|
1
|
Lin M, Horgan L, Hsieh A. Beware of the rinse: magic mouthwash as a rare cause of iatrogenic Cushing syndrome and secondary adrenal insufficiency. Med J Aust 2024; 221:591-593. [PMID: 39543079 DOI: 10.5694/mja2.52523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 08/26/2024] [Indexed: 11/17/2024]
Affiliation(s)
- Mike Lin
- Royal Prince Albert Hospital, Sydney, NSW
- Garvan Institute of Medical Research, Sydney, NSW
| | - Lisa Horgan
- Royal Prince Albert Hospital, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Albert Hsieh
- Royal Prince Albert Hospital, Sydney, NSW
- University of Sydney, Sydney, NSW
| |
Collapse
|
|
2
|
Kaur S, Bains K. Aloe Barbadensis Miller (Aloe Vera). INT J VITAM NUTR RES 2024; 94:308-321. [PMID: 37915246 DOI: 10.1024/0300-9831/a000797] [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] [Indexed: 11/03/2023]
Abstract
Aloe Barbadensis Miller (Aloe Vera, AV) is a widely recognized for its diverse health-promoting, skin care, and medicinal properties. This narrative review provides a comprehensive overview of AV's bioactive compounds, pharmacological activities, potential applications, its toxic and adverse effects, as well as the clinical evidence supporting AV's efficacy in disease prevention. AV contains over 200 bioactive compounds, with the inner clear gel of the leaves containing the majority of these compounds. These include phenolic acids (274.5-307.5 mg/100 g), flavonoids. (3.63-4.70 g/kg), polysaccharides (3.82-6.55 g/kg), saponins, alkaloids, terpenoids, and anthraquinone derivatives. Findings from clinical studies involving both humans and animals highlight the therapeutic potential of AV across diverse health domains. The studies demonstrate AV's efficacy in reducing blood glucose levels, exhibiting antioxidant and immunomodulatory effects, inducing apoptosis in cancer cells, protecting the liver from damage, and displaying antimicrobial properties. In the fields of dermatology and dentistry, AV has also been observed to promote skin and oral health. However, it is imperative to acknowledge potential risks, adhere to recommended dosages, and seek guidance from healthcare experts before employing AV as a natural therapeutic option. Moreover, considering safety concerns, further well-designed randomized controlled trials are necessary to substantiate the potential benefits of AV and comprehensively assess any associated risks.
Collapse
Affiliation(s)
- Sukhdeep Kaur
- Department of Food & Nutrition, Punjab Agricultural University, Ludhiana, Punjab, India
| | - Kiran Bains
- Department of Food & Nutrition, Punjab Agricultural University, Ludhiana, Punjab, India
| |
Collapse
|
|
3
|
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] [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.
Collapse
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
| |
Collapse
|
|
4
|
Hanna R, Dalvi S, Tomov G, Hopper C, Rebaudi F, Rebaudi AL, Bensadoun RJ. Emerging potential of phototherapy in management of symptomatic oral lichen planus: A systematic review of randomised controlled clinical trials. JOURNAL OF BIOPHOTONICS 2023:e202300046. [PMID: 37017292 DOI: 10.1002/jbio.202300046] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/01/2023] [Accepted: 04/02/2023] [Indexed: 06/19/2023]
Abstract
Phototherapy incorporating photobiomodulation therapy and antimicrobial photodynamic therapy has been utilised as antioxidants in symptomatic oral lichen planus (OLP) management; however, its role of intervention remains controversial. The aim of this systematic review of CRD42021227788 PROSPERO (an international prospective register of systematic reviews in health and social care) registration number was to oversee and determine phototherapy efficacy in patients with symptomatic OLP, identifying and bridging the literature gaps by proposing recommendations for future studies. A search strategy was developed in consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Various electronic databases were exercised to search for randomised controlled clinical trials (RCTs). Several search engines were employed to analyse a total of 177 studies of which nine included. A wide range of utilised laser and light-emitted diode wavelengths between 630 and 808 nm and irradiance ranged between 10 and 13 mW/cm2 were noted. 67% of studies reported a high risk of bias and a high heterogeneity obtained from numerical data for quantitative analysis, therefore meta-analysis was impossible to conduct. Despite inconsistency and diversity in phototherapy parameters, treatment protocols, photosensitiser (type, concentration and method of application) and outcome assessment tools, the majority of the studies showed positive results compared with standard care treatments. Hence, a necessity to perform well-designed RCTs with robust methodology is warranted, after acknowledging the current drawbacks and addressing the suggested recommendations highlighted in our review. Moreover, advanced knowledge in understanding further phototherapy-antioxidants molecular mechanistic in symptomatic OLP is required.
Collapse
Affiliation(s)
- Reem Hanna
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Genoa, Italy
- Department of Restorative and Dental Sciences, UCL-Eastman Dental Institute, Faculty of Medical Sciences, Rockefeller Building, London, UK
| | - Snehal Dalvi
- Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, India
| | - Georgi Tomov
- Department of Periodontology, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Colin Hopper
- Department of Maxillofacial Surgery, Diagnostics, Medical and Surgical Sciences, UCL-Eastman Dental Institute, Faculty of Medical Sciences, Rockefeller Building, London, UK
| | - Federico Rebaudi
- Department of Expiremental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Alberto Luigi Rebaudi
- Department of Surgery and Implants, School of Dentistry, Universitat International de Catalunya (UIC), Barcelona, Spain
| | | |
Collapse
|
|
5
|
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: 9] [Impact Index Per Article: 3.0] [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.
