Outcomes of oral lichen planus and oral lichenoid lesions treated with topical corticosteroid

Extrahepatic Cancer Risk in Patients with Hepatitis C Virus Infection Treated with Direct-Acting Antivirals

Chronic hepatitis C virus (HCV) infection is associated with an increased risk of extrahepatic cancers, particularly non-Hodgkin lymphoma. The introduction of direct-acting antivirals (DAAs) has revolutionized HCV therapy, resulting in high cure rates. However, concerns have been raised about potential effects on cancer risk. This review summarizes the current evidence on extrahepatic cancer risk in HCV-infected patients treated with DAAs. We examined epidemiologic data on HCV-associated extrahepatic cancers and explored potential mechanisms linking HCV to carcinogenesis outside the liver. Studies evaluating cancer outcomes after DAA therapy were critically reviewed while considering methodological challenges. While some studies suggested a reduced risk of extrahepatic cancers after DAA therapy, others showed no significant change. Limitations included short follow-up periods and confounding variables. Immunological changes following rapid HCV clearance may have complex effects on cancer risk. Long-term prospective studies and mechanistic investigations are needed to fully elucidate the relationship between DAA therapy and extrahepatic cancer risk in HCV patients. Clinicians should remain vigilant for extrahepatic malignancies in this population.

The relationship between clinical symptoms of oral lichen planus and quality of life related to oral health

INTRODUCTION

Oral Lichen Planus (OLP) is a chronic and relatively common mucocutaneous disease that often affects the oral mucosa. Although, OLP is generally not life-threatening, its consequences can significantly impact the quality of life in physical, psychological, and social aspects. Therefore, the aim of this research is to investigate the relationship between clinical symptoms of OLP and oral health-related quality of life in patients using the OHIP-14 (Oral Health Impact Profile-14) questionnaire.

MATERIALS AND METHODS

This descriptive-analytical study has a cross-sectional design, with case-control comparison. In this study, 56 individuals were examined as cases, and 68 individuals were included as controls. After recording demographic characteristics and clinical features by reviewing patients' records, the OHIP-14 questionnaire including clinical severity of lesions assessed using the Thongprasom scoring system, and pain assessed by the Visual Analog Scale (VAS) were completed. The ADD (Additive) and SC (Simple Count) methods were used for scoring, and data analysis was performed using the T-test, Mann-Whitney U test, Chi-Square, Spearman's Correlation Coefficient, and SPSS 24.

RESULTS

Nearly all patients (50 individuals, 89.3%) reported having pain, although the average pain intensity was mostly mild. This disease has affected the quality of life in 82% of the patients (46 individuals). The patient group, in comparison to the control group, significantly expressed a lower quality of life in terms of functional limitations and physical disability. There was a statistically significant positive correlation between clinical symptoms of OLP, gender, location (palate), and clinical presentation type (erosive, reticular, and bullous) of OLP lesions with OHIP-14 scores, although the number or bilaterality of lesions and patient age did not have any significant correlation with pain or OHIP scores.

CONCLUSION

It appears that certain aspects of oral health-related quality of life decrease in patients with OLP, and that of the OLP patient group is significantly lower in terms of functional limitations and physical disability compared to the control group. Additionally, there was a significant correlation between clinical symptoms of OLP and pain as well as OHIP scores.

Topical clobetasol treatment for oral lichen planus can cause adrenal insufficiency

OBJECTIVE

Glucocorticoids suppress the hypothalamic-pituitary-adrenal axis, which may lead to glucocorticoid-induced adrenal insufficiency. The study aimed to investigate the prevalence of this state in patients with oral lichen planus treated with topical clobetasol propionate.

METHODS

In this cross-sectional study, 30 patients with oral lichen planus receiving long-term (>6 weeks) clobetasol propionate gel 0.025% were invited to participate. Adrenal function was assessed by measuring morning plasma cortisol after a 48-h withdrawal of clobetasol treatment. In patients with plasma cortisol <280 nmol/L, a cosyntropin stimulation test was performed.

