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Lavoro A, Cultrera G, Gattuso G, Lombardo C, Falzone L, Saverio C, Libra M, Salmeri M. Role of Oral Microbiota Dysbiosis in the Development and Progression of Oral Lichen Planus. J Pers Med 2024; 14:386. [PMID: 38673013 PMCID: PMC11050998 DOI: 10.3390/jpm14040386] [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: 03/07/2024] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Oral lichen planus (OLP) is a chronic inflammatory autoimmune disease of the oral cavity with malignant potential affecting 1.01% of the worldwide population. The clinical patterns of this oral disorder, characterized by relapses and remissions of the lesions, appear on buccal, lingual, gingival, and labial mucosa causing a significant reduction in the quality of life. Currently, there are no specific treatments for this disease, and the available therapies with topical and systemic corticosteroids only reduce symptoms. Although the etiopathogenesis of this pathological condition has not been completely understood yet, several exogenous and endogenous risk factors have been proposed over the years. The present review article summarized the underlying mechanisms of action involved in the onset of OLP and the most well-known triggering factors. According to the current data, oral microbiota dysbiosis could represent a potential diagnostic biomarker for OLP. However, further studies should be undertaken to validate their use in clinical practice, as well as to provide a better understanding of mechanisms of action and develop novel effective intervention strategies against OLP.
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Affiliation(s)
- Alessandro Lavoro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (A.L.); (G.C.); (G.G.); (C.L.); (C.S.); (M.L.); (M.S.)
| | - Giovanni Cultrera
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (A.L.); (G.C.); (G.G.); (C.L.); (C.S.); (M.L.); (M.S.)
| | - Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (A.L.); (G.C.); (G.G.); (C.L.); (C.S.); (M.L.); (M.S.)
| | - Cinzia Lombardo
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (A.L.); (G.C.); (G.G.); (C.L.); (C.S.); (M.L.); (M.S.)
| | - Luca Falzone
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (A.L.); (G.C.); (G.G.); (C.L.); (C.S.); (M.L.); (M.S.)
| | - Candido Saverio
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (A.L.); (G.C.); (G.G.); (C.L.); (C.S.); (M.L.); (M.S.)
- Research Center for Prevention, Diagnosis and Treatment of Cancer, University of Catania, 95123 Catania, Italy
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (A.L.); (G.C.); (G.G.); (C.L.); (C.S.); (M.L.); (M.S.)
- Research Center for Prevention, Diagnosis and Treatment of Cancer, University of Catania, 95123 Catania, Italy
| | - Mario Salmeri
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (A.L.); (G.C.); (G.G.); (C.L.); (C.S.); (M.L.); (M.S.)
- Research Center for Prevention, Diagnosis and Treatment of Cancer, University of Catania, 95123 Catania, Italy
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Najafizade N, Mobini Dehkordi R, Hemati S. Investigating the effect of Aloe vera on the prevention and treatment of radiotherapy-induced oral mucositis in patients with head-and-neck cancer. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 29:16. [PMID: 38808218 PMCID: PMC11132420 DOI: 10.4103/jrms.jrms_115_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 08/31/2023] [Accepted: 11/14/2023] [Indexed: 05/30/2024]
Abstract
Background Oral mucositis is one of the main complications of radiotherapy (RT) while treating head-and-neck cancers and can affect the patients' treatment process and life. Therefore, this study evaluated the effect of Aloe vera on the prevention and treatment of radiotherapy-induced oral mucositis (RIOM) in patients with head-and-neck cancer. Materials and Methods This was a double-blind clinical trial performed in 2019 on 75 patients with head-and-neck cancer. Patients were randomly assigned to two groups receiving gargles of 5 cc Aloe vera and the same dose of placebo mouthwash three times a day, respectively. Then, the incidence and severity of RIOM were evaluated and compared between the two groups over 6 weeks of RT. Results There was no significant difference between the two groups in terms of the severity of RIOM from the 1st to 3rd weeks of RT (P > 0.05). However, the severity of RIOM in the 4th, 5th, and 6th weeks of RT was significantly lower in the Aloe vera group compared with the placebo group (P < 0.05). Conclusion According to the results of the present study, the long-term use of Aloe vera mouthwash can reduce the severity of RIOM.
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Affiliation(s)
- Nadia Najafizade
- Department of Radiation Oncology, Cancer Prevention Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Mobini Dehkordi
- Department of Radiation Oncology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Simin Hemati
- Department of Radiation Oncology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Kumar S L, Naik Z, Panwar A, M S, Keluskar V, Kumar RS. Comparative evaluation of the efficacy of Nigella sativa (75% v/v) cream and clobetasol propionate (0.05% w/w) gel in oral lichen planus-a double-blinded randomized control trial. Oral Maxillofac Surg 2024; 28:225-234. [PMID: 36547822 DOI: 10.1007/s10006-022-01130-6] [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: 10/22/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The a im of this study is to evaluate and compare the efficacy of Nigella sativa (75% v/v) cream and clobetasol propionate (0.05% w/w) gel for the management of oral lichen planus (OLP). STUDY DESIGN Sixty clinically diagnosed cases of OLP were stratified into moderate cases or severe cases based on burning sensation before getting allocated to group I receiving Nigella sativa cream and group II receiving clobetasol propionate gel, two times a day for 45 days. Patients were examined every 15 days for a change in burning sensation and size of the lesion using the numeric pain rating scale (NRS) and a standard Vernier caliper, respectively. Statistical tests including Mann-Whitney U, Wilcoxon signed-rank, Friedman's, Dunn's post hoc, unpaired t, paired t, one-way repeated measures ANOVA, and Bonferroni's post hoc were applied. RESULTS There was a statistically significant reduction in the burning sensation as well as the size of the lesion in both groups (P ≤ 0.05). There was an 87.8% (moderate cases) and 85.7% (severe cases) reduction in the mean NRS scores on the 45th day in group I when compared to the 96.5% (moderate cases) and 93.48% (severe cases) in group II. There was a 92.9% (moderate cases) and 90.7% (severe cases) reduction in the size of the lesion in group I when compared to the 92.6% (moderate cases) and 93.1% (severe cases) in group II. CONCLUSION The topical application of Nigella sativa cream was effective and comparable to clobetasol propionate 0.05% gel in the management of OLP, without any side effects. Hence, this study recommends the use of topical Nigella sativa cream therapy in the management of OLP. CLINICAL RELEVANCE The current mainstay of treatment for OLP is the administration of topical or systemic corticosteroids, which are known to cause side effects, demanding a search for an alternative. Nigella sativa oil cream could be a safe, promising, cost-effective, adjunctive, or alternative modality. Clinical trial registration number: CTRI/2020/07/026745 (India).
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Affiliation(s)
- Lokesh Kumar S
- Department of Oral Medicine, Radiology, and Special Care Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), No. 162, Poonamalle High Road, Chennai-, 600077, Tamil Nadu, India.