Collapse
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.
| |
Collapse
|
|
6
|
Hijazi A, Ahmed W, Gaafar S. Efficacy of intralesional injections of platelet-rich plasma in patients with oral lichen planus: A pilot randomized clinical trial. Clin Exp Dent Res 2022; 8:707-714. [PMID: 35218680 PMCID: PMC9209796 DOI: 10.1002/cre2.550] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/11/2022] [Indexed: 11/08/2022] Open
Abstract
Objective To evaluate the clinical efficacy of intralesional platelet‐rich plasma (PRP) injections compared to intralesional triamcinolone acetonide (TA) injections in the treatment of erosive oral lichen planus (EOLP). Material and Methods Twenty patients with EOLP were assigned randomly to either PRP or TA group. Patients received weekly intralesional injections for 4 weeks, and then followed up for 3 months on regular visits every 2 weeks. Pain scores using numerical pain score and clinical score were recorded by a blinded assessor each visit for all patients and remission score at the end of the trial was recorded. Results Both groups showed significant improvement in the clinical parameters (pain and clinical score) “p = .001.” Regarding remission of the lesions, 80% of patients in the PRP group showed complete remission compared to 70% in the TA group. However, there is no statistical significance when comparing the two groups in pain score, clinical score, or remission. Conclusions PRP injections could be considered as an effective alternative single treatment modality for EOLP. The protocol for this study registered in Clinicaltrials.gov registry under the identifier number: NCT03293368.
Collapse
Affiliation(s)
- AbdelHameed Hijazi
- Department of Oral Medicine, Faculty of DentistryCairo UniversityCairoEgypt
| | - Wesam Ahmed
- Department of Oral Medicine and Periodontology, Faculty of DentistryCairo UniversityCairoEgypt
| | - Soheir Gaafar
- Department of Oral Medicine and Periodontology, Faculty of DentistryCairo UniversityCairoEgypt
| |
Collapse
|
|
7
|
Seebauer C, Freund E, Hasse S, Miller V, Segebarth M, Lucas C, Kindler S, Dieke T, Metelmann HR, Daeschlein G, Jesse K, Weltmann KD, Bekeschus S. Effects of cold physical plasma on oral lichen planus: An in vitro study (Effects of CAP on OLP). Oral Dis 2021; 27:1728-1737. [PMID: 33107655 DOI: 10.1111/odi.13697] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/23/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES In the search for more effective and safe treatment avenues, we investigated cold physical plasma as a new treatment modality for therapy of oral lichen planus (OLP). MATERIAL AND METHODS Healthy and diseased human mucosal tissue samples with a size of 3 mm in diameter obtained from OLP patients were subjected to plasma treatment ex vivo or were left untreated. Tissue sections were quantified for immune-infiltration of CD4+ , CD8+ , CD45RA+ , and CD45R0+ T cells. Moreover, the tissues' inflammatory profile was assessed by analyzing 12 different cytokines in the surrounding media. RESULTS A significantly increased infiltrate of CD8+ and CD45-R0+ T cells was detected in OLP tissue samples when compared to healthy tissue. A higher concentration of interleukin (IL) 1β, IL6, IL8, and granulocyte macrophage-colony stimulating factor (GM-CMF) was detected in OLP samples compared to healthy mucosal tissue. For all cytokines and chemokines investigated, 23 out of 24 comparisons showed a decrease in tendency (significant for IL1β, IL2, IL10, and GM-CSF) in response to plasma treatment. In ex vivo-treated tissue, a decrease of T-cell infiltrate in OLP lesions compared with healthy tissue was observed. CONCLUSION Our findings suggest cold physical plasma can be a promising therapeutic option for OLP that requires further validation in vivo.
Collapse
Affiliation(s)
- Christian Seebauer
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Eric Freund
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany
| | - Sybille Hasse
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany
| | - Vandana Miller
- Department of Microbiology and Immunology, Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Maria Segebarth
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Christian Lucas
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Kindler
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Tobias Dieke
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Hans-Robert Metelmann
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Georg Daeschlein
- Department of Dermatology, University Medicine Greifswald, Greifswald, Germany
| | - Katja Jesse
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Klaus-Dieter Weltmann
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany
| | - Sander Bekeschus
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany
| |
Collapse
|
|
8
|
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]
|
|
9
|
da Silva EL, de Lima TB, Rados PV, Visioli F. Efficacy of topical non-steroidal immunomodulators in the treatment of oral lichen planus: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:5149-5169. [PMID: 34342763 DOI: 10.1007/s00784-021-04072-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this systematic review was to assess the efficacy and safety of topical non-steroidal immunomodulators (TNSIs) for oral lichen planus (OLP) treatment. MATERIALS AND METHODS A search strategy designed for this purpose retrieved 1156 references. After analysis of titles and abstracts, 75 studies were selected for full-text analysis. Only randomized controlled clinical trials were selected, resulting in 28 studies included for qualitative and quantitative analysis. RESULTS The meta-analysis showed similar benefits in clinical response and symptom resolution between tacrolimus 0.1% and pimecrolimus 1% in comparison to topical steroids (TS). Pimecrolimus showed superior efficacy of clinical response but not for symptom resolution compared to placebo. Tacrolimus and pimecrolimus showed better performance preventing symptom relapse, while pimecrolimus also prevented clinical relapse better than TS. Cyclosporine was superior to placebo; however, TS showed better efficacy of clinical response. Thalidomide and retinoid were assessed in only one trial each, and both showed similar efficacy to TS. Rapamycin also presented similar clinical response to TS; however, the later showed greater reduction of symptoms. Mycophenolate mofetil 2% mucoadhesive was no better than placebo. No serious adverse effects have been reported. Cyclosporine showed a higher frequency and variety of adverse effects. CONCLUSIONS Topical tacrolimus and pimecrolimus are safe and effective alternatives for OLP treatment. CLINICAL RELEVANCE TS are usually the first choice for OLP treatment. Because some oral lesions may have a low response to treatment with TS, more topical therapeutic options, such as TNSIs, should be considered before systemic steroids are used.
