SEPTIEMBRE 2.003
SEPTEMBER 2.003
ORAL EROSIVE LICHEN
PLANUS
1.) Treatment of chronic erosive oral
lichen planus with low concentrations of topical tacrolimus: an open
prospective study.
2.)
Treatment of severe erosive gingival lesions by topical application of
clobetasol propionate in custom trays.
3.) Oral erosive/ulcerative
lichen planus: preliminary findings in an open trial of sulodexide compared with
cyclosporine (ciclosporin) therapy.
4.)
Hydroxychloroquine sulfate (Plaquenil) improves oral lichen planus: An open
trial
5.) Management of recalcitrant
ulcerative oral lichen planus with topical tacrolimus.
6.) Dramatic response to levamisole and
low-dose prednisolone in 23 patients with oral lichen planus: a 6-year
prospective follow-up study.
7.) [Simvastatin-induced lichen planus
pemphigoides]
8.) Topical tacrolimus and
pimecrolimus: future directions.
9.) [The topical treatment of atrophic-erosive
oral lichen planus with fluocinonide in a bioadhesive gel, chlorhexidine and
miconazole gel. A totally open trial]
10.) The efficacy of cyclosporin for
topical use in oral lichen planus]
11.) Levamisole and/or Chinese
medicinal herbs can modulate the serum level of squamous cell carcinoma
associated antigen in patients with erosive oral lichen planus.
12.) Efficacy of fluocinolone
acetonide gel in the treatment of oral lichen planus.
1.) Treatment of chronic erosive oral lichen planus
with low concentrations of topical tacrolimus: an open prospective study.
Arch Dermatol. 2002 Oct;138(10):1335-8.
Olivier V, Lacour JP, Mousnier A, Garraffo R, Monteil RA, Ortonne JP.
Department of Dermatology, Hopital Archet-2, BP 3079, 06202 Nice CEDEX, France.
BACKGROUND: Chronic erosive oral lichen planus (EOLP) is a severe form of lichen
of the buccal mucosa that is often resistant to systemic or topical therapies.
OBJECTIVE: To evaluate the efficacy and safety of topical tacrolimus, 0.1 mg per
100 mL of water, in treating EOLP. DESIGN: Open-label, prospective,
noncomparative study, with 6 months of treatment and 6 months of follow-up.
SETTING: Dermatology department at a university hospital in Nice, France.
PATIENTS: Ten patients with histologically proved EOLP that was refractory to
treatment. Two patients were withdrawn because of noncompliance; findings in 8
were available for evaluation. INTERVENTIONS: Mouthwashes with tacrolimus, 0.1
mg per 100 mL of distilled water, 4 times daily for 6 months. MAIN OUTCOME
MEASURES: Efficacy was assessed using a calculated score that combined the
intensity of spontaneous and meal-triggered pain and the surface area of
erosions. Safety assessment included the monitoring of adverse effects, clinical
laboratory values, and blood concentrations of tacrolimus. RESULTS: Among the 8
patients evaluated, 1 had no improvement and 7 were improved. The mean score
decreased from 7.00 at baseline to 5.43 (a 22.43% decrease) at 1 month, 4.14 (a
40.86% decrease) at 2 months, 3.00 (a 57.14% decrease) at 3 months, 2.43 (a
65.29% decrease) at 4 months, 2.57 (a 63.29% decrease) at 5 months, and 3.43 (a
51.00% decrease) at 6 months. A decrease of symptoms was reported by the 7
responding patients as soon as the first month of treatment. No severe adverse
effects were observed. All patients had whole-blood concentrations of tacrolimus
below the detection limit of the assay (1.5 ng/mL) at all intervals. At 9 months,
6 patients had had a relapse within a mean of 38.6 days. At 12 months, all
patients had had a relapse and required treatment with topical corticosteroids
or systemic hydroxychloroquine sulfate. CONCLUSION: Results of our study suggest
a rapid and important palliating effect of low concentration of topical
tacrolimus in distilled water in patients with EOLP.