| | - Zameera Naik
- Department of Oral Medicine and Radiology, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, JNMC Campus, Nehru Nagar, Belagavi-, 590010, Karnataka, India
| | - Arun Panwar
- Department of Oral Medicine and Radiology, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, JNMC Campus, Nehru Nagar, Belagavi-, 590010, Karnataka, India
| | - Sridhar M
- Department of Oral Medicine and Radiology, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, JNMC Campus, Nehru Nagar, Belagavi-, 590010, Karnataka, India
| | - Vaishali Keluskar
- Department of Oral Medicine and Radiology, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, JNMC Campus, Nehru Nagar, Belagavi-, 590010, Karnataka, India
| | - Ram Surath Kumar
- Department of Public Health Dentistry, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, JNMC Campus, Nehru Nagar, Belagavi-, 590010, Karnataka, India
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Amanpour S, Akbari Javar M, Sarhadinejad Z, Doustmohammadi M, Moghadari M, Sarhadynejad Z. A systematic review of medicinal plants and herbal products' effectiveness in oral health and dental cure with health promotion approach. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:306. [PMID: 38023092 PMCID: PMC10670971 DOI: 10.4103/jehp.jehp_1297_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/27/2022] [Indexed: 12/01/2023]
Abstract
Medicinal plants and herbal drugs are being used increasingly as part of primary health care in most parts of the world. As important adjunctive and alternative treatments for oral health care, herbal products' use may continue to increase and become more widespread. The objective of this study is to present a comprehensive systematic review of the current published literature on the effectiveness of medicinal plants and herbal products employed to improve oral health in adolescents with a health promotion approach. The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The keywords "herbal medicine," "herbal extract," "herbal supplements," "plant extract," "natural drug," "pulpitis," "dental caries," "oral viral diseases," and "abscess" were used in combination with the Boolean operators OR and AND. PubMed, Embase, Scopus, and Web of Science were searched. Quality assessment of the included studies was performed using the Cochrane Handbook for Systematic Reviews of Interventions. The search yielded 49 original research studies. A total of 22 studies had low or unclear risk bias. The geographical distribution of included studies was primarily concentrated on western countries. Overall, studies reported herbal product users' age, ranging from young adults aged 18 years to elderly people aged 75 years or older. Most studies reported multiple compounds, including herbal drugs and herbal extracts. Chamomile and Aloe vera were the most frequently reported herbal compounds. The most commonly described herbal products to treat oral diseases were gels, mouth rinses, and pastes. The studies included a range of people with oral diseases, including periodontal and gingival diseases, recurrent aphthous stomatitis, oral lichen planus, and oral candidiasis. Herbal product interventions were found to be effective and safe alternatives for oral health care. One of the most important goals of the World Health Organization (until 2015) is the oral health index, so it is important that dental services be followed up more seriously. Considering the problems in reaching this goal of the World Health Organization in our country, herbal products have the ability to improve clinical oral health outcomes in adolescents. Limited adverse side effects indicate the overall safety of these treatments for a wide range of oral diseases. Therefore, the use of medicinal plants as well as alternative medicine is one of the useful methods in achieving this important goal of public health.
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Affiliation(s)
- Sara Amanpour
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahsa Akbari Javar
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Zohreh Sarhadinejad
- Noncommunicable Disease Research Center, Bam University of Medical Sciences, Bam, Iran
| | - Mohammadmahdi Doustmohammadi
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Masoud Moghadari
- Department of Persian Medicine, Faculty of Persian Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Zarrin Sarhadynejad
- Herbal and Traditional Medicines Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Traditional Pharmacy, Faculty of Persian Medicine, Kerman University of Medical Sciences, Kerman, Iran
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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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Sahoo A, Jena AK, Panda M. Experimental and clinical trial investigations of phyto-extracts, phyto-chemicals and phyto-formulations against oral lichen planus: A systematic review. JOURNAL OF ETHNOPHARMACOLOGY 2022; 298:115591. [PMID: 35963418 DOI: 10.1016/j.jep.2022.115591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Bio-assay guided phytoextracts and derived phytoconstituents reported having multipotent biological activities and nearly 60-80% of the global population still using natural regimens as an alternative therapeutic source. This study focused on the ethnopharmacological and experimental evidence of natural remedies that are effective in treating oral lichen planus (OLP), a chronic T-cell mediated autoimmune disease that is associated with oral cancer transmission. AIM OF THE REVIEW A number of studies have shown that antioxidants and antiinflammatory phytoextracts and phyto-constituents are effective against OLP. In this systematic review, we summarize the details of experimentally assessed ancient Traditional Chinese Medicine (TCM), Indian Ayurveda or Ayurvedic Medicine, and Japanese Kampo Medicine (JKM) regimens (crude extracts, individual phytochemicals, and phyto-formulations) that reduce oral lesion, severity index and pain associated with OLP based on studies conducted in vivo, in vitro, and in randomized controlled trials (RCTs). MATERIALS AND METHODS Experimental, clinical and RCT investigation reports were gathered and presented according to PRISMA-2020 format. Briefly, the information was obtained from PubMed, ScienceDirect, Wiley journal library, Scopus, Google Scholar with ClinicalTrials.gov (a clinical trial registry database operated by the National Library of Medicine in the United States). Further, individual phytochemical structures were verified from PubChem and ChemSpider databases and visualized by ChemDraw 18.0 software. RESULTS We summarized 11 crude phytoextracts, 7 individual phytochemicals, 9 crude formulations, 8 specific TCM and JKM herbal cocktails, and 6 RCTs/patents corroborated by multiple in vitro, in vivo and enzyme assay methods. Briefly, plants and their family name, used plant parts, reported phytochemicals and their chemical structure, treatment doses, and duration of each experiment were presented more concisely and scientifically. CONCLUSION Documentation of evidence-based natural ethnomedicines or remedies could be useful for promoting them as potential, cost-effective and less toxic alternatives or as complementary to commonly prescribed steroids towards the control of OLP.
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Affiliation(s)
- Alaka Sahoo
- Department of Skin & VD, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, 751003, Odisha, India.
| | - Ajaya K Jena
- Department of Skin & VD, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, 751003, Odisha, India
| | - Maitreyee Panda
- Department of Skin & VD, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, 751003, Odisha, India.
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Second-Degree Burns and Aloe Vera: A Meta-analysis and Systematic Review. Adv Skin Wound Care 2022; 35:1-9. [DOI: 10.1097/01.asw.0000875056.29059.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhou Y, Wang M, Yan C, Liu H, Yu DG. Advances in the Application of Electrospun Drug-Loaded Nanofibers in the Treatment of Oral Ulcers. Biomolecules 2022; 12:1254. [PMID: 36139093 PMCID: PMC9496154 DOI: 10.3390/biom12091254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/26/2022] [Accepted: 09/04/2022] [Indexed: 02/07/2023] Open
Abstract
Oral ulcers affect oral and systemic health and have high prevalence in the population. There are significant individual differences in the etiology and extent of the disease among patients. In the treatment of oral ulcers, nanofiber films can control the drug-release rate and enable long-term local administration. Compared to other drug-delivery methods, nanofiber films avoid the disadvantages of frequent administration and certain side effects. Electrospinning is a simple and effective method for preparing nanofiber films. Currently, electrospinning technology has made significant breakthroughs in energy-saving and large-scale production. This paper summarizes the polymers that enable oral mucosal adhesion and the active pharmaceutical ingredients used for oral ulcers. Moreover, the therapeutic effects of currently available electrospun nanofiber films on oral ulcers in animal experiments and clinical trials are investigated. In addition, solvent casting and cross-linking methods can be used in conjunction with electrospinning techniques. Based on the literature, more administration systems with different polymers and loading components can be inspired. These administration systems are expected to have synergistic effects and achieve better therapeutic effects. This not only provides new possibilities for drug-loaded nanofibers but also brings new hope for the treatment of oral ulcers.
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Affiliation(s)
- Yangqi Zhou
- School of Materials Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Menglong Wang
- School of Materials Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Chao Yan
- School of Materials Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Hui Liu
- School of Materials Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Deng-Guang Yu
- School of Materials Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
- Shanghai Engineering Technology Research Center for High-Performance Medical Device Materials, Shanghai 200093, China
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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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Xiao J, Chen S, Chen Y, Su J. The potential health benefits of aloin from genus Aloe. Phytother Res 2022; 36:873-890. [PMID: 35040198 DOI: 10.1002/ptr.7371] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 01/04/2023]
Abstract
The Aloe species is known for its medicinal and cosmetic properties. Aloin is an active ingredient found in the leaves of medicinal plants of the genus Aloe. Aloin has attracted considerable interest for its antiinflammatory, anticancer, antibacterial, and antioxidant activities. However, since its clinical application is restricted by its unclear mechanism of action, a deeper understanding of its pharmacological activity is required. This review provides an overview of current pharmacological and toxicological studies published in English from February 2000 to August 2021. Herein, we summarized the sources and potential health benefits of aloin from a clinical application perspective to guide for further studies on the sources of aloin, aimed at efficiently increasing aloin production. Importantly, the function and mechanism of action of aloin remain unclarified. In future research, it is necessary to develop new approaches for studying the pharmacological molecular mechanisms underlying the activity of this compound against various diseases.