Collapse
Affiliation(s)
- Eduardo Liberato da Silva
- Oral Pathology and Oral Medicine Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil
| | - Taiane Berguemaier de Lima
- Oral Pathology and Oral Medicine Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil
| | - Pantelis Varvaki Rados
- Oral Pathology and Oral Medicine Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil
| | - Fernanda Visioli
- Oral Pathology and Oral Medicine Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil.
- Experimental Center Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90035-903, Brazil.
| |
Collapse
|
|
10
|
da Silva EL, de Lima TB, Rados PV, Visioli F. Efficacy of topical non-steroidal immunomodulators in the treatment of oral lichen planus: a systematic review and meta-analysis. Clin Oral Investig 2021. [PMID: 34342763 DOI: 10.1007/s00784-021-04072-7/figures/10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVES The aim of this systematic review was to assess the efficacy and safety of topical non-steroidal immunomodulators (TNSIs) for oral lichen planus (OLP) treatment. MATERIALS AND METHODS A search strategy designed for this purpose retrieved 1156 references. After analysis of titles and abstracts, 75 studies were selected for full-text analysis. Only randomized controlled clinical trials were selected, resulting in 28 studies included for qualitative and quantitative analysis. RESULTS The meta-analysis showed similar benefits in clinical response and symptom resolution between tacrolimus 0.1% and pimecrolimus 1% in comparison to topical steroids (TS). Pimecrolimus showed superior efficacy of clinical response but not for symptom resolution compared to placebo. Tacrolimus and pimecrolimus showed better performance preventing symptom relapse, while pimecrolimus also prevented clinical relapse better than TS. Cyclosporine was superior to placebo; however, TS showed better efficacy of clinical response. Thalidomide and retinoid were assessed in only one trial each, and both showed similar efficacy to TS. Rapamycin also presented similar clinical response to TS; however, the later showed greater reduction of symptoms. Mycophenolate mofetil 2% mucoadhesive was no better than placebo. No serious adverse effects have been reported. Cyclosporine showed a higher frequency and variety of adverse effects. CONCLUSIONS Topical tacrolimus and pimecrolimus are safe and effective alternatives for OLP treatment. CLINICAL RELEVANCE TS are usually the first choice for OLP treatment. Because some oral lesions may have a low response to treatment with TS, more topical therapeutic options, such as TNSIs, should be considered before systemic steroids are used.
Collapse
Affiliation(s)
- Eduardo Liberato da Silva
- Oral Pathology and Oral Medicine Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil
| | - Taiane Berguemaier de Lima
- Oral Pathology and Oral Medicine Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil
| | - Pantelis Varvaki Rados
- Oral Pathology and Oral Medicine Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil
| | - Fernanda Visioli
- Oral Pathology and Oral Medicine Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil. .,Experimental Center Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90035-903, Brazil.
| |
Collapse
|
|
11
|
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.
Collapse
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
| |
Collapse
|
|
12
|
Santonocito S, Polizzi A, De Pasquale R, Ronsivalle V, Lo Giudice A, Isola G. Analysis of the Efficacy of Two Treatment Protocols for Patients with Symptomatic Oral Lichen Planus: A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:56. [PMID: 33374791 PMCID: PMC7794703 DOI: 10.3390/ijerph18010056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
Oral lichen planus (OLP) is a chronic, inflammatory, immune-mediated disease, which can alter the quality of life of patients. The aim of this randomized clinical trial was to compare the therapeutic efficacy of clobetasol oral gel 0.05% versus an anti-inflammatory in oral solution (mouthwash) in the management of patients suffering from symptomatic OLP. The secondary objective was to analyze which one of the two treatments induced a greater risk of developing side effects. Forty patients were assigned (20 patients for group), through a randomized design, to receive clobetasol gel 0.05% or an anti-inflammatory mouthwash, which contains calcium hydroxide, hyaluronic acid, umbelliferone and oligomeric pro-anthocyanidins) for three months. At baseline (T0) and after 3 months (T1), patients underwent dental and dermatological examinations to assess their symptoms (Numerical Pain Scale (NRS) score) and signs (Thongprasom score). Data were calculated using T-test for the dependent variable, Wilcoxon test and Mann-Whitney u test. Both clobetasol and anti-inflammatory resulted in a statistically significant reduction of signs, (p < 0.001 and p = 0.02, respectively) and symptoms (p < 0.001 for clobetasol and p = 0.02 for anti-inflammatory). In conclusion, the results evidenced that, compared to clobetasol, the anti-inflammatory was less effective in determining the reduction of signs and symptom in OLP patients.
Collapse
Affiliation(s)
- Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Rocco De Pasquale
- Department of General Surgery and Surgical-Medical Specialties, Unit of Dermatology, University of Catania, 95124 Catania, Italy;
| | - Vincenzo Ronsivalle
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| |
Collapse
|
|
13
|
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]
|
|
14
|
Morais EFD, Felix FA, Santos JLDMD, Martins HDD, Barboza CAG, Freitas RDA. YouTube™ and oral lichen planus: an appraisal of the educational quality of information. Braz Oral Res 2020; 35:e006. [PMID: 33206779 DOI: 10.1590/1807-3107bor-2021.vol35.0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/20/2020] [Indexed: 11/21/2022] Open
Abstract
The objective of this study was to analyze the quality of videos on oral lichen planus (OLP) available in YouTube™. A cross-sectional analytical study was conducted by searching the video sharing platform YouTube™. Videos aimed at clarifying the etiological and clinical characteristics, diagnostic criteria, treatment, and prognosis of OLP were included. A total of 481 videos were retrieved and 37 were included in the study according to the selection criteria established. Most of the videos evaluated (86.5%; n = 32) were produced by independent users. The average reliability was 1.8 and quality assessment classified only three videos (8.1%) as having good/excellent quality. A significant correlation was observed between the length of the video analyzed and its quality and reliability (p < 0.05), as well as between the reliability and usefulness of the video (p = 0.03). YouTube™ has become a leading source of information for the general population. However, a significant number of these videos have a low quality. Students, professionals, and healthcare providers must be more actively involved in providing clear, accurate, and reliable evidence-based information in an accessible language in order to enable significant improvement in patient care delivery.