RESULTS

Twenty-seven patients were included. Twenty-one (78%) patients presented with plasma cortisol ≥280 nmol/L (range 280-570 nmol/L), and six (22%) <280 nmol/L (range 13-260 nmol/L). Five of these six patients underwent cosyntropin stimulation that revealed severe adrenal insufficiency in two patients (cortisol peak 150 nmol/L and 210 nmol/L) and mild adrenal insufficiency in three patients (cortisol peak 350-388 nmol/L).

CONCLUSION

In this study, approximately 20% of patients receiving intermittent topical glucocorticoid treatment for oral lichen planus had glucocorticoid-induced adrenal insufficiency. It is essential for clinicians to be aware of this risk and to inform patients about the potential need for glucocorticoid stress doses during intercurrent illness.

Integrative Approaches for the Diagnosis and Management of Erosive Oral Lichen Planus

Erosive oral lichen planus (EOLP) represents a significant challenge in dental and medical management due to its chronic inflammatory nature, painful symptoms, and impact on quality of life. This study aims to evaluate the current diagnostic approach with novel non-invasive techniques, such as dermoscopy, and also the landscape of treatment options for EOLP, focusing on its efficacy, safety, and the challenges that it present in clinical practice. Through a comprehensive literature review, we explored the use of topical corticosteroids, systemic immunosuppressants, biologics, and Janus kinase (JAK) inhibitors in treating EOLP, alongside examining patient compliance, psychological impacts, and the risk of adverse effects and recurrence. Our findings reveal that while topical corticosteroids are the cornerstone of EOLP treatment, offering symptomatic relief, their long-term use is limited by side effects and tolerance development. Systemic therapies and biologics provide alternatives for refractory cases but necessitate careful adverse effect monitoring. JAK inhibitors show promise as an innovative treatment avenue but require more evidence on long-term safety and efficacy. This study highlights the necessity of personalized treatment approaches due to the variable disease course and response to treatment, underscoring the importance of a multidisciplinary strategy in managing EOLP. The complexity of EOLP treatment, compounded by its psychological and quality of life impacts, demands ongoing research into targeted therapies, the establishment of standardized treatment protocols, and the development of effective outcome measures to improve patient care and treatment outcomes.

Oral Lichen Planus: An Update on Diagnosis and Management

Oral lichen planus (OLP) is a chronic inflammatory disease whose pathogenesis involves a T-cell mediated, epithelium-directed inflammation in response to unknown antigen(s). The disease evolves by intermittent flares and displays polymorphous clinical features (reticular, erosive, atrophic, plaque, papular, bullous, etc.). When present, symptoms vary depending on the clinical form and range from discomfort to severe pain. Topical superpotent corticosteroids constitute the first-line treatment of symptomatic flares, whereas a wide range of second/third-line treatments are available among topical calcineurin inhibitors, systemic corticosteroids, systemic retinoids, topical/systemic immunomodulators, etc. Follow-up of patients is necessary to detect transformation into squamous cell carcinoma, occurring in approximately 1% of patients.

Changes in the Oral-Health-Related Quality of Life of Thai patients with oral lichen planus after topical corticosteroid treatment: a 1-month longitudinal study

BACKGROUND

Oral lichen planus (OLP) is a chronic inflammatory disease of the oral cavity that affects many patients' daily living activities. Topical corticosteroids are the first-line drug for treating OLP. The Oral Impact on Daily Performances index (OIDP) is an Oral-Health-Related Quality of Life (OHRQoL) measure developed to assess the ultimate impacts. The aims of this study were to evaluate the clinical, pain and OHRQoL responses after treating OLP patients with topical corticosteroids for 1 month, and secondly to assess the relationships of changes in the clinical sign score, pain score, and OHRQoL.

METHODS

Seventy-two OLP patients were treated by topical corticosteroids based on their dentists' clinical judgments. Clinical and patient-based outcomes were assessed at baseline and follow-up visit. The clinical outcomes were evaluated by the highest and total Thongprasom sign score. Patient-based outcomes were evaluated by numeric rating scale (NRS) and OIDP. The self-rated overall changes in quality of life during the 1-month treatment period using the Patient Global Impression of Change (PGIC) were also recorded at the follow-up visit.