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Affiliation(s)
- Jianbin Xiao
- College of Life Science, Fujian Normal University, Fuzhou, China.,The Public Service Platform for Industrialization Development Technology of Marine Biological Medicine and Products of the State Oceanic Administration, Fujian Key Laboratory of Special Marine Bioresource Sustainable Utilization, Southern Institute of Oceanography, Fujian Normal University, Fuzhou, China
| | - Siyuan Chen
- College of Life Science, Fujian Normal University, Fuzhou, China.,The Public Service Platform for Industrialization Development Technology of Marine Biological Medicine and Products of the State Oceanic Administration, Fujian Key Laboratory of Special Marine Bioresource Sustainable Utilization, Southern Institute of Oceanography, Fujian Normal University, Fuzhou, China
| | - Youqiang Chen
- College of Life Science, Fujian Normal University, Fuzhou, China.,The Public Service Platform for Industrialization Development Technology of Marine Biological Medicine and Products of the State Oceanic Administration, Fujian Key Laboratory of Special Marine Bioresource Sustainable Utilization, Southern Institute of Oceanography, Fujian Normal University, Fuzhou, China
| | - Jingqian Su
- College of Life Science, Fujian Normal University, Fuzhou, China.,Fujian Key Laboratory of Innate Immune Biology, Biomedical Research Center of South China, Fujian Normal University, Fuzhou, China
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11
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Pourshahidi S, Sheykhbahaei N. Effectiveness of herbal based medications in the treatment of oral lichen planus: A review article. J Herb Med 2021. [DOI: 10.1016/j.hermed.2021.100458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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12
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Solimani F, Forchhammer S, Schloegl A, Ghoreschi K, Meier K. Lichen planus – ein Klinikleitfaden. J Dtsch Dermatol Ges 2021; 19:864-883. [PMID: 34139075 DOI: 10.1111/ddg.14565_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Farzan Solimani
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | | | | | - Kamran Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | - Katharina Meier
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
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13
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Solimani F, Forchhammer S, Schloegl A, Ghoreschi K, Meier K. Lichen planus - a clinical guide. J Dtsch Dermatol Ges 2021; 19:864-882. [PMID: 34096678 DOI: 10.1111/ddg.14565] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/05/2021] [Indexed: 12/15/2022]
Abstract
Lichen planus (LP) is a chronic lichenoid inflammatory disorder of the skin, mucosa and of the appendages. LP is classically characterized by the presence of a rich infiltration of inflammatory T cells, which migrate in the upper part of the dermis, arranged in a band-like pattern. Different sub types of the disease have been so far described. Albeit LP is clinically well defined, the disease still represents a therapeutic enigma. Especially with regard to mucosal or scalp affecting LP types, which often present a recalcitrant and treatment unresponsive course, efficacious therapeutic options are still lacking. Thus, LP represents a disease with a high psychosocial burden. Yet, development in the deciphering of LP pathogenesis reveals possible new druggable targets, thus paving the way for future therapeutic options. In this clinical guide, we summarize the current clinical knowledge and therapeutic standards and discuss the future perspective for the management of LP.
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Affiliation(s)
- Farzan Solimani
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Forchhammer
- Department of Dermatology, University Medical Center, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Alexandra Schloegl
- Department of Dermatology, University Medical Center, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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14
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Kalaskar AR, Bhowate RR, Kalaskar RR, Ghonmode S. Novel neem leaves extract mouthwash therapy for oral lichen planus. J Herb Med 2021. [DOI: 10.1016/j.hermed.2020.100408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Vadivel JK, Ezhilarasan D, Govindarajan M, Somasundaram E. Therapeutic effectiveness of alternative medications in oral lichen planus: A systematic review. J Oral Maxillofac Pathol 2021; 24:344-351. [PMID: 33456246 PMCID: PMC7802873 DOI: 10.4103/jomfp.jomfp_68_20] [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: 02/13/2020] [Revised: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 01/13/2023] Open
Abstract
Lichen planus is a chronic inflammatory condition affecting the skin and mucosa. The etiology is unknown but the pathogenesis appears to be an immune-mediated reaction. The mainstay drugs used in the treatment are immunomodulators. The aim of this paper is to report on the therapeutic effectiveness of the alternate medications used in the management of oral lichen planus (OLP). A systematic search of PubMed, Web of Science and Cochrane Controlled Clinical trials were done for all the papers published until December 2019. The search resulted in a total of 20 studies that were found suitable for the review. The results showed that the reduction in pain, treatment effectiveness was comparable between the steroids and alternative medications. However, the alternative medications had a therapeutic advantage in studies that had used placebo as controls and the results were statistically significant (P < 0.05). No major adverse effects were reported with the usage of alternative medications. There is definitely a therapeutic potential in the usage of alternative medications in the management of OLP. In terms of therapeutic effectiveness, they are on par with the immunomodulators. These alternative medications offer us a new therapeutic option in the management of OLP without any adverse effects.
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Affiliation(s)
- Jayanth Kumar Vadivel
- Department of Oral Medicine and Radiology, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India
| | - Devaraj Ezhilarasan
- Department of Pharmacology, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India
| | - Meera Govindarajan
- Consultant Pathologist, R and D Histopath Labs, Chennai, Tamil Nadu, India
| | - Elangovan Somasundaram
- Department of Oral Medicine and Radiology, KSR Institute of Dental Sciences and Research, Tiruchengode, Tamil Nadu, India
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16
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Mutalik S, Belgaumkar V, Rasal Y. Current perspectives in the treatment of childhood lichen planus. INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2021. [DOI: 10.4103/ijpd.ijpd_165_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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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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18
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Natural remedies versus topical steroids for the treatment of oral lichen planus: A systematic review. J Herb Med 2020. [DOI: 10.1016/j.hermed.2020.100394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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19
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Gholizadeh N, Pirzadeh F, Mirzaii-Dizgah I, Sheykhbahaei N. Relationship between salivary vitamin D deficiency and oral lichen planus. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 36:384-386. [PMID: 32335958 DOI: 10.1111/phpp.12567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/13/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Narges Gholizadeh
- Department of Oral & Maxillofacial Medicine, School of Dentistry, Tehran University of Medical Science, Tehran, Iran
| | - Fatemeh Pirzadeh
- Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj Mirzaii-Dizgah
- Department of Physiology, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Nafiseh Sheykhbahaei
- Department of Oral & Maxillofacial Medicine, School of Dentistry, Tehran University of Medical Science, Tehran, Iran
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20
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Shavit E, Hagen K, Shear N. Oral lichen planus: a novel staging and algorithmic approach and all that is essential to know. F1000Res 2020; 9. [PMID: 32226613 PMCID: PMC7096219 DOI: 10.12688/f1000research.18713.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2020] [Indexed: 01/04/2023] Open
Abstract
Lichen planus (LP) is a chronic autoimmune disease. Oral lesions may occur in isolation or in combination with other affected muco-cutaneous sites. Oral LP (OLP) may present as one of the various manifestations of LP or may present as a disease sui generis with a broad range of severity. Despite this disease targeting the oral mucosa, its great impact on quality of life is underrated. In this article, we provide an updated review of the pathophysiology and epidemiology of OLP and offer guidance for its diagnosis and management. We also propose an algorithmic approach to the clinical forms of OLP and a novel staging system to facilitate management decisions.