Collapse
Affiliation(s)
- Everton Freitas de Morais
- Universidade Federal do Rio Grande do Norte - UFRN, Health Sciences Center, Department of Oral Pathology, Natal, RN, Brazil
| | - Fernanda Aragão Felix
- Universidade Federal do Rio Grande do Norte - UFRN, Health Sciences Center, Department of Oral Pathology, Natal, RN, Brazil
| | | | | | - Carlos Augusto Galvao Barboza
- Universidade Federal do Rio Grande do Norte - UFRN, Health Sciences Center, Department of Oral Pathology, Natal, RN, Brazil
| | - Roseana de Almeida Freitas
- Universidade Federal do Rio Grande do Norte - UFRN, Health Sciences Center, Department of Oral Pathology, Natal, RN, Brazil
| |
Collapse
|
|
15
|
Kiyani A, Sohail K, Saeed MHB. Efficacy of 0.1% tacrolimus in long-term management of erosive lichen planus. J DERMATOL TREAT 2019; 32:367-371. [PMID: 31390902 DOI: 10.1080/09546634.2019.1654072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study documented the response of erosive oral lichen planus (OLP) to exclusive treatment with 0.1% topical tacrolimus over a 12-month period or until the patient became unresponsive to therapy. MATERIALS AND METHODS A retrospective cohort design was used to acquire data on 12 patients with recalcitrant OLP that were prescribed 0.1% tacrolimus. These patients were prescribed 0.1% tacrolimus after failing to respond to conventional corticosteroid therapy. Information about their response to medication initially and on flare ups were included in this study. RESULTS The sample consisted of nine women and three men. All patients were given 0.1% tacrolimus to be applied 3 times a day. Two patients did not respond to the treatment at all, 4 patients showed partial response to tacrolimus treatment. Six patients showed complete initial response to treatment. CONCLUSION 50% of our patients showed a suboptimal response to 0.1% tacrolimus use for erosive OLP, thus, suggesting that in some cases 0.1% tacrolimus may be an ineffective option for managing erosive OLP.
Collapse
Affiliation(s)
- Amber Kiyani
- Islamic International Dental Hospital, Islamabad, Pakistan
| | - Kanwal Sohail
- Islamic International Dental Hospital, Islamabad, Pakistan
| | | |
Collapse
|
|
16
|
Lorenzo-Pouso AI, Pérez-Sayáns M, Kujan O, Castelo-Baz P, Chamorro-Petronacci C, García-García A, Blanco-Carrión A. Patient-centered web-based information on oral lichen planus: Quality and readability. Med Oral Patol Oral Cir Bucal 2019; 24:e461-e467. [PMID: 31246939 PMCID: PMC6667009 DOI: 10.4317/medoral.22992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/21/2019] [Indexed: 01/17/2023] Open
Abstract
Background To assess the readability and quality of web-based information available for patients about oral lichen planus (OLP). Material and Methods Three major search engines (Google, Bing and Yahoo!) were used to identify websites of particular interest to the study using the search term ‘oral lichen planus’. The first 100 sites of each search engine were considered for the study. The quality of the contents was evaluated using the DISCERN instrument. The Flesch-Kinkaid Reading Grade Level (FKRGL) and the Flesh Reading Ease Score (FRES) were used to assess readability. The presence of the Health on the Net (HON) seal was also evaluated. Results Following the application of the study’s exclusion criteria, only 28 websites were compiled for further analysis. The median of the DISCERN instrument was 3 [2-3] which means serious or potentially important shortcoming in the quality of the information. Readability indexes pointed to a high reading difficulty (FRES: 48.14±11.22; FKRGL:11.13±2.90). Conclusions The information provided by the Internet to the general public regarding OLP has major deficits in terms of quality, and at the same time is difficult for a comprehensive reading. Further studies are warranted to test well-produced patient-centered information on OLP. Key words:Oral lichen planus, oral diseases, health literacy, health information.
Collapse
Affiliation(s)
- A-I Lorenzo-Pouso
- Oral Medicine, Oral Surgery and Implantology Unit- Faculty of Medicine and Odontology, University of Santiago de Compostela, Rúa Entrerríos S/N, 15782 - Santiago de Compostela, (Spain),
| | | | | | | | | | | | | |
Collapse
|
|
17
|
Warnakulasuriya S. White, red, and mixed lesions of oral mucosa: A clinicopathologic approach to diagnosis. Periodontol 2000 2019; 80:89-104. [DOI: 10.1111/prd.12276] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Saman Warnakulasuriya
- King's College London and WHO Collaborating Centre for Oral Cancer and Precancer London UK
| |
Collapse
|
|
18
|
Thongprasom K. Oral lichen planus: Challenge and management. Oral Dis 2018; 24:172-173. [PMID: 29480607 DOI: 10.1111/odi.12712] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/10/2017] [Indexed: 12/21/2022]
Affiliation(s)
- K Thongprasom
- Oral Medicine Department, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
|
19
|
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: 15] [Impact Index Per Article: 2.1] [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.