RESULTS

This study comprised 59 women and 13 men. All clinical and patient-based outcomes were significantly reduced after 1-month treatment with topical corticosteroids (P < 0.01). The most commonly affected activities were Emotional stability, followed by Eating and Cleaning the oral cavity. Forty-six percent reported the same or up to moderately improved, while 54% had a greatly improved quality of life as assessed by PGIC. There were no significant differences in the improvement of clinical and patient-based outcomes between these groups. There were significant relationships between the differences in the highest Thongprasom sign score and the differences in total Thongprasom sign score (r = 0.293; P < 0.05), and the differences in total OIDP percentage score and the difference in pain score (r = 0.427; P < 0.001). The differences in the total Thongprasom sign score also significantly related to the difference in the total OIDP percentage score (r = 0.335; P < 0.01).

CONCLUSIONS

Topical corticosteroids were significantly effective after 1-month treatment of OLP based on the clinical and patient-based outcomes. The OHRQoL improvement was significantly related to the reductions in pain and clinical severity.

TRIAL REGISTRATION

The trial was registered at the Thai Clinical Trials Registry (TCTR identifier: TCTR 20221110001).

Early Diagnosis of Oral Cancer: A Complex Polyhedral Problem with a Difficult Solution

Oral and oropharyngeal cancers are a growing problem, accounting for 377,713 and 98,412 new cases per year all over the world and 177,757 and 48,143 deaths annually, respectively. Despite the substantial improvement in diagnostic procedures and treatment techniques in recent years, the mortality rate has not decreased substantially in the last 40 years, which is still close to 50% of cases. The major cause responsible for this high mortality is associated with the high percentage of oral cancers diagnosed in advanced stages (stages III and IV) where the treatment harbors poor efficacy, resulting in challenges, mutilations, or disability. The main reason for cancer to be diagnosed at an advanced stage is a diagnostic delay, so it is critical to reduce this delay in order to improve the prognosis of patients suffering from oral cancer. The causes of oral cancer diagnostic delay are complex and concern patients, healthcare professionals, and healthcare services. In this manuscript, oral cancer diagnostic delay is critically reviewed based on current evidence, as well as their major causes, main problems, and potential improvement strategies.

Experimental and clinical trial investigations of phyto-extracts, phyto-chemicals and phyto-formulations against oral lichen planus: A systematic review

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.

Synergistic Efficacy of Plaque Control with Intralesional Triamcinolone Acetonide Injection on Erosive Non-Gingival Oral Lichen Planus: A Randomized Controlled Clinical Trial

This study is the first time to assess the synergistic efficacy and safety of plaque control on erosive non-gingival oral lichen planus (OLP). A randomized, controlled, clinical trial with blind evaluation was designed, and 48 OLP patients with erosive non-gingival OLP lesions were randomly assigned to the experimental group (n = 25, receiving intralesional triamcinolone acetonide injection, periodontal scaling, and oral hygiene instruction) and the control group (n = 23, only receiving intralesional triamcinolone acetonide injection) once a week for 2 weeks. Erosion size, pain level, plaque index, and community periodontal index were measured at every visit. Patients cured of erosion were followed up for 3 months to evaluate the recurrence rate. Adverse reactions were also recorded. At day 14 ± 2, the experimental group showed a higher completely healed percentage of erosion, a greater reduction of erosion size and pain level. However, no significant difference was observed in the recurrence rate. No participants had any severe adverse reactions. In conclusion, an improvement was observed in patients with plaque control, and future studies with larger sample sizes are needed to reinforce the external validity of this study.

Photobiomodulation of gingival lesions resulting from autoimmune diseases: systematic review and meta-analysis

Objectives

To evaluate the effects of photobiomodulation (PBM) in gingival lesions resulting from autoimmune diseases; to compare PBM and topical corticosteroid (CS) treatment; and to assess PBM outcome over time of follow-up.