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Affiliation(s)
- Eran Shavit
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Dermatology Unit, Barzilai University Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Klieb Hagen
- Department of Dentistry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Neil Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Department of Medicine (Dermatology, Clinical Pharmacology, and Toxicology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Pharmacology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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21
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Lodi G, Manfredi M, Mercadante V, Murphy R, Carrozzo M. Interventions for treating oral lichen planus: corticosteroid therapies. Cochrane Database Syst Rev 2020; 2:CD001168. [PMID: 32108333 PMCID: PMC7047223 DOI: 10.1002/14651858.cd001168.pub3] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Oral lichen planus (OLP) is a relatively common chronic T cell-mediated disease, which can cause significant pain, particularly in its erosive or ulcerative forms. As pain is the indication for treatment of OLP, pain resolution is the primary outcome for this review. This review is an update of a version last published in 2011, but focuses on the evidence for corticosteroid treatment only. A second review considering non-corticosteroid treatments is in progress. OBJECTIVES To assess the effects and safety of corticosteroids, in any formulation, for treating people with symptoms of oral lichen planus. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases to 25 February 2019: Cochrane Oral Health's Trials Register, CENTRAL (2019, Issue 1), MEDLINE Ovid, and Embase Ovid. ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. There were no restrictions on language or date of publication. SELECTION CRITERIA We considered randomised controlled clinical trials (RCTs) of any local or systemic corticosteroid treatment compared with a placebo, a calcineurin inhibitor, another corticosteroid, any other local or systemic (or both) drug, or the same corticosteroid plus an adjunctive treatment. DATA COLLECTION AND ANALYSIS Three review authors independently scanned the titles and abstracts of all reports identified, and assessed risk of bias using the Cochrane tool and extracted data from included studies. For dichotomous outcomes, we expressed the estimates of effects of an intervention as risk ratios (RR), with 95% confidence intervals (CI). For continuous outcomes, we used mean differences (MD) and 95% CI. The statistical unit of analysis was the participant. We conducted meta-analyses only with studies of similar comparisons reporting the same outcome measures. We assessed the overall certainty of the evidence using GRADE. MAIN RESULTS We included 35 studies (1474 participants) in this review. We assessed seven studies at low risk of bias overall, 11 at unclear and the remaining 17 studies at high risk of bias. We present results for our main outcomes, pain and clinical resolution measured at the end of the treatment course (between one week and six months), and adverse effects. The limited evidence available for comparisons between different corticosteroids, and corticosteroids versus alternative or adjunctive treatments is presented in the full review. Corticosteroids versus placebo Three studies evaluated the effectiveness and safety of topical corticosteroids in an adhesive base compared to placebo. We were able to combine two studies in meta-analyses, one evaluating clobetasol propionate and the other flucinonide. We found low-certainty evidence that pain may be more likely to be resolved when using a topical corticosteroid rather than a placebo (RR 1.91, 95% CI 1.08 to 3.36; 2 studies, 72 participants; I² = 0%). The results for clinical effect of treatment and adverse effects were inconclusive (clinical resolution: RR 6.00, 95% CI 0.76 to 47.58; 2 studies, 72 participants; I² = 0%; very low-certainty evidence; adverse effects RR 1.48, 95% 0.48 to 4.56; 3 studies, 88 participants, I² = 0%, very low-certainty evidence). Corticosteroids versus calcineurin inhibitors Three studies compared topical clobetasol propionate versus topical tacrolimus. We found very low-certainty evidence regarding any difference between tacrolimus and clobetasol for the outcomes pain resolution (RR 0.45, 95% CI 0.24 to 0.88; 2 studies, 100 participants; I² = 80%), clinical resolution (RR 0.61, 95% CI 0.38 to 0.99; 2 studies, 52 participants; I² = 95%) and adverse effects (RR 0.05, 95% CI 0.00 to 0.83; 2 studies, 100 participants; very low-certainty evidence) . One study (39 participants) compared topical clobetasol and ciclosporin, and provided only very low-certainty evidence regarding the rate of clinical resolution with clobetasol (RR 3.16, 95% CI 1.00 to 9.93), pain resolution (RR 2.11, 95% CI 0.76 to 5.86) and adverse effects (RR 6.32, 95% CI 0.84 to 47.69). Two studies (60 participants) that compared triamcinolone and tacrolimus found uncertain evidence regarding the rate of clinical resolution (RR 0.86, 95% CI 0.55 to 1.35; very low-certainty evidence) and that there may be a lower rate of adverse effects in the triamcinolone group (RR 0.47, 95% CI 0.22 to 0.99; low-certainty evidence). These studies did not report on pain resolution. AUTHORS' CONCLUSIONS Corticosteroids have been first line for the treatment of OLP. This review found that these drugs, delivered topically as adhesive gels or similar preparations, may be more effective than placebo for reducing the pain of symptomatic OLP; however, with the small number of studies and participants, our confidence in the reliability of this finding is low. The results for clinical response were inconclusive, and we are uncertain about adverse effects. Very low-certainty evidence suggests that calcineurin inhibitors, specifically tacrolimus, may be more effective at resolving pain than corticosteroids, although there is some uncertainty about adverse effects and clinical response to tacrolimus showed conflicting results.
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Affiliation(s)
- Giovanni Lodi
- University of MilanDepartment of Biomedical, Surgical and Dental SciencesVia Beldiletto 1/3MilanItaly20142
| | - Maddalena Manfredi
- University of ParmaPolo Clinico di Odontostomatologia, SBiBiT DepartmentVia Gramsci, 14ParmaItaly43100
| | - Valeria Mercadante
- University College of LondonEastman Dental Institute256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Ruth Murphy
- Sheffield Children's NHS Foundation TrustDepartment of Dermatology, Sheffield Children's HospitalSheffieldUKS10 2JF
| | - Marco Carrozzo
- University of Newcastle upon TyneDepartment of Oral Medicine, School of Dental SciencesFramlington PlaceNewcastle upon TyneUKNE2 4BW
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22
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Alkhouli M, Laflouf M, Alhaddad M. Efficacy of Aloe-Vera Use for Prevention of Chemotherapy-Induced Oral Mucositis in Children with Acute Lymphoblastic Leukemia: A Randomized Controlled Clinical Trial. Compr Child Adolesc Nurs 2020; 44:49-62. [PMID: 32101488 DOI: 10.1080/24694193.2020.1727065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Oral mucositis can be caused by chemotherapy and can affect a patient's quality of life. Nowadays, to prevent chemotherapy-induced oral mucositis (CIOM) is a crucial point in palliative care centers. This trial aimed to assess the effectiveness of aloe-vera in that concept. The trial was accomplished at Hematology Department of Hospital of Children of Damascus University, Syria. Acute lymphoblastic leukemia (ALL) children were the population from which 26 children were enrolled in the study. They were aged between 3 and 6 years old and were randomly referred according to the intervention into two groups, Aloe-vera (AV) and sodium bicarbonate 5% (13 each). Spongeous sticks were used to help in applying the material on tongue, labial and buccal mucosa, lips, floor of the mouth, and hard palate. Two blinded external examiners evaluated oral mucosa weekly for up to 2 months using the World Health Organization grading scale. Mann-Whitney U test was used to analyze data. According to the observed findings, CIOM degrees were less severe in the aloe-vera group than in the sodium bicarbonate group. Statistically significant difference of occurrence of different CIOM degrees between groups was recorded in the 2nd, 3rd, 4th, and 7th weeks of follow-up period. Moreover, Mann-Whitney U test indicated that patients in the sodium bicarbonate group began CIOM sooner than those in the aloe-vera group with a statistically significant difference (p = .001). These findings show that topical application of aloe-vera solution is effective in the prevention of CIOM in ALL children.
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Affiliation(s)
- Muaaz Alkhouli
- Department of Pediatric Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Mohannad Laflouf
- Department of Pediatric Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Mazen Alhaddad
- Department of Pediatrics, Faculty of Medicine, Damascus University, Damascus, Syria
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23
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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: 94] [Impact Index Per Article: 18.8] [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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24
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Salehi B, Lopez-Jornet P, Pons-Fuster López E, Calina D, Sharifi-Rad M, Ramírez-Alarcón K, Forman K, Fernández M, Martorell M, Setzer WN, Martins N, Rodrigues CF, Sharifi-Rad J. Plant-Derived Bioactives in Oral Mucosal Lesions: A Key Emphasis to Curcumin, Lycopene, Chamomile, Aloe vera, Green Tea and Coffee Properties. Biomolecules 2019; 9:biom9030106. [PMID: 30884918 PMCID: PMC6468600 DOI: 10.3390/biom9030106] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/06/2019] [Accepted: 03/13/2019] [Indexed: 02/07/2023] Open
Abstract
Oral mucosal lesions have many etiologies, including viral or bacterial infections, local trauma or irritation, systemic disorders, and even excessive alcohol and tobacco consumption. Folk knowledge on medicinal plants and phytochemicals in the treatment of oral mucosal lesions has gained special attention among the scientific community. Thus, this review aims to provide a brief overview on the traditional knowledge of plants in the treatment of oral mucosal lesions. This review was carried out consulting reports between 2008 and 2018 of PubMed (Medline), Web of Science, Embase, Scopus, Cochrane Database, Science Direct, and Google Scholar. The chosen keywords were plant, phytochemical, oral mucosa, leukoplakia, oral lichen planus and oral health. A special emphasis was given to certain plants (e.g., chamomile, Aloe vera, green tea, and coffea) and plant-derived bioactives (e.g., curcumin, lycopene) with anti-oral mucosal lesion activity. Finally, preclinical (in vitro and in vivo) and clinical studies examining both the safety and efficacy of medicinal plants and their derived phytochemicals were also carefully addressed.