Collapse
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
| |
Collapse
|
|
20
|
Tziotzios C, Brier T, Lee JY, Saito R, Hsu CK, Bhargava K, Stefanato CM, Fenton DA, McGrath JA. Lichen planus and lichenoid dermatoses. J Am Acad Dermatol 2018; 79:807-818. [DOI: 10.1016/j.jaad.2018.02.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
|
21
|
Ferri EP, Gallo CDB, Abboud CS, Yanaguizawa WH, Horliana ACRT, Silva DDFTD, Pavani C, Bussadori SK, Nunes FD, Mesquita-Ferrari RA, Fernandes KPS, Rodrigues MFSD. Efficacy of photobiomodulation on oral lichen planus: a protocol study for a double-blind, randomised controlled clinical trial. BMJ Open 2018; 8:e024083. [PMID: 30297352 PMCID: PMC6194464 DOI: 10.1136/bmjopen-2018-024083] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Oral lichen planus (OLP) is an idiopathic chronic mucocutaneous disease with a wide range of clinical manifestations, including white reticular patches, erosive/ulcerative and atrophic lesions, both associated with intense symptomatology. Topical corticosteroids are commonly used as standard therapy. However, patients frequently present relapses after the discontinuation of treatment as well as developing resistance to corticosteroid therapy. Photobiomodulation (PBM) has been shown to be a potential therapeutic tool to treat inflammatory disorders, including OLP. The aim of this study was to compare the efficacy of PBM (660 nm) with corticosteroid therapy with clobetasol propionate 0.05% for the treatment of OLP. METHODS AND ANALYSIS Forty-four patients with symptomatic and histopathological diagnosis of OLP will be randomised into two experimental groups in a double-blind manner: control group (n=22): clobetasol propionate 0.05%+placebo PBM, and experimental group (n=22): PBM (λ=660 nm, power 100 mW, radiant exposure: 177 J/cm2 and 0.5J per point)+placebo gel. Laser will be applied 2×/week for 1 month and clobetasol propionate three times a day for 30 days and the same for placebo treatments. The primary variable (pain) and the secondary variables (clinical score, evaluation of functional scores, clinical resolution, OLP recurrence, quality of life and anxiety and depression) will be evaluated at the baseline, once a week during treatment (depending on the variables) and after 30 days and 60 days of follow-up. Pain will be evaluated using visual analogue scale and clinical characteristics will be scored using the Thongprasom Index. The quality of life and anxiety and depression will be evaluated by Oral Health Impact Profile-14 questionnaire and by Hospital Anxiety and Depression Scale for anxiety scale, respectively. The serum and salivary levels of interleukin (IL)-6, IL-10, IL-1β, INF-γ and tumour necrosis factor-α will be evaluated by ELISA at baseline and at the end of treatment. ETHICS AND DISSEMINATION This protocol was approved (#2.375.410) by the Nove de Julho University (UNINOVE) Research Ethics Committee. The data gathered using this protocol will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03320460.
Collapse
Affiliation(s)
- Elza Padilha Ferri
- Biophotonics Applied to Health Sciences, Nove de Julho University, São Paulo, Brazil
| | - Camila de Barros Gallo
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Clery Saad Abboud
- Biophotonics Applied to Health Sciences, Nove de Julho University, São Paulo, Brazil
| | | | | | | | - Christiane Pavani
- Biophotonics Applied to Health Sciences, Nove de Julho University, São Paulo, Brazil
| | - Sandra Kalil Bussadori
- Biophotonics Applied to Health Sciences, Nove de Julho University, São Paulo, Brazil
- Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, Brazil
| | - Fabio Daumas Nunes
- Department of Oral Pathology, School of Dntistry, University of São Paulo, São Paulo, Brazil
| | - Raquel Agnelli Mesquita-Ferrari
- Biophotonics Applied to Health Sciences, Nove de Julho University, São Paulo, Brazil
- Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, Brazil
| | | | | |
Collapse
|
|
22
|
Robledo-Sierra J, van der Waal I. How general dentists could manage a patient with oral lichen planus. Med Oral Patol Oral Cir Bucal 2018; 23:e198-e202. [PMID: 29476684 PMCID: PMC5911349 DOI: 10.4317/medoral.22368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/22/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The literature hardly contains information on how patients suffering from oral lichen planus could be managed by dentists. MATERIAL AND METHODS Based on the limited available literature and particularly on the long-term clinical and histopathological experience of one of the authors, suggestions on how dentists could manage patients with oral lichen planus have been put forward. RESULTS In most cases, the dentist should be able to establish a correct diagnosis. Occasionally, the dentist may call upon a specialist, usually an oral medicine specialist or an oral and maxillofacial surgeon for confirmation of the diagnosis, possibly a biopsy procedure, and management of the patient in case of severe symptoms. Proper patient information is of utmost importance in the management. CONCLUSIONS General dentists can be expected to manage the majority of patients with oral lichen planus. Some patients may need to be referred for diagnostic purposes to a specialist; this is also the case for the rare patient with severe symptoms, possibly requiring systemic treatment.
Collapse
Affiliation(s)
- J Robledo-Sierra
- VU University Medical Center (VUmc)/ ACTA, Department of Oral and Maxillofacial Surgery and Pathology, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands,
| | | |
Collapse
|
|
23
|
Platelet-Rich Plasma (PRP) Rinses for the Treatment of Non-Responding Oral Lichen Planus: A Case Report. Biomedicines 2018; 6:biomedicines6010015. [PMID: 29724987 PMCID: PMC5874672 DOI: 10.3390/biomedicines6010015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/29/2018] [Accepted: 02/02/2018] [Indexed: 12/19/2022] Open
Abstract
Platelet-rich plasma (PRP) has been proposed for different applications in the medical field and in maxillofacial surgery thanks to its many growth factors, such as epidermal growth factor (EGF), fibroblast growth factor (FGF), and keratinocyte growth factor (KGF). Oral lichen planus (OLP) is a disease that affects the oral mucosa in a chronic way. This disease frequently worsens the quality of life of patients, particularly when clinical manifestations are of the erythematous or erosive/ulcerative type. The properties of PRP that are supported by scientific literature in both oral medicine and other medical fields have suggested the introduction of PRP in clinical practice for the medical treatment of different soft tissues diseases, such as when OLP patients do not respond to conventional therapies, or when conventional treatments have some contraindications or side effects. The aim of this work is to describe the use of PRP used as an oral rinse for the treatment of a patient diagnosed as affected by OLP at the Dentistry, Special Needs and Maxillo-Facial Surgery Unit of the Hospital of Piacenza. PRP protocol was started after the failure of conventional therapies based on the use of topical and systemic corticosteroids, hydroxychloroquine, and low-level laser therapy applications.