2.) Treatment of severe erosive gingival lesions by topical
application of clobetasol propionate in custom trays.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Jun;95(6):688-92.
Gonzalez-Moles MA, Ruiz-Avila I, Rodriguez-Archilla A, Morales-Garcia P,
Mesa-Aguado F, Bascones-Martinez A, Bravo M.
University of Granada, Jaen General Hospital, and University Complutense of
Madrid, Spain. [email protected]
OBJECTIVE: We sought to describe the response of patients with severe erosive
gingival lesions to treatment with clobetasol propionate in Orabase paste
administered in trays. The adverse effects were also recorded. STUDY DESIGN: A
descriptive pretest/posttest clinical study with no control group (33 patients
total) was developed. All patients received repeated applications of 0.05%
clobetasol propionate plus 100,000 IU/cc of nystatin in Orabase paste. Over the
48-week period, the pain levels, ulcerations, presence of atrophy, and the
patients' daily activities were recorded, and Likert scales were used to
classify each outcome as either a complete recovery, excellent, good, poor, or
failed. The presence of any adverse effect was also noted. RESULTS: At the end
of the study period, the pain and ulceration had disappeared (complete response)
in 100% of the sample (33/33; 95% confidence interval = 89.4%-100%), and there
was a complete recovery of daily activities and remission of atrophy in 93.9%
(31/33; 95% confidence interval = 79.8%-99.3%) and 21.2% (7/33; 95% confidence
interval = 9.0%-38.9%) of the patients, respectively. No adverse effects related
to the treatment were observed. CONCLUSIONS: The application of an Orabase paste
of 0.05% clobetasol 17-propionate plus 100,000 IU/cc of nystatin by means of a
tray appears to be an efficacious treatment for severe erosive gingival lesions.
3.) Oral erosive/ulcerative lichen planus: preliminary
findings in an open trial of sulodexide compared with cyclosporine (ciclosporin)
therapy.
Int J Dermatol. 2003 Apr;42(4):308-11.
Femiano F, Gombos F, Scully C.
Stomatology Clinic, University of Medicine and Surgery, Naples, Italy. [email protected]
OBJECTIVE: To study the effect of the heparinoid sulodexide systemically,
compared with topical cyclosporine (ciclosporin), on chronic oral erosive/ulcerative
lichen planus. STUDY DESIGN: An open nonrandomized trial was conducted in two
groups of 10 Italian patients with lichen planus, with subjective assessment of
pain and assessment of ulceration amelioration by nonblinded clinicians. RESULTS:
Comparable pain relief and amelioration of erosions/ulcers were seen in patients
on sulodexide and in those on ciclosporin, but with faster healing in those on
sulodexide. CONCLUSIONS: Sulodexide appears to be as effective, and perhaps more
effective, than topical ciclosporin in the therapy of oral lichen planus, and is
less expensive, but full double-blind placebo-controlled studies are required.
4.) Hydroxychloroquine sulfate (Plaquenil)
improves oral lichen planus: An open trial.
J Am Acad Dermatol. 1993 Apr;28(4):609-12.
Dermatology Associates of Cincinnati, Inc., OH 45230.
BACKGROUND: Oral lichen planus is chronic and can be debilitating. Topical
corticosteroids are most frequently used for treatment, but they are not always
effective. OBJECTIVE: Hydroxychloroquine sulfate (Plaquenil), an antimalarial
agent, was evaluated in an open trial (10 patients) for its ability to improve
oral lichen planus. METHODS: Patients received hydroxychloroquine, 200 to 400 mg
daily, as a monotherapy for 6 months. Patients were assessed at baseline and
every 4 to 8 weeks during treatment. Baseline ophthalmologic examinations were
performed, and laboratory values were monitored before and during treatment.
