphthous ulcers and related diseases.
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Affiliation(s)
- Mohan H Kudur
- Department of Dermatology and Venereology, Srinivas Institute of Medical Sciences and Research Centre, Mukka, Surathkal, Mangalore, Karnataka, India
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Lavanya N, Jayanthi P, Rao UK, Ranganathan K. Oral lichen planus: An update on pathogenesis and treatment. J Oral Maxillofac Pathol 2013; 15:127-32. [PMID: 22529568 PMCID: PMC3329692 DOI: 10.4103/0973-029x.84474] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Oral lichen planus (OLP) is a chronic inflammatory disease that affects the mucus membrane of the oral cavity. It is a T-cell mediated autoimmune disease in which the cytotoxic CD8+ T cells trigger apoptosis of the basal cells of the oral epithelium. Several antigen-specific and nonspecific inflammatory mechanisms have been put forward to explain the accumulation and homing of CD8+ T cells subepithelially and the subsequent keratinocyte apoptosis. A wide spectrum of treatment modalities is available, from topical corticosteroids to laser ablation of the lesion. In this review, we discuss the various concepts in the pathogenesis and current treatment modalities of OLP.
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Affiliation(s)
- N Lavanya
- Department of Oral and Maxillofacial Pathology, Ragas Dental College and Hospital, Uthandi, Chennai, India
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Sonthalia S, Singal A. Comparative efficacy of tacrolimus 0.1% ointment and clobetasol propionate 0.05% ointment in oral lichen planus: a randomized double-blind trial. Int J Dermatol 2012; 51:1371-8. [DOI: 10.1111/j.1365-4632.2012.05459.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Manfredi M, Polonelli L, Aguirre-Urizar JM, Carrozzo M, McCullough MJ. Urban legends series: oral candidosis. Oral Dis 2012; 19:245-61. [PMID: 22998462 DOI: 10.1111/odi.12013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 01/10/2023]
Abstract
Candida species (spp) are commensal yeast that can only instigate oral infection (oral candidosis - OC) when there is an underlying predisposing condition in the host. We investigated four controversial topics on OC: (i) How can a microbiological determination of OC be made as Candida spp. are commensal yeasts and not all of them form hyphae or pseudohyphae during infection? (ii) Is median rhomboid glossitis (MRG) a manifestation of candidal infection? (iii) Can candidal infection cause palate papillary hyperplasia (PPH)? (iv) What is the best therapeutic treatment for denture-associated erythematous stomatitis (DAES)? Results from extensive literature searches, including a systematic review, suggested the following: (i) the diagnosis of OC merely on the basis of the presence of yeasts is an oversimplification of a complex process. No convincing evidence of a single test or method better able to discriminate the transition from candidal saprophytism to pathogenicity has been reported in the literature; (ii-iii) conclusive evidence of a direct aetiopathogenic relationship between MRG and PPH and candidal infection has not been found; and (iv) only limited evidence is available for any DAES treatment, thus making it impossible to make strong therapeutic recommendations.
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Affiliation(s)
- M Manfredi
- Oral Medicine, Pathology and Laser-assisted Surgery Unit, University of Parma, Parma, Italy
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Cheng S, Kirtschig G, Cooper S, Thornhill M, Leonardi‐Bee J, Murphy R. Interventions for erosive lichen planus affecting mucosal sites. Cochrane Database Syst Rev 2012; 2012:CD008092. [PMID: 22336835 PMCID: PMC10794897 DOI: 10.1002/14651858.cd008092.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Erosive lichen planus (ELP) affecting mucosal surfaces is a chronic autoimmune disease of unknown aetiology. It is often more painful and debilitating than the non-erosive types of lichen planus. Treatment is difficult and aimed at palliation rather than cure. Several topical and systemic agents have been used with varying results. OBJECTIVES To assess the effects of interventions in the treatment of erosive lichen planus affecting the oral, anogenital, and oesophageal regions. SEARCH METHODS We searched the following databases up to September 2009: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE (from 2005), EMBASE (from 2007), and LILACS (from 1982). We also searched reference lists of articles and online trials registries for ongoing trials. SELECTION CRITERIA We considered all randomised controlled trials (RCTs) that evaluated the effectiveness of any topical or systemic interventions for ELP affecting either the mouth, genital region, or both areas, in participants of any age, gender, or race. DATA COLLECTION AND ANALYSIS The primary outcome measures were as follows:(a) Pain reduction using a visual analogue scale rated by participants; (b) Physician Global Assessment; and (c) Participant global self-assessment.Changes in scores at the end of therapy compared with baseline were analysed. MAIN RESULTS A total of 15 RCTs were identified, giving a total of 473 participants with ELP. All studies involved oral ELP only. Six of the 15 studies included participants with non-erosive lichen planus. In these studies, only the erosive subgroup was included for intended subgroup analysis. We were unable to pool data from any of the nine studies with only ELP participants or any of the six studies with the ELP subgroup, due to small numbers and the heterogeneity of the interventions, design methods, and outcome variables between studies. One small study