Collapse
|
|
24
|
Siponen M, Huuskonen L, Kallio-Pulkkinen S, Nieminen P, Salo T. Topical tacrolimus, triamcinolone acetonide, and placebo in oral lichen planus: a pilot randomized controlled trial. Oral Dis 2017; 23:660-668. [PMID: 28168769 DOI: 10.1111/odi.12653] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/26/2016] [Accepted: 01/15/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To carry out a double-blind randomized controlled trial (RCT) to compare the effectiveness of topical tacrolimus (TAC), triamcinolone acetonide (TRI), and placebo (PLA) in symptomatic oral lichen planus (OLP). SUBJECTS AND METHODS A clinical score (CS, range 0-130) was developed to measure the clinical signs and symptoms of OLP. Twenty-seven OLP patients with a CS of ≥20 were randomly allocated to receive 0.1% TAC ointment (n = 11), 0.1% TRI paste (n = 7), or Orabase® paste as PLA (n = 9) for 3 weeks. If the CS dropped ≥20% (interpreted as response), the patients continued the same medication for another 3 weeks. If the CS dropped <20% or increased (non-response), the patients were switched to TAC for 6 weeks. A 6-month follow-up period ensued. The primary outcome variable was the change in CS from baseline to week 3. In primary outcome analysis, CS values between the treatment arms were compared. RESULTS Tacrolimus and TRI were more effective (P = 0.012 and 0.031, respectively) than PLA in reducing the CS at week 3. No difference in the efficacy was noted between TAC and TRI (P = 0.997). CONCLUSIONS This pilot RCT provides evidence for the effectiveness of TAC and TRI over PLA in the management of OLP.
Collapse
Affiliation(s)
- M Siponen
- Institute of Dentistry, University of Oulu, Oulu, Finland.,Cancer and Translational Medicine Research Unit, University of Oulu, Oulu, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| | - L Huuskonen
- Institute of Dentistry, University of Oulu, Oulu, Finland
| | | | - P Nieminen
- Medical Informatics and Statistics Research Group, University of Oulu, Oulu, Finland
| | - T Salo
- Institute of Dentistry, University of Oulu, Oulu, Finland.,Cancer and Translational Medicine Research Unit, University of Oulu, Oulu, Finland.,Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| |
Collapse
|
|
25
|
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: 3.3] [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.
Collapse
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
| |
Collapse
|
|
26
|
Cao T, Zhang H, Zhou L, Wang Y, Du G, Yao H, Wang Y, Luo Q, Chen F, Wang W, Tang G. In vitrocell culture system optimization of keratinocytes from oral lichen planus (OLP) patients. Oral Dis 2016; 23:225-232. [PMID: 27763705 DOI: 10.1111/odi.12599] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 09/24/2016] [Accepted: 10/17/2016] [Indexed: 11/26/2022]
Affiliation(s)
- T Cao
- Department of Oral Medicine; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
- Department of Endodontics and Oral Medicine; Nantong Stomatological Hospital; Nantong China
| | - H Zhang
- Department of Clinical Immunology; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - L Zhou
- Department of Oral Medicine; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Y Wang
- Department of Oral Medicine; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - G Du
- Department of Oral Medicine; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - H Yao
- Department of Oral Medicine; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Y Wang
- Department of Oral Medicine; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Q Luo
- Department of Clinical Immunology; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - F Chen
- Department of Clinical Immunology; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - W Wang
- Department of Periodontology and Oral Medicine; Qingdao Stomatological Hospital; Qingdao China
| | - G Tang
- Department of Oral Medicine; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| |
Collapse
|
|
27
|
Cheng YSL, Gould A, Kurago Z, Fantasia J, Muller S. Diagnosis of oral lichen planus: a position paper of the American Academy of Oral and Maxillofacial Pathology. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:332-54. [PMID: 27401683 DOI: 10.1016/j.oooo.2016.05.004] [Citation(s) in RCA: 325] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/03/2016] [Accepted: 05/11/2016] [Indexed: 12/26/2022]
Abstract
Despite being one of the most common oral mucosal diseases and recognized as early as 1866, oral lichen planus (OLP) is still a disease without a clear etiology or pathogenesis, and with uncertain premalignant potential. More research is urgently needed; however, the research material must be based on an accurate diagnosis. Accurate identification of OLP is often challenging, mandating inclusion of clinico-pathological correlation in the diagnostic process. This article summarizes current knowledge regarding OLP, discusses the challenges of making an accurate diagnosis, and proposes a new set of diagnostic criteria upon which to base future research studies. A checklist is also recommended for clinicians to provide specific information to pathologists when submitting biopsy material. The diagnostic process of OLP requires continued clinical follow-up after initial biopsy, because OLP mimics can manifest, necessitating an additional biopsy for direct immunofluorescence study and/or histopathological evaluation in order to reach a final diagnosis.