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Affiliation(s)
- Bahare Salehi
- Student Research Committee, School of Medicine, Bam University of Medical Sciences, Bam 44340847, Iran.
| | - Pia Lopez-Jornet
- Instituto Murciano de InvestigaciónBiosanitaria (IMIB-Arrixaca-UMU), Clínica Odontológica Universitaria Hospital Morales Meseguer Adv. Marques de los velez s/n, 30008 Murcia, Spain.
| | - Eduardo Pons-Fuster López
- University of Murciaand, Clínica Odontológica Universitaria Hospital Morales Meseguer, Adv. Marques de los velez s/n, 30008 Murcia, Spain.
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
| | - Mehdi Sharifi-Rad
- Department of Medical Parasitology, Zabol University of Medical Sciences, Zabol 61663-335, Iran.
| | - Karina Ramírez-Alarcón
- Department of Nutrition and Dietetics, Faculty of Pharmacy, University of Concepcion, Concepcion 4070386, Chile.
| | - Katherine Forman
- Department of Nutrition and Dietetics, Faculty of Pharmacy, University of Concepcion, Concepcion 4070386, Chile.
| | - Marcos Fernández
- Department of Pharmacy, Faculty of Pharmacy, University of Concepcion, Concepcion 4070386, Chile.
| | - Miquel Martorell
- Department of Nutrition and Dietetics, Faculty of Pharmacy, University of Concepcion, Concepcion 4070386, Chile.
| | - William N Setzer
- Department of Chemistry, University of Alabama in Huntsville, Huntsville, AL 35899, USA.
| | - Natália Martins
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
- Institute for Research and Innovation in Health (i3S), University of Porto, 4200-135 Porto, Portugal.
| | - Célia F Rodrigues
- LEPABE, Department of Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal.
| | - Javad Sharifi-Rad
- Food Safety Research Center (Salt), Semnan University of Medical Sciences, Semnan 35198-99951, Iran.
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25
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Ghahremanlo A, Boroumand N, Ghazvini K, Hashemy SI. Herbal medicine in oral lichen planus. Phytother Res 2018; 33:288-293. [PMID: 30421555 DOI: 10.1002/ptr.6236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 01/18/2023]
Abstract
Oral lichen planus (OLP) is a common chronic inflammatory and T cell-mediated autoimmune disease in which the oral mucosa, tongue, and gingiva are involved. Different treatments have been suggested to reduce the symptoms of this disease. Currently, a common treatment for OLP is the use of corticosteroids as the gold standard, although they have considerable side effects. The chronicity of the disease needs the long-term use of these drugs with ensuing side effects. Therefore, various studies have been done to find an alternative and effective treatment. The use of herbal medicine as an alternative therapy with antioxidant and anti-inflammatory properties seems promising. Hence, this review study was done to summarize the efficiency of different herbal medicine in the treatment of OLP.
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Affiliation(s)
- Atefeh Ghahremanlo
- Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nadia Boroumand
- Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kiarash Ghazvini
- Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Isaac Hashemy
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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26
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Affiliation(s)
- Yan Gao
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
| | - Kit Ieng Kuok
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
| | - Ying Jin
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
| | - Ruibing Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
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Ai R, Tao Y, Hao Y, Jiang L, Dan H, Ji N, Zeng X, Zhou Y, Chen Q. Microenvironmental regulation of the progression of oral potentially malignant disorders towards malignancy. Oncotarget 2017; 8:81617-81635. [PMID: 29113419 PMCID: PMC5655314 DOI: 10.18632/oncotarget.20312] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/04/2017] [Indexed: 02/05/2023] Open
Abstract
Oral potentially malignant disorders (OPMD) develop in a complex tissue microenvironment where they grow sustainably, acquiring oral squamous cell carcinoma (OSCC) characteristics. The malignant tumor depends on interactions with the surrounding microenvironment to achieve loco-regional invasion and distant metastases. Unlike abnormal cells, the multiple cell types in the tissue microenvironment are relatively stable at the genomic level and, thus, become therapeutic targets with lower risk of resistance, decreasing the risk of OPMD acquiring cancer characteristics and carcinoma recurrence. However, deciding how to disrupt the OPMD and OSCC microenvironments is itself a daunting challenge, since their microenvironments present opposite capacities, resulting in diverse consequences. Furthermore, recent studies revealed that tumor-associated immune cells also participate in the process of differentiation from OPMD to OSCC, suggesting that reeducating stromal cells may be a new strategy to prevent OPMD from acquiring OSCC characteristics and to treat OSCC. In this review, we discuss the characteristics of the microenvironment of OPMD and OSCC as well as new therapeutic strategies.
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Affiliation(s)
- Ruixue Ai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yan Tao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yilong Hao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Lu Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Hongxia Dan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ning Ji
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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García-Pola MJ, González-Álvarez L, Garcia-Martin JM. Treatment of oral lichen planus. Systematic review and therapeutic guide. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.medcle.2017.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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García-Pola MJ, González-Álvarez L, Garcia-Martin JM. Tratamiento del liquen plano oral. Revisión sistemática y protocolo de actuación. Med Clin (Barc) 2017; 149:351-362. [DOI: 10.1016/j.medcli.2017.06.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 06/11/2017] [Accepted: 06/12/2017] [Indexed: 01/03/2023]
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Gupta S, Ghosh S, Gupta S. Interventions for the management of oral lichen planus: a review of the conventional and novel therapies. Oral Dis 2017; 23:1029-1042. [PMID: 28055124 DOI: 10.1111/odi.12634] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This narrative review focuses on the rationale and role of conventional and newer therapies in the management of oral lichen planus (OLP) with emphasis on randomized controlled trials (RCTs) reported over two decades. MATERIALS AND METHODS Literature search was conducted to identify RCTs for the management of OLP from 1 January 1995 to 31 December 2015; Medline and Cochrane databases complemented with manual search were used. Primary outcome as resolution of pain was evaluated with the analysis of clinical resolution of erythema and ulceration as secondary outcome. RESULTS The search provided 260 abstracts, of which 70 full-text articles were included. Majority of trials used topical steroids with very few trials on newer therapies. It was found that topical steroids are effective for symptomatic management of OLP with equal efficacy shown by topical calcineurin inhibitors and retinoids. However, the side effect of transient burning sensation with relapse was more with calcineurin inhibitors. CONCLUSION Although the newer therapies offer advantage over steroids for the management of OLP in recalcitrant cases, extensive lesions, and cases unresponsive to steroids, but sufficient clinical data on their use are still lacking. Hence, more RCTs with large sample size, adequate treatment duration, and long-term follow-up are required for clinical utility.
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Affiliation(s)
- S Gupta
- Department of Oral Medicine & Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - S Ghosh
- Department of Oral Medicine & Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - S Gupta
- Department of Oral Medicine & Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Ali S, Wahbi W. The efficacy of aloe vera in management of oral lichen planus: a systematic review and meta-analysis. Oral Dis 2017; 23:913-918. [PMID: 28029732 DOI: 10.1111/odi.12631] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/09/2016] [Accepted: 12/21/2016] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The main objective of oral lichen planus management is to control symptomatic outbreaks via eliminating lesions and alleviating symptoms. Corticosteroids, calcineurin inhibitors, and most of the available modalities are associated with adverse effects, which may limit their use. The aim of this review was to assess the effect of aloe vera on pain alleviation and/or clinical improvement in patients with symptomatic oral lichen planus. METHODS MEDLINE-PubMed; CENTRAL, and LILACS were searched in May 2016 to identify all clinical trials evaluating aloe vera vs placebo or corticosteroids for treatment of oral lichen planus. The included studies were five clinical trials and two case reports. RESULTS From the included studies, there is weak evidence that aloe vera is more efficient than placebo and has comparable effect to triamcinolone acetonide. The meta-analyses show heterogeneity and reveals that aloe vera is inferior to the control in general. CONCLUSION Although corticosteroids are still the gold standard, aloe vera shows promising results especially with no adverse effects compared with various adverse effects of corticosteroids. We recommend conducting new randomized clinical trials with larger sample size, sufficiently long follow-up period as well as standardized aloe vera formulations and outcome measures.