involving 50 participants found that 0.025% clobetasol propionate administered as liquid microspheres significantly reduced pain compared to ointment (Mean difference (MD) -18.30, 95% confidence interval (CI) -28.57 to -8.03), but outcome data was only available in 45 participants. However, in another study, a significant difference in pain was seen in the small subgroup of 11 ELP participants, favouring ciclosporin solution over 0.1% triamcinolone acetonide in orabase (MD -1.40, 95% CI -1.86 to -0.94). Aloe vera gel was 6 times more likely to result in at least a 50% improvement in pain symptoms compared to placebo in a study involving 45 ELP participants (Risk ratio (RR) 6.16, 95% CI 2.35 to 16.13). In a study involving 20 ELP participants, 1% pimecrolimus cream was 7 times more likely to result in a strong improvement as rated by the Physician Global Assessment when compared to vehicle cream (RR 7.00, 95% CI 1.04 to 46.95).There is no overwhelming evidence for the efficacy of a single treatment, including topical steroids, which are the widely accepted first-line therapy for ELP. Several side-effects were reported, but none were serious. With topical corticosteroids, the main side-effects were oral candidiasis and dyspepsia. AUTHORS' CONCLUSIONS This review suggests that there is only weak evidence for the effectiveness of any of the treatments for oral ELP, whilst no evidence was found for genital ELP. More RCTs on a larger scale are needed in the oral and genital ELP populations. We suggest that future studies should have standardised outcome variables that are clinically important to affected individuals. We recommend the measurement of a clinical severity score and a participant-rated symptom score using agreed and validated severity scoring tools. We also recommend the development of a validated combined severity scoring tool for both oral and genital populations.
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Affiliation(s)
- Suzanne Cheng
- Queen's Medical CentreDepartment of DermatologyNottinghamUKNG7 2UH
| | - Gudula Kirtschig
- University of TübingenInstitute of General Medicine and Interprofessional CareTübingenGermany
| | - Susan Cooper
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LJ
| | - Martin Thornhill
- University of Sheffield School of Clinical DentistryClinical Academic Unit of Oral and Maxillofacial Medicine and SurgeryClaremont CrescentSheffieldUKS10 2TA
| | - Jo Leonardi‐Bee
- The University of NottinghamDivision of Epidemiology and Public HealthClinical Sciences BuildingNottingham City Hospital NHS Trust Campus, Hucknall RoadNottinghamUKNG5 1PB
| | - Ruth Murphy
- Sheffield Children's NHS Foundation TrustDepartment of Dermatology, Sheffield Children's HospitalSheffieldUKS10 2JF
- Sheffield Teaching Hospitals NHS Foundation TrustDepartment of DermatologySheffieldUK
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Varoni EM, Molteni A, Sardella A, Carrassi A, Di Candia D, Gigli F, Lodi F, Lodi G. Pharmacokinetics study about topical clobetasol on oral mucosa. J Oral Pathol Med 2011; 41:255-60. [DOI: 10.1111/j.1600-0714.2011.01087.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Jajarm HH, Falaki F, Mahdavi O. A Comparative Pilot Study of Low Intensity Laser versus Topical Corticosteroids in the Treatment of Erosive-Atrophic Oral Lichen Planus. Photomed Laser Surg 2011; 29:421-5. [DOI: 10.1089/pho.2010.2876] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Farnaz Falaki
- Department of Oral Medicine and Dental Research Center, Faculty of Dentistry, Mashhad, Iran
| | - Omid Mahdavi
- Department of Oral Medicine and Dental Research Center, Faculty of Dentistry, Yazd, Iran
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Nazhmutdinova DK. The use of clobetasol for therapy of lichen ruber planus. VESTNIK DERMATOLOGII I VENEROLOGII 2011. [DOI: 10.25208/vdv969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Data of the literature regarding the use of clobetasol propionate for treatment of lichen ruber planus are represented. The results of authors' comparative investigations for assessment of treatment efficacy using clobetasol propionate and betamethasone valerate in patients suffering lichen ruber planus demonstrated an advantage of the use of clobetasol propionate.
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A new mucoadhesive dosage form for the management of oral lichen planus: Formulation study and clinical study. Eur J Pharm Biopharm 2010; 76:437-42. [DOI: 10.1016/j.ejpb.2010.07.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 07/28/2010] [Accepted: 07/29/2010] [Indexed: 11/22/2022]
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Scattarella A, Petruzzi M, Ballini A, Grassi F, Nardi G. Oral lichen planus and dental hygiene: a case report. Int J Dent Hyg 2010; 9:163-6. [PMID: 21356010 DOI: 10.1111/j.1601-5037.2010.00454.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED BACKGROUND The presence of atrophic-erosive lesions among gingival tissues makes oral hygiene procedures difficult for several reasons. Plaque control and rigorous oral hygiene are a fundamental requisite for the treatment of any oromucosal disease. CASE REPORT A patient suffering from a mixed atrophic-erosive form of oral lichen planus (OLP), with serious gingival involvement, was also treated with the topical application of clobetasol propionate 0.05% using gingival trays. The highest hygiene standards of both patient and trays were of fundamental importance. DISCUSSION The management of the patient suffering from gingival atrophic-erosive OLP requires the synergic treatment of both dentist and dental hygienist, whose contribution supports the corticosteroid and/or immunosuppressive treatment.