Collapse
Affiliation(s)
- Yi-Shing Lisa Cheng
- Department of Diagnostic Sciences, Texas A&M University College of Dentistry, Dallas, TX, USA.
| | - Alan Gould
- Louisville Oral Pathology Laboratory, Louisville, KY, USA
| | - Zoya Kurago
- Department of Oral Health and Diagnostic Sciences, College of Dental Medicine, Augusta University, Augusta, GA, USA
| | - John Fantasia
- Department of Dental Medicine, Hofstra North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA
| | - Susan Muller
- Professor Emeritus, Emory University School of Medicine, Atlanta, GA; Atlanta Oral Pathology, Decatur, GA, USA
| |
Collapse
|
|
28
|
Alrashdan MS, Cirillo N, McCullough M. Oral lichen planus: a literature review and update. Arch Dermatol Res 2016; 308:539-51. [PMID: 27349424 DOI: 10.1007/s00403-016-1667-2] [Citation(s) in RCA: 260] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/16/2016] [Accepted: 06/17/2016] [Indexed: 12/22/2022]
Abstract
Lichen planus (LP) is a common chronic inflammatory condition that can affect skin and mucous membranes, including the oral mucosa. Because of the anatomic, physiologic and functional peculiarities of the oral cavity, the oral variant of LP (OLP) requires specific evaluations in terms of diagnosis and management. In this comprehensive review, we discuss the current developments in the understanding of the etiopathogenesis, clinical-pathologic presentation, and treatment of OLP, and provide follow-up recommendations informed by recent data on the malignant potential of the disease as well as health economics evaluations.
Collapse
Affiliation(s)
- Mohammad S Alrashdan
- Department of Oral Medicine and Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Nicola Cirillo
- Melbourne Dental School, The University of Melbourne, Victoria, Australia
| | - Michael McCullough
- Melbourne Dental School, The University of Melbourne, Victoria, Australia
| |
Collapse
|
|
29
|
Lopez Jornet P, Aznar-Cayuela C. Efficacy of topical chamomile management vs. placebo in patients with oral lichen planus: a randomized double-blind study. J Eur Acad Dermatol Venereol 2016; 30:1783-1786. [PMID: 27324515 DOI: 10.1111/jdv.13770] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/14/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND The purpose of this study was to compare the clinical therapeutic efficacy of topical applications of chamomile vs. a placebo for treating oral lichen planus (OLP). METHODS This double-blind study, randomly divided 60 patients with OLP into two groups, 30 treated with 2% Chamaemelum nobile gel (0.5 mL/3 times a day) and 30 treated with a placebo (Trial Registration NCT02421770). A visual analogue scale was used to rate pain, itching and burning sensation, and Thongprasom Index, the Oral Health Impact Profile 14 (OHIP-14) and the Hospital Anxiety-Depression Scale. Patients were evaluated at baseline and after 4 weeks of treatment. RESULTS Patients treated with chamomile showed significant improvements after 4 weeks for pain (P < 0.001), burning sensation (P < 0.001), itching (P = 0.011), OHIP-14 (P < 0.001) and Thongprasom index (P = 0.001); 92% of patients treated with chamomile showed a partial or total response, while only five subjects (17%) in the placebo group showed any improvement. CONCLUSION The topical application of 2% chamomile gel is an effective treatment for OLP.
Collapse
Affiliation(s)
- P Lopez Jornet
- Department of Oral Medicine, Faculty of Medicine and Dentistry, University of Murcia, Murcia, Spain.
| | - C Aznar-Cayuela
- Colaborate Department of Oral Medicine, Faculty of Medicine and Dentistry, University of Murcia, Murcia, Spain
| |
Collapse
|
|
30
|
Possible alternative therapies for oral lichen planus cases refractory to steroid therapies. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:496-509. [PMID: 27068310 DOI: 10.1016/j.oooo.2016.02.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 01/15/2016] [Accepted: 02/02/2016] [Indexed: 02/05/2023]
Abstract
Oral lichen planus (OLP) is a chronic inflammatory disorder with a multifactorial etiopathogenesis. Immune dysregulation plays a critical role in the development and progression of this disease. Patients' lives may be affected by pain caused by atrophic-erosive lesions. Given the obscure etiology, treatment is usually symptomatic. Topical steroids remain the mainstay of management. However, their therapeutic benefits are not always evident. There are substantial data on the possible therapeutic strategies that are effective in OLP cases refractory to steroids. This review provides an overview of the current approaches for the management of steroid-refractory OLP. The miscellaneous treatment regimens include tacrolimus, pimecrolimus, thalidomide, low-level laser therapy, photodynamic therapy, and surgical excision. Some results obtained from these studies were promising. However, further studies, especially randomized controlled trials with strict inclusion and exclusion criteria and larger sample sizes, are required for the evaluation of the long-term safety and efficacy of these therapies.
Collapse
|
|
31
|
Wang H, Zhang D, Han Q, Zhao X, Zeng X, Xu Y, Sun Z, Chen Q. Role of distinct CD4(+) T helper subset in pathogenesis of oral lichen planus. J Oral Pathol Med 2015; 45:385-93. [PMID: 26693958 DOI: 10.1111/jop.12405] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2015] [Indexed: 02/05/2023]
Abstract
Oral lichen planus (OLP) is one of the most common chronic inflammatory oral mucosal diseases with T-cell-mediated immune pathogenesis. In subepithelial and lamina propria of OLP local lesions, the presence of CD4(+) T helper (CD4(+) Th) cells appeared as the major lymphocytes. These CD4(+) T lymphocytes can differentiate into distinct Th cell types such as Th1, Th2, Treg, Th17, Th22, Th9, and Tfh within the context of certain cytokines environment. Growing evidence indicated that Th1/Th2 imbalance may greatly participate into the cytokine network of OLP immunopathology. In addition, Th1/Th2 imbalance can be regulated by the Treg subset and also greatly influenced by the emerging novel CD4(+) Th subset Th17. Furthermore, the presence of novel subsets Th22, Th9 and Tfh in OLP patients is yet to be clarified. All these Th subsets and their specific cytokines may play a critical role in determining the character, extent and duration of immune responses in OLP pathogenesis. Therefore, we review the roles of distinct CD4(+) Th subsets and their signature cytokines in determining disease severity and susceptibility of OLP and also reveal the novel therapeutic strategies based on T lymphocytes subsets in OLP treatment.
