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Chirravur P, Sroussi H, Treister N, Al Hadlaq M, Whiting B, Santoianni JA, Woo SB. Hydroxychloroquine for the management of recalcitrant oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:355-361. [PMID: 38278674 DOI: 10.1016/j.oooo.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE The objective of this study is to describe the efficacy of hydroxychloroquine (HCQ) in patients with oral lichen planus (OLP) refractory to conventional therapy. STUDY DESIGN In this single-center retrospective study, patients were prescribed HCQ 200 mg twice daily. Pain, reticulation, erythema, and ulceration scores were recorded. Two-sample and paired t tests were used to evaluate mean and paired pain scores and paired t test to determine substantial differences in paired REU scores, at HCQ initiation visit and final follow-up at 12 to 24 months. RESULTS Thirty-six patients (69.4% female) with a median age of 70 ± 12.0 (range 48-99) were initiated on HCQ. Only 30 patients were evaluable because pruritus developed in 5 patients (13.9%) and gastrointestinal symptoms in 1 (2.8%). The mean follow-up was 23.2 months (range 1-74). In 19 patients, there was a significant decline in the worst pain score from a mean of 3.9 (SD± 2.8, n = 19) to 1.9 (SD ± 2.4, n = 19) (t = 2.837, P < .006). Paired reticulation, erythema, and ulceration (REU scores) decreased from a weighted mean score of 16.0 (SD ± 8.0, n = 12) to 12.0 (SD ± 6.3, n = 12) (t = 2.07, P < .032). CONCLUSION Hydroxychloroquine was a suitable option and effective in reducing symptoms and disease severity in patients with recalcitrant OLP who do not adequately respond to standard therapy.
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Affiliation(s)
- Prazwala Chirravur
- Oral Medicine, Oral and Maxillofacial Diagnostic Sciences, UCONN Health, Farmington, CT, USA; Carole and Ray Neag Comprehensive Cancer Center, Farmington, CT, USA.
| | - Herve Sroussi
- Division of Oral Medicine and Dentistry, Brigham, and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham, and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Malak Al Hadlaq
- Division of Oral Medicine and Dentistry, Brigham, and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Brent Whiting
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - James A Santoianni
- Division of Oral Medicine and Dentistry, Brigham, and Women's Hospital, Boston, MA, USA
| | - Sook Bin Woo
- Division of Oral Medicine and Dentistry, Brigham, and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
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Chirravur P, Vacharotayangul P, Sroussi H, Klasser GD. Use of oral devices in the management of oral dysesthesia: case reports and literature review. Quintessence Int 2024; 55:60-67. [PMID: 37725000 DOI: 10.3290/j.qi.b4418471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Oral dysesthesia (OD) is a diagnosis of exclusion that manifests as an unpleasant and abnormal sensation of the oral mucosa without any noticeable oral lesions. Burning sensation is one of the manifestations of OD which may advocate for similar pharmacotherapeutic options to burning mouth syndrome (BMS), resulting in possible adverse events. The aim of these case reports was to illustrate the significance and rationale for the use of oral devices as a mechanical/physical barrier and a safe approach in the management of OD, without experiencing any antagonistic effects from pharmacotherapeutic agents. Two patients with spontaneous and evoked (following dental procedures) OD symptoms in the right posterior mandibular quadrant and anterior hard palatal areas were evaluated. Additionally, their OD symptoms were associated with hyposalivation and taste changes. A thorough history and complete head and neck examination, with the exclusion of oral lesions and systemic conditions, were performed. These patients were previously prescribed topical clonazepam rinses. An in-office trial, with application of orthodontic wax to the affected area, was performed as a preliminary test in order to justify the fabrication of an oral device for possible symptomatic relief. Conclusion: The case reports demonstrated significant improvement of OD symptoms and amelioration of pain following fabrication of oral devices in two patients with no undesirable effects from pharmacotherapy. Additionally, the oral devices aided as a mechanical/physical barrier, potentially exerting a placebo effect while facilitating an improved quality of life. Furthermore, the cost-effectiveness and ease of fabricating the oral device has been advantageous over other systemic medications. This encourages the need for a detailed prospective study.
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Chirravur P, Sroussi H, Villa A. Caphosol tolerability in oral mucositis patients induced by bone marrow transplantation. Oral Dis 2023; 29:1525-1530. [PMID: 35194897 DOI: 10.1111/odi.14167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/21/2022] [Accepted: 02/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Prazwala Chirravur
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Herve Sroussi
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California San Francisco, San Francisco, California, USA
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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: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Chirravur P, Sroussi H, Sahni S. Never waste a crisis: An online collaborative learning module in oral medicine. J Dent Educ 2021; 86 Suppl 1:789-791. [PMID: 34719781 DOI: 10.1002/jdd.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Prazwala Chirravur
- Division of Oral Medicine and Dentistry, Harvard School of Dental Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Herve Sroussi
- Division of Oral Medicine and Dentistry, Harvard School of Dental Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shibani Sahni
- Faculty of Masters in Dental Education, Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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