Materials and methods

A comprehensive electronic search was performed in four electronic databases. Treatment effects were measured through visual analog scale of pain (VAS) and clinical evolution of lesion (Thongprasom scale for oral lichen planus (OLP)). Meta-analysis was performed to compare PBM with topical corticosteroid treatment and to evaluate PBM effect over time of follow-up.

Results

Seventeen studies were included in this review, of which six were used for the meta-analysis. Meta-analysis results showed no significant differences between PBM and topical CS in pain reduction at baseline (MD = 0.20, 95% CI =  − 0.92, 1.32, p = 0.72) and 60-day follow-up (MD = 0.63, 95% CI =  − 3.93, 5.19, p = 0.79); however, VAS showed significant pain reduction when compared before and after PBM at 30-day (MD =  − 3.52, 95% CI =  − 5.40, − 1.64, p = 0.0002) and 60-day (MD =  − 5.04, 95% CI =  − 5.86, − 4.22, p < 0.00001) follow-up. Thongprasom clinical scale for OLP also showed significant improvement at 30-day follow-up (MD =  − 2.50, 95% CI =  − 2.92, − 2.08, p < 0.00001) after PBM.

Conclusion

PBM led to significant reduction of pain and clinical scores of the lesions, not having shown significant differences when compared to topical CS.

Clinical relevance

PBM has been used in the treatment of autoimmune gingival lesions, but so far there is little strong evidence to support its use.

Modulation of the oral glucocorticoid system during black raspberry mediated oral cancer chemoprevention

Recent reports suggest that glucocorticoids (GCs), which can be synthesized in the oral mucosa, play an important role in cancer development. Therefore, the objectives of this study were to characterize the role of the oral GC system in oral cancer, and determine the effect of black raspberry (BRB) administration on GC modulation during oral cancer chemoprevention. We determined the expression of GC enzymes in various oral cancer cell lines, and investigated the role of the GC inactivating enzyme HSD11B2 on CAL27 oral cancer cells using siRNA mediated knockdown approaches. Using two in vivo models of oral carcinogenesis with 4-nitroquinoline-1-oxide (4NQO) carcinogen on C57Bl/6 mice and F344 rats, we determined the effect of BRB on GC modulation during HNSCC chemoprevention. Our results demonstrate that HSD11B2, which inactivates cortisol to cortisone, is downregulated during oral carcinogenesis in clinical and experimental models. Knockdown of HSD11B2 in oral cancer cells promotes cellular proliferation, invasion and expression of angiogenic biomarkers EGFR and VEGFA. An ethanol extract of BRB increased HSD11B2 expression on oral cancer cells. Dietary administration of 5% BRB increased Hsd11b2 gene and protein expression and reduced the active GC, corticosterone, in cancer-induced mouse tongues. Our results demonstrate that the oral GC system is modulated during oral carcinogenesis, and black raspberry administration upregulates Hsd11b2 during oral cancer chemoprevention. In conclusion, our findings challenge the use of synthetic glucocorticoids in head and neck cancer, and support the use of natural product alternatives that potentially modulate GC metabolism in a manner that supports oral cancer chemoprevention.

Corticosteroid delivery using oral mucosa equivalents for the treatment of inflammatory mucosal diseases