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Affiliation(s)
- S Ali
- Department of Oral Medicine and Periodontology, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt.,Department of Oral Medicine and Periodontology, Faculty of Oral and Dental Medicine, Misr International University, Cairo, Egypt
| | - W Wahbi
- Department of Chemistry, School of Sciences and Engineering, American University in Cairo, Cairo, Egypt
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Akaberi M, Sobhani Z, Javadi B, Sahebkar A, Emami SA. Therapeutic effects of Aloe spp. in traditional and modern medicine: A review. Biomed Pharmacother 2016; 84:759-772. [PMID: 27716590 DOI: 10.1016/j.biopha.2016.09.096] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/24/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022] Open
Abstract
Traditional medicine is a useful guide in medical sciences. In the Islamic Iranian traditional medicine, the medicinal properties of many plants have been mentioned that could be exploited in drug discovery. We aimed to explore the nature and properties of Aloe spp. As described in some major Islamic traditional texts including Ferdows al-Hekmah fi'l-Tibbe (The Paradise of Wisdom in Medicine), Al-Hawi fi'l-Tibb (Comprehensive Book of Medicine), Kamel al-Sanaat al-Tibbyyah (Complete Book of the Medical Art), Al-Qanun fi'l-Tibb (Canon of Medicine), Zakhireh Kharazmshahi (Treasure of Kharazmshah), and Makhzan al-Adwiah (Drug Treasure), and assess the conformity of traditional medicine instructions with the findings of modern pharmacological studies. Gastrointestinal activities, hepato-protective properties, beneficial effects against skin problems such as wounds, injuries, and infective diseases are among the most frequently mentioned properties of Aloe spp. Several activities of Aloe spp. described in traditional medicine have been the subject of recent in vitro and in vivo studies as well as clinical trials. Owing to the positive findings, different preparations of Aloe spp. are now present in pharmaceutical markets such as Aloe cosmetic products. On the other hand, there are many traditional therapeutic effects of Aloe spp. which have not been studied and require confirmatory experimental or clinical investigations. It is hoped that the present study could stimulate further research on the unexplored aspects of the medicinal properties of Aloe spp.
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Affiliation(s)
- Maryam Akaberi
- Department of Pharmacognosy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Sobhani
- Department of Traditional Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behjat Javadi
- Department of Traditional Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Seyed Ahmad Emami
- Department of Pharmacognosy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Traditional Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Fallahi HR, Hamadzade H, Nezhad AM, Zandian D, Taghizadeh M. Effect of Aloe vera mouthwash on postoperative complications after impacted third molar surgery: A randomized, double-blind clinical trial. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2016. [DOI: 10.1016/j.ajoms.2016.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nair GR, Naidu GS, Jain S, Nagi R, Makkad RS, Jha A. Clinical Effectiveness of Aloe Vera in the Management of Oral Mucosal Diseases- A Systematic Review. J Clin Diagn Res 2016; 10:ZE01-7. [PMID: 27656587 PMCID: PMC5028429 DOI: 10.7860/jcdr/2016/18142.8222] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/23/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Aloe vera is well known for its medicinal properties which lead to its application in treating various diseases. Its use in treating oral lesions has not been much documented in literature. AIM Although, systematic reviews on aloe vera and its extracts have been done earlier, but in relation to oral diseases this is the first systematic review. The aim of the present systematic review was to compile evidence based studies on the effectiveness of Aloe vera in treatment of various oral diseases. MATERIALS AND METHODS Computerized literature searches were performed to identify all published articles in the subject. The following databases were used: PUBMED [MEDLINE], SCOPUS, COCHRANE DATABASE, EMBASE and SCIENCE DIRECT using specific keywords. The search was limited to articles published in English or with an English Abstract. All articles (or abstracts if available as abstracts) were read in full. Data were extracted in a predefined fashion. Assessment was done using Jadad score. RESULTS Fifteen studies satisfied the inclusion criteria. Population of sample study ranged from 20 patients to 110 patients with clinically diagnosed oral mucosal lesions. Out of 15 studies, five were on patients with oral lichen planus, two on patients with oral submucous fibrosis, other studies were carried on patients with burning mouth syndrome, radiation induced mucositis, candida associated denture stomatitis, xerostomic patients and four were on minor recurrent apthous stomatitis. Most studies showed statistically significant result demonstrating the effectiveness of Aloe vera in treatment of oral diseases. CONCLUSION Although there are promising results but in future, more controlled clinical trials are required to prove the effectiveness of Aloe vera for management of oral diseases.
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Affiliation(s)
- Gopakumar Ramachandran Nair
- Ex-Professor and Head, Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, India
| | - Giridhar Seetharam Naidu
- Professor, Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, India
| | - Supreet Jain
- Senior Lecturer, Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, India
| | - Ravleen Nagi
- Senior Lecturer, Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, India
| | - Ramanpal Singh Makkad
- Senior Lecturer, Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, India
| | - Abhishek Jha
- Senior Lecturer, Department of Preventive and community Dentistry, New Horizon Dental College and Research Institute, Sakri, Bilaspur, India
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Na HS, Song YR, Kim S, Heo JY, Chung HY, Chung J. Aloin Inhibits Interleukin (IL)-1β−Stimulated IL-8 Production in KB Cells. J Periodontol 2016; 87:e108-15. [DOI: 10.1902/jop.2016.150447] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Suresh SS, Chokshi K, Desai S, Malu R, Chokshi A. Medical Management of Oral Lichen Planus: A Systematic Review. J Clin Diagn Res 2016; 10:ZE10-5. [PMID: 27042598 DOI: 10.7860/jcdr/2016/16715.7225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/25/2015] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Oral Lichen Planus (OLP) is a chronic inflammatory, T-cell-mediated autoimmune oral mucosal disease with unclear aetiology. The clinical management of OLP poses considerable difficulties to the oral physician. AIM The aim was to assess the efficacy of any form of intervention used to medically manage OLP. MATERIALS AND METHODS We searched and analysed the following databases (from January 1990 to December 2014):- Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. All Randomised Controlled Trials (RCTs) for the medical management of OLP which compared active treatment with placebo or between active treatments were considered in this systematic review. Participants of any age, gender or race having symptomatic OLP (including mixed forms), unconnected to any identifiable cause (e.g. lichenoid drug reactions) and confirmed by histopathology have been included. Interventions of all types, including topical treatments or systemic drugs of variable dosage, duration & frequency of delivery have been considered. All the trials identified were appraised by five review authors and the data for all the trials were synthesised using specifically designed data extraction form. Binary data has been presented as risk ratios (RR) with 95% confidence intervals (CI) and continuous data as mean differences (MD) with 95% CIs. RESULTS A total of 35 RCTs were included in this systematic review on medical management of OLP. No strong evidence suggesting superiority of any specific intervention in reducing pain and clinical signs of OLP were shown by the RCTs included here. CONCLUSION Future RCTs on a larger scale, adopting standardized outcome assessing parameters should be considered.