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Affiliation(s)
- A Scattarella
- Department of Dental Sciences and Surgery, University of Bari, Bari, Italy.
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Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies. Clin Dermatol 2010; 28:100-8. [PMID: 20082959 DOI: 10.1016/j.clindermatol.2009.03.004] [Citation(s) in RCA: 197] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lichen planus (LP) is an inflammatory disease of the stratified squamous epithelia of unknown etiology. LP affects most frequently the oral mucosa, but it may also involve other mucosa and the skin. Oral LP (OLP) most frequently affects woman aged between 30 and 60 years. Histopathologic examination typically shows orthokeratotic hyperkeratosis, basal cell degeneration, and a dense well-defined infiltrate of lymphocytes in the superficial dermis. OLP lesions may result from the induction of keratinocytes apoptosis by cytotoxic CD8+ T cells stimulated by a yet unidentified self-antigen on a genetically predisposed patient. The association of OLP with hepatitis C virus (HCV) has been more consistently demonstrated in the Mediterranean area. Although HCV RNA and HCV-specific CD4+ and CD8+ T cells have been retrieved in the mucosal lesions of patients with chronic HCV infection and OLP, the eventual pathophysiology of HCV in OLP lesions remains unclear. Available treatments of OLP are not curative, and many have potentially prominent side effects. The objectives of OLP management should be to prevent and screen for malignant transformation and alleviate symptoms on the long-term. Avoidance of potential precipitating drugs, tobacco, alcohol, and local trauma, as well as strict oral hygiene, is essential. The first-line pharmacologic treatment relies on topical steroids. Systemic steroids should be limited to the short-term cure of severe refractory OLP. Life-long clinical follow-up, at least annually, is fundamental.
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Affiliation(s)
- David Farhi
- Department of Dermatology and Venereology, Hôpital Cochin, APHP, Université Descartes - Paris 5, Pavillon Tarnier, 75006 Paris, France.
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Abstract
Steroids have been found to be effective in treating symptomatic oral lichen planus (OLP) by reducing pain and inflammation. In fact, systemic corticosteroids should be reserved for acute exacerbation, and multiple or widespread lesions. They may be indicated in patients whose condition is unresponsive to topical steroids. However, various potent topical steroids have been reported to be effective in the treatment of symptomatic OLP. They can be used as the first line drugs in the treatment of OLP with no serious side-effects. During the therapy, candidiasis was commonly found and in addition, bad taste, nausea, dry mouth, sore throat and swollen mouth may occur as minor side-effects from some topical steroids. Because OLP is a chronic disorder that requires long-term treatment, topical steroids are recommended for the treatment OLP because of minimal side-effects and the cost benefit. This manuscript reviews the use of steroids, especially its topical application, in the treatment of OLP.
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Affiliation(s)
- Kobkan Thongprasom
- Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Cendras J, Bonnetblanc JM. Lichen plan buccal érosif. Ann Dermatol Venereol 2009; 136:458-68; quiz 457, 469-70. [DOI: 10.1016/j.annder.2008.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 06/25/2008] [Indexed: 10/21/2022]
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Motta ACF, Domaneschi C, Komesu MC, Souza CDS, Aoki V, Migliari DA. Double-blind, crossover, placebo-controlled clinical trial with clobetasol propionate in desquamative gingivitis. Braz Dent J 2009; 20:231-6. [DOI: 10.1590/s0103-64402009000300011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the efficacy of a 0.05% clobetasol propionate ointment administered in trays to 22 patients with desquamative gingivitis in a double-blind, crossover, placebo-controlled trial. Patients received container number 1 and were instructed to apply the ointment 3 times a day for 2 weeks, and to reduce the application to once a day in the third week. Next, the patients were then instructed to discontinue the treatment for 2 weeks, and were then given container 2, used in the same way and for the same length of time as container 1. Regarding signs, 17 patients presented some improvement, while 5 experienced worsening with clobetasol propionate. With the placebo, 14 patients presented some improvement, and 8 patients presented worsening. For symptoms, there was complete improvement in 2 patients, partial improvement in 12, no response in 7, and worsening in 1 with clobetasol propionate. With the placebo, there was partial improvement in 8 patients, no response in 12 and worsening in 2. No statistically significant difference was found between clobetasol and placebo (p>0.05). Within the period designed to treat the gingival lesions of the patients, clobetasol propionate did not significantly outperform the placebo.
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van der Hem P, Egges M, van der Wal J, Roodenburg J. CO2 laser evaporation of oral lichen planus. Int J Oral Maxillofac Surg 2008; 37:630-3. [DOI: 10.1016/j.ijom.2008.04.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 12/04/2007] [Accepted: 04/01/2008] [Indexed: 11/26/2022]
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