Oral lichen planus (OLP) is an immune‐mediated disease of the oral mucosa with idiopathic aetiology. It is frequently treated with topical corticosteroids (applied as gels, mouthwashes, or sprays); however, the mucosal exposure times of topical corticosteroids are short because of removal by the constant flow of saliva and mechanical forces. In this study we used cell monolayers, as well as oral mucosal equivalents (OMEs) containing activated T‐cells, to examine corticosteroid potency and delivery of clobetasol‐17‐propionate from a novel electrospun mucoadhesive patch. The OMEs displayed tight junctions, desmosomes, hemidesmosomes, and an efficient permeability barrier. Following application of corticosteroids to cells cultured as monolayers, the degree of cytotoxicity measured correlated to the level of potency recognized for each corticosteroid; by contrast, OMEs were largely unaffected by corticosteroid treatment. Permeation of clobetasol‐17‐propionate into and through the OMEs was time‐ and dose‐dependent, regardless of whether this corticosteroid was delivered in liquid form or from a mucoadhesive patch, and both liquid‐ and patch‐delivered clobetasol‐17‐propionate significantly reduced the secretion of interleukin‐2 by activated T‐cells. This study confirms that OMEs are more suitable models than cell monolayers for evaluating toxicity and drug delivery. After topical exposure, clobetasol‐17‐propionate accumulated in OMEs at a higher level than betamethasone‐17‐valerate and hydrocortisone‐17‐valerate, and exerted its immunosuppressive actions following application via the patch delivery system, highlighting the efficacy of this mode of drug delivery to treat OLP.

Association between Clinical Signs of Oral Lichen Planus and Oral Health-Related Quality of Life: A Preliminary Study

Subjective patient’s symptoms and Oral Health-Related Quality of Life (OHRQoL) are recommended to be involved in oral lichen planus (OLP) studies. This study aims to assess the OHRQoL of OLP patients, and their associations with pain and OLP in Thai patients. Sixty-nine patients were interviewed using the Numeric Rating Scale (NRS) for pain perception and Oral Impacts on Daily Performance (OIDP) index. OLP signs examined included localization, types, number of affected sides and clinical severity using the Thongprasom sign scoring system. There were significant associations (r_s = 0.490, p < 0.001) between clinical severity and the intensity of oral impacts as well as pain (r_s = 0.298, p = 0.013). The intensity of oral impacts and pain increased according to the increasing OLP clinical severity, except for the white striae lesions (Thongprasom sign score 1). The erosive/ulcerative OLP lesions (Thongprasom sign scores 4 and 5) were the most painful symptom and had the highest degree of oral impacts (p < 0.001). No significant associations were found between the number of affected lesion sides and OHRQoL (p = 0.316) and pain (p = 0.284). OHRQoL was associated with OLP type and clinical severity but not with the number of affected sides.

Clinicopathological and prognostic characteristics of oral squamous cell carcinomas arising in patients with oral lichen planus: A systematic review and a comprehensive meta-analysis

OBJECTIVES

To evaluate current evidence in relation to the prognostic and clinicopathological significance of oral squamous cell carcinomas arising in patients with oral lichen planus (OLP-OSCC).

MATERIAL AND METHODS

We searched PubMed, Embase, Web of Science and Scopus for studies published before May-2019. We evaluated the quality of studies (QUIPS tool). We carried out meta-analyses to fulfill our objective. We examined the between-study heterogeneity and small-study effects, and conducted sensitivity and subgroup analyses.

RESULTS

Inclusion criteria were met by 27 studies (10,505 patients with OLP, of whom 205 developed a total of 247 OSCCs). The combined 5-year mortality rate was 15.48% for OLP-OSCC (95%CI  =  7.34-25.19), clearly lower than the 34.70-50.00% mortality rate for conventional oral cancer communicated in previous official reports. Also, 14.67% (95%CI  =  6.34-24.81) of OLP-OSCC developed N+ status, compared to 47.00% of conventional oral carcinomas. Likewise, most of the OSCCs in the study were T1/T2 (93.57%, 95%CI  =  82.20-99.88) and presented at stage I/II (81.51%, 95%CI = 68.32-92.38) at the time of diagnosis, which contrasts with 50.00% of conventional carcinomas diagnosed in stages I/II. Furthermore, most of the cases were grade I (well differentiated OSCC) (67.79%; 95%CI = 43.50-88.65), in comparison to conventional OSCCs, which present typically in grade II in 90.00% of cases. Our results also show an 11.21% of the OLP-OSCC patients in this study developed multiple tumors.

CONCLUSIONS

Oral squamous cell carcinomas that developed in oral lichen planus show favorable prognostic parameters, especially with regard to the mortality rate. Around 11% of OLP-OSCC patients develop multiple tumors, which confirms that OLP can lead to field cancerization.