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Affiliation(s)
- Swetha Singh Suresh
- Private Practicner, Department of Oral Pathology and Microbiology, Bangalore, Karnataka, India
| | - Krunal Chokshi
- Senior Lecturer, Department of Pedodontics and Preventive Dentistry, Ahmedabad Dental College and Hospital , Bhadaj - Ranchodpura Road, Ahmedabad, India
| | - Sachin Desai
- Senior Lecturer, Department of Periodontology, A.C.P.M. Dental College , Dhule, India
| | - Rahul Malu
- Lecturer, Department of Prosthodontics, Terna Dental College , Nerul, Navi Mumbai, India
| | - Achala Chokshi
- Senior Lecturer, Department of Oral Pathology, Narsinhbhai Patel Dental College & Hospital , Visnagar, Gujarat, India
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Jeon IK, On HR, Kim SC. Quality of Life and Economic Burden in Recessive Dystrophic Epidermolysis Bullosa. Ann Dermatol 2016; 28:6-14. [PMID: 26848213 PMCID: PMC4737837 DOI: 10.5021/ad.2016.28.1.6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/06/2015] [Accepted: 04/27/2015] [Indexed: 12/12/2022] Open
Abstract
Background Patients with recessive dystrophic epidermolysis bullosa (RDEB) exhibit blisters and erosions since birth, causing pain, pruritus and various complications. RDEB affects quality of life (QoL) in physical, emotional and social aspects. Furthermore, interminable dressing changes and supportive therapies impose a significant economic burden on the patient's family. Objective We assessed the QoL and economic burden in patients with RDEB. Methods Sixteen patients with RDEB were surveyed to assess the QoL and economic burden. Patients answered questionnaires consisting of a visual analogue scale (VAS) on pain and pruritus, Skindex-29, Quality of Life in EB questionnaire (QOLEB), and the economic burden due to EB. Results Thirteen patients with RDEB completed the questionnaire. Female patients presented higher VAS, QOLEB and total Skindex-29 scores than male patients. Patients with RDEB showed severe levels of pruritus, which was more intolerable than pain. Mean VAS score on pain in RDEB was higher than in oral lichen planus and post-herpetic neuralgia. VAS score on pruritus was similar to those in chronic urticaria, atopic dermatitis, and prurigo nodularis. Compared with other dermatologic conditions, patients with RDEB were profoundly affected in all three scales of skindex-29. Mean "medical cost" in a month was $257.54 (USD) (±169.39) and mean "dressing cost" was $358.41 (USD) (±312.55), which was negatively related to patient age. Conclusion RDEB had a profound impact on QoL and economic burden. Compared with other dermatologic diseases, RDEB showed severe symptoms and QoL was seriously impaired. Most patients sustained economic burdens, especially on preparing dressing materials. Younger patients experienced more economic burdens.
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Affiliation(s)
- In Kyung Jeon
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Rang On
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-Chan Kim
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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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: 12] [Impact Index Per Article: 1.3] [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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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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De Caro V, Scaturro AL, Di Prima G, Avellone G, Sutera FM, Di Fede O, Campisi G, Giannola LI. Aloin delivery on buccal mucosa: ex vivo studies and design of a new locoregional dosing system. Drug Dev Ind Pharm 2015; 41:1541-7. [PMID: 25311426 DOI: 10.3109/03639045.2014.971030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Chemoprevention of potential malignant disorders or cancerous lesions that affect oral mucosae requires extended duration of treatment. Locoregional delivery of natural products could represent a promising strategy for this purpose. OBJECTIVE To investigate the aptitude of aloin to permeate through, or accumulate in, the buccal mucosa and to develop a new prolonged oro-mucosal drug delivery system. MATERIALS AND METHODS Permeation/accumulation of aloin from Curacao Aloe (containing 50% barbaloin) was evaluated ex vivo, using porcine buccal mucosa as the most useful model to simulate human epithelium. Oro-mucosal matrix tablets were prepared by dispersing aloin (10% w/w) in Eudragit® RS 100 as, biocompatible, low permeable, pH-independent, and non-swelling polymer. The prepared tablets were evaluated for drug-polymer compatibility, weight variation, drug uniformity content, diameter, thickness, hardness, friability, swelling, mucoadhesive strength, and drug release. RESULTS Aloin has low tendency to cross buccal mucosa, permeation is marginal, and high drug amounts remain entrapped into the epithelium. Matrix tablets characteristics were in agreement with pharmacopoeial requirements. Drug release showed highly reproducible Higuchian profile. Delivery through matrix tablets promoted drug accumulation in the mucosal tissue. DISCUSSION AND CONCLUSION Following application of matrix tablets on porcine buccal mucosa, the amount of discharged drug recovered in the tissue should be sufficient to produce the desired effects, providing therapeutic drug levels directly at the site of action. Aloin-loaded tablets are valid candidates for prevention/treatment of potentially malignant disorders and oral cancer and could potentially lead to clinically relevant drug delivery system as coadjuvant of conventional chemotherapy/radiation therapy.
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Affiliation(s)
- Viviana De Caro
- a Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF) , Università degli Studi di Palermo , Palermo , Italy and
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Amirchaghmaghi M, Delavarian Z, Iranshahi M, Shakeri MT, Mosannen Mozafari P, Mohammadpour AH, Farazi F, Iranshahy M. A Randomized Placebo-controlled Double Blind Clinical Trial of Quercetin for Treatment of Oral Lichen Planus. J Dent Res Dent Clin Dent Prospects 2015; 9:23-8. [PMID: 25973150 PMCID: PMC4417489 DOI: 10.15171/joddd.2015.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 12/08/2014] [Indexed: 01/06/2023] Open
Abstract
Background and aims. Standard treatment of oral lichen planus (OLP) includes topical or systemic corticosteroids that have many adverse effects. A trend toward alternative natural or herbal drugs has attended recently. This study was conducted to evaluate the effect of quercetin in treatment of erosive-atrophic OLP. Materials and methods. Thirty patients participated in this randomized clinical trial from April 2010 to June 2010 (Trial Registration Number: NCT01375101). Patients were randomly allocated in two groups. Both groups received the standard treatment (dexamethasone mouthwash and nystatin suspension). Experimental group received oral 250 mg quercetin hydrate capsules (bid) and the control group received placebo capsules. The pain and severity of the lesions were recorded at the initial visit and the follow-ups. All recorded data were analyzed with chi-square, Mann-Whitney, t-test, Wilcoxon and Friedman tests using SPSS 11.5. Results. There were no significant differences between the two groups in severity of the lesions and pain in the follow-ups.According to the Friedman test, there was a significant reduction in pain (P = 0.01) and severity indices (P = 0.00) in the case group. These differences were not observed in the control group(P = 0.26,SI; and P = 0.86, PI). No adverse effect of quercetin was reported. Conclusion. According to the results, no significant therapeutic effect can be considered for quercetin in treatment of OLP.
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Affiliation(s)
- Maryam Amirchaghmaghi
- Associate Professor, Oral and Maxillofacial Diseases Research Center & Department of Oral Medicine, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Delavarian
- Associate Professor, Oral and Maxillofacial Diseases Research Center & Department of Oral Medicine, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrdad Iranshahi
- Associate Professor of Pharmacognosy, Biotechnology Research Center & School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Taghi Shakeri
- Professor of Biostatistics, Department of Biostatistics & Epidemiology, School of Health, Mashhad University of Medical Science, Mashhad, Iran
| | - Pegah Mosannen Mozafari
- Assistant Professor, Oral and Maxillofacial Diseases Research Center & Department of Oral Medicine, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hushang Mohammadpour
- Associate Professor of Pharmacodynamy & Toxicology, School of Pharmacy & Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Farazi
- Assistant Professor, Department of Oral Medicine, School of Dentistry, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Milad Iranshahy
- PhD Student, Department of Pharmacognosy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Sánchez-Regaña M, Llambí-Mateos F, Salleras-Redonnet M, Iglesias Sancho M, Collgros Totosaus H, Umbert-Millet P. Compounding as a Current Therapeutic Option in Dermatology. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Sánchez-Regaña M, Llambí-Mateos F, Salleras-Redonnet M, Iglesias Sancho M, Collgros Totosaus H, Umbert-Millet P. La formulación magistral en la terapéutica dermatológica actual. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:738-56. [DOI: 10.1016/j.ad.2012.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 03/01/2012] [Accepted: 03/09/2012] [Indexed: 10/28/2022] Open
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Mansour G, Ouda S, Shaker A, Abdallah HM. Clinical efficacy of new aloe vera- and myrrh-based oral mucoadhesive gels in the management of minor recurrent aphthous stomatitis: a randomized, double-blind, vehicle-controlled study. J Oral Pathol Med 2013; 43:405-9. [PMID: 24164309 DOI: 10.1111/jop.12130] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the clinical efficacy, and safety of newly customized natural oral mucoadhesive gels, containing either aloe vera or myrrh as active ingredients, in the management of minor recurrent aphthous stomatitis (MiRAS). SUBJECTS AND METHODS Ninety subjects with MiRAS were recruited from Oral Medicine Clinic, at Faculty of Dentistry, King Abdulaziz University, Saudi Arabia, for this randomized, double-blind, placebo-controlled study. Two new natural gels, containing aloe vera and myrrh, were prepared in a concentration of (0.5% w/w), in addition to a plain mucoadhesive gel used as a placebo. Patients with fresh ulcers (<48-h duration) were instructed to apply either one of the three gels four times a day for a period of 5 days. Clinical efficacy was investigated in the form of changes in ulcer size, pain intensity, erythema, and exudation at days 4 and 6 of study entry. Participants were interviewed for the emergence of any side effects. RESULTS 76.6% of patients using aloe gel showed complete ulcer healing, 86.7%, and 80% of them revealed subsidence of erythema and exudation, respectively, especially at day 6 visit, whereas 76.7% of myrrh-treated patients revealed almost absence of pain at day 6. No side effects were encountered with the use of any of the three gels. CONCLUSION The new formulated aloe- and myrrh-based gels proved to be effective in topical management of MiRAS. Aloe was superior in decreasing ulcer size, erythema, and exudation; whereas myrrh resulted in more pain reduction.