Collapse
Affiliation(s)
- Hui Wang
- Department of Oral Medicine, School of Stomatology, Capital Medical University, Beijing, China.,State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Dunfang Zhang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Mucosal Immunology Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Qi Han
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Zhao
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi Xu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zheng Sun
- Department of Oral Medicine, School of Stomatology, Capital Medical University, Beijing, China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| |
Collapse
|
|
32
|
Gangeshetty N, Kumar BP. Oral lichenplanus: Etiology, pathogenesis, diagnosis, and management. World J Stomatol 2015; 4:12-21. [DOI: 10.5321/wjs.v4.i1.12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 12/01/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023] Open
Abstract
Oral Lichen planus (OLP) is a common chronic mucocutaneous disorder with an immune mediated pathogenesis. Its appearance may vary from presence of keratotic to erythematous areas. Etiology of OLP is unknown, but it is thought to be the result of an autoimmune process with an unknown predisposing factor. Oral lichen planus is a complex and poorly understood clinical condition with periods of remissions and exacerbations. Management of the OLP is diversified with few lesions requiring treatment for years and few others are mild, requiring no treatment.
Collapse
|
|
33
|
Prucktrakul C, Youngnak-Piboonratanakit P, Kanjanabuch P, Prueksrisakul T, Thongprasom K. Oral lichenoid lesions and serum antinuclear antibodies in Thai patients. J Oral Pathol Med 2014; 44:468-74. [DOI: 10.1111/jop.12257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Chalakorn Prucktrakul
- Oral Medicine Department, Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
| | | | - Patnarin Kanjanabuch
- Oral Medicine Department, Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
| | - Titipong Prueksrisakul
- Oral Medicine Department, Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
| | - Kobkan Thongprasom
- Oral Medicine Department, Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
| |
Collapse
|
|
34
|
Dillenburg CS, Martins MAT, Munerato MC, Marques MM, Carrard VC, Sant'Ana Filho M, Castilho RM, Martins MD. Efficacy of laser phototherapy in comparison to topical clobetasol for the treatment of oral lichen planus: a randomized controlled trial. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:068002. [PMID: 24887747 DOI: 10.1117/1.jbo.19.6.068002] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 04/30/2014] [Indexed: 06/03/2023]
Abstract
Oral lichen planus (OLP) is a relatively common chronic mucocutaneous inflammatory disease and a search for novel therapeutic options has been performed. We sought to compare the efficacy of laser phototherapy (LPT) to topical clobetasol propionate 0.05% for the treatment of atrophic and erosive OLP. Forty-two patients with atrophic/erosive OLP were randomly allocated to two groups: clobetasol group (n=21): application of topical clobetasol propionate gel (0.05%) three times a day; LPT group (n=21): application of laser irradiation using InGaAlP diode laser three times a week. Evaluations were performed once a week during treatment (Days 7, 14, 21, and 30) and in four weeks (Day 60) and eight weeks (Day 90) after treatment. At the end of treatment (Day 30), significant reductions in all variables were found in both groups. The LPT group had a higher percentage of complete lesion resolution. At follow-up periods (Days 60 and 90), the LPT group maintained the clinical pattern seen at Day 30, with no recurrence of the lesions, whereas the clobetasol group exhibited worsening for all variables analyzed. These findings suggest that the LPT proved more effective than topical clobetasol 0.05% for the treatment of OLP.
Collapse
Affiliation(s)
- Caroline Siviero Dillenburg
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Marco Antonio Trevizani Martins
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Medicine, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Maria Cristina Munerato
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Medicine, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Márcia Martins Marques
- University of São Paulo, School of Dentistry, Department of Dentistry, São Paulo, São Paulo 05508-000, Brazil
| | - Vinícius Coelho Carrard
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Manoel Sant'Ana Filho
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Rogério Moraes Castilho
- University of Michigan, School of Dentistry, Laboratory of Epithelial Biology, Department of Periodontics and Oral Medicine, Ann Arbor, Michigan 48109-1078
| | - Manoela Domingues Martins
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| |
Collapse
|
|
35
|
Lin XC, Sun HY, Zhen YX, Zhang H, Shi H, Wang XX. Low expression of glucocorticoid receptor α in oral lichen planus correlates with activation of nuclear factor κB: a preliminary study. J Oral Pathol Med 2014; 43:600-5. [PMID: 25320751 DOI: 10.1111/jop.12168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Xue-cai Lin
- Department of Stomatology; Huashan Hospital; Fudan University; Shanghai China
| | - Hong-ying Sun
- Department of Stomatology; Huashan Hospital; Fudan University; Shanghai China
| | - Yue-xiang Zhen
- Department of Stomatology; Huashan Hospital; Fudan University; Shanghai China
| | - Hui Zhang
- Department of Stomatology; Huashan Hospital; Fudan University; Shanghai China
| | - Hang Shi
- Department of Stomatology; Huashan Hospital; Fudan University; Shanghai China
| | - Xia-xia Wang
- Department of Stomatology; Huashan Hospital; Fudan University; Shanghai China
| |
Collapse
|
|
36
|
Bendas ER, Abdullah H, El-Komy MH, Kassem MA. Hydroxychloroquine niosomes: A new trend in topical management of oral lichen planus. Int J Pharm 2013; 458:287-95. [DOI: 10.1016/j.ijpharm.2013.10.042] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 10/22/2013] [Indexed: 11/28/2022]
|