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Affiliation(s)
- Ghada Mansour
- Department of Oral Basic and Clinical Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Oral Medicine, Periodontology, Oral Diagnosis and Oral Radiology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Thongprasom K, Prapinjumrune C, Carrozzo M. Novel therapies for oral lichen planus. J Oral Pathol Med 2013; 42:721-7. [PMID: 23668304 DOI: 10.1111/jop.12083] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 02/06/2023]
Abstract
Oral lichen planus (OLP) is a chronic mucocutaneous disorder commonly found in middle-aged women. Despite the progress in research and advance in knowledge on OLP, a successful management is still difficult to achieve. The main aim of OLP treatment is to control the symptoms of the affected patients. Steroids and other immunosuppressive drugs have been recommended and widely used in the treatment of OLP. Topical corticosteroids are the mainstay of OLP treatment, but strong evidence on their effectiveness is lacking. The effectiveness of alternative ways of managing OLP has been recently reported. Topical aloe vera, topical pimecrolimus and oral curcuminoids are the most promising of the new treatment modalities. Other interesting modalities are topically applied thalidomide and amlexanox. Nevertheless, the careful assessment between the risks and benefits of these drugs is crucial and larger and well-conducted trials need to confirm the above encouraging results.
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Affiliation(s)
- Kobkan Thongprasom
- Oral Medicine Department, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Gupta VK, Malhotra S. Pharmacological attribute of Aloe vera: Revalidation through experimental and clinical studies. Ayu 2013; 33:193-6. [PMID: 23559789 PMCID: PMC3611630 DOI: 10.4103/0974-8520.105237] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aloe vera has long been used as a traditional medicine for inducing wound healing. It is a natural product that now a days is used in cosmetic industry. Benefits associated with Aloe vera have been attributed to the polysaccharides contained in the gel of the leaves though there are various indications for its use. Biological activities include promotion of wound healing, antifungal activity, anti-inflammatory, anticancer and immunomodulatory. Gingival fibroblasts play an important role in oral wound healing. Double blind-controlled trials are needed to determine its real efficacy in oral health.
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Affiliation(s)
- Vinay K Gupta
- Assistant Professor, Department of Public Health Dentistry, Faculty of Dental Sciences, Chhatrapati Shahuji Maharaj Medical University (upgrade KGMC), Lucknow, Uttar Pradesh, India
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Potential prevention: Aloe vera mouthwash may reduce radiation-induced oral mucositis in head and neck cancer patients. Chin J Integr Med 2012; 18:635-40. [PMID: 22855041 DOI: 10.1007/s11655-012-1183-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Indexed: 10/28/2022]
Abstract
In recent years, more head and neck cancer patients have been treated with radiotherapy. Radiation-induced mucositis is a common and dose limiting toxicity of radiotherapy among patients with head and neck cancers. Patients undergoing radiation therapy for head and neck cancer are also at increased risk of developing oral candidiasis. A number of new agents applied locally or systemically to prevent or treat radiation-induced mucositis have been investigated, but there is no widely accepted prophylactic or effective treatment for mucositis. Topical Aloe vera is widely used for mild sunburn, frostbites, and scalding burns. Studies have reported the beneficial effects of Aloe gel for wound healing, mucous membrane protection, and treatment of oral ulcers, in addition to antiinflammatory, immunomudulation, antifungal, scavenging free radicals, increasing collagen formation and inhibiting collagenase. Herein the author postulates that oral Aloe vera mouthwash may not only prevent radiation-induced mucositis by its wound healing and antiinflammatory mechanism, but also may reduce oral candidiasis of patients undergoing head and neck radiotherapy due to its antifungal and immunomodulatory properties. Hence, Aloe vera mouthwash may provide an alternative agent for treating radiation-induced oral mucositis and candidiasis in patients with head and neck cancers.
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Abstract
Oral Diseases (2012) Lichen planus (LP) is a common disorder affecting the oral cavity (OLP) and skin. Despite intensive research, LP/OLP etiology and treatment remain controversial. We investigated four controversial topics: (i) Is hepatitis C virus (HCV) infection associated with LP and involved in its pathogenesis? (ii) Should all patients with LP be screened for HCV? (iii) Should patients with OLP have all their amalgam restorations removed? (iv) Are there any new treatments for OLP? Results from extensive literature searches suggested that: (i) Robust evidence from three meta-analyses indicate that HCV is associated with LP and might be involved in OLP pathogenesis (ii) It would be prudent to screen patients with LP/OLP at significant risk with an ELISA for HCV antibodies using country-specific screening strategies (iii) There is no evidence that either OLP or oral lichenoid lesions patients would routinely benefit from having all their amalgam restorations replaced. Weak evidence from potentially very biased, small, non-randomized, unblinded studies suggests that a small fraction of patients may benefit from targeted amalgam replacement. (iv) There is weak evidence that, among new OLP treatments, topical pimecrolimus, aloe vera, and oral curcuminoids may be useful. The development of specific formulations for oral delivery of topical medications is a promising field.
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Affiliation(s)
- L Baccaglini
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE, USA Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand Department of Oral Medicine, Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
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Keenan AV, Ferraiolo D. Insufficient evidence for effectiveness of any treatment for oral lichen planus. Evid Based Dent 2011; 12:85-6. [PMID: 21979773 DOI: 10.1038/sj.ebd.6400814] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
DATA SOURCES The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase databases were searched with no restrictions regarding language or date of publication. Bibliographies of identified publications were also checked for relevant studies, and authors were contacted to identify missing and unreported trials. The WHO International Trials Registry Platform was searched for ongoing studies, using the term 'oral lichen planus'. STUDY SELECTION Randomised controlled clinical trials (RCTs) of therapy for symptomatic OLP which compared treatment with a placebo or between treatments or no intervention were considered for this review. DATA EXTRACTION AND SYNTHESIS The titles and abstracts of all reports identified were scanned independently by two review authors. All studies meeting the inclusion criteria were assessed for risk of bias and data were extracted. For dichotomous outcomes, the estimates of effects for the intervention were expressed as risk ratios (RR) together with 95% confidence intervals. For continuous outcomes, mean differences (MD) and 95% confidence intervals were used to summarise the data. Meta-analyses were conducted for studies with similar comparisons reporting the same outcome measures. RESULTS Twenty-eight trials were included. Although topical steroids are considered first line treatment for symptomatic OLP, we identified no RCTs that compared steroids with placebo. There is no evidence from the three trials of pimecrolimus that this treatment is better than placebo in reducing pain from OLP. There is weak evidence from two trials, at unclear and high risk of bias respectively, that aloe vera may be associated with a reduction in pain compared to placebo, but it was not possible to pool the pain data from these trials. There is weak and unreliable evidence from two small trials, at high risk of bias, that cyclosporin may reduce pain and clinical signs of OLP, but meta-analysis of these trials was not possible.There were five trials that compared steroids with calcineurin inhibitors, each evaluating a different pair of interventions. There is no evidence from these trials that there is a difference between treatment with steroids compared to calcineurin inhibitors with regard to reducing pain associated with OLP. From six trials there is no evidence that any specific steroid therapy is more or less effective at reducing pain compared to another type or dose of steroid. CONCLUSIONS From the 28 trials included in this systematic review, the wide range of interventions compared means there is insufficient evidence to support the effectiveness of any specific treatment as being superior.
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