RESULTS: Nine of ten patients had an excellent response to therapy. Three of six
patients with erosions at baseline had complete healing. Pain relief and reduced
erythema were usually observed after 1 to 2 months of therapy, but erosions
required 3 to 6 months of treatment before they resolved. There were no adverse
effects. CONCLUSION: Hydroxychloroquine may be useful in the treatment of oral
lichen planus.
5.) Management of recalcitrant ulcerative oral lichen planus with topical
tacrolimus.
J Am Acad Dermatol. 2002 Jan;46(1):35-41.
Kaliakatsou F, Hodgson TA, Lewsey JD, Hegarty AM, Murphy AG, Porter SR.
Unit of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences,
University College London, United Kingdom
OBJECTIVE: Our purpose was to investigate the efficacy and safety of 0.1%
topical tacrolimus in erosive or ulcerative oral lichen planus. METHODS: This
was an open-label, noncomparative study conducted in an outpatient oral medicine
unit in London, United Kingdom. The study covered an 8-week period with a 22-week
follow-up after cessation of therapy. Nineteen patients, aged 28 to 87 years
with biopsy-proven oral lichen planus refractory to, or dependent on, systemic
immunosuppressive agents, were enrolled. Seventeen patients (89%) completed the
study. Application of 0.1% tacrolimus was administered to all symptomatic oral
mucosal lesions. Clinical review took place 1, 3, 5, 7, and 8 weeks after
commencing therapy. Alleviation of symptoms was evaluated by using a visual
analogue scale as well as the McGill Pain and Oral Health Impact profile
questionnaires. The extent of the oral mucosal erosion or ulceration was
directly measured by the same clinician at all visits. Safety assessments
included monitoring of adverse events, complete blood cell count, renal and
hepatic clinical chemistry, and tacrolimus blood concentrations. RESULTS:
Tacrolimus caused a statistically significant improvement in symptoms within 1
week of commencement of therapy. A mean decrease of 73.3% occurred in the area
of ulceration over the 8-week study period. Local irritation (in 6 subjects,
35%) was the most commonly reported adverse effect. Laboratory values showed no
significant changes with time. Therapeutic levels of tacrolimus were
demonstrated in 8 subjects but were unrelated to the extent of oral mucosal
involvement. Thirteen of 17 patients suffered a relapse of oral lichen planus
within 2 to 15 weeks of cessation of tacrolimus therapy. CONCLUSION: Topical
tacrolimus is effective therapy for erosive or ulcerative oral lichen planus.
6.) Dramatic response to levamisole and low-dose prednisolone in
23 patients with oral lichen planus: a 6-year prospective follow-up study.
Oral Surg Oral Med Oral
Pathol Oral Radiol Endod. 1995 Dec;80(6):705-9.
Lu SY, Chen WJ, Eng HL.
Department of Dentistry, Ghang Gung Memorial Hospital, Kaohsiung, Taiwan,
Republic of China.
The purpose of this prospective study was to evaluate the short-term and long-term
clinical efficacy of levamisole used with low-dose prednisolone in patients with
refractory oral lichen planus. Twenty-three patients with OLP who had been
treated unsuccessfully with other modalities were given 150 mg/day levamisole
and 15 mg/day prednisolone for 3 consecutive days each week. Twelve patients
showed dramatic remission of signs and symptoms within 2 weeks, whereas 11 had
partial remission. All 23 reported significant pain relief and showed no
evidence of erosive oral lichen planus after 4 to 6 weeks of treatment. All 23
also remained free from symptoms for 6 to 9 months after the treatment ended.
There were few side effects from this treatment besides minor skin rash,
headache, and insomnia from the levamisole in three cases. We conclude that the
addition of levamisole to prednisolone may produce improved results in the
management of erosive oral lichen planus.
7.) [Simvastatin-induced lichen planus pemphigoides]
Ann Dermatol Venereol. 2003 Feb;130(2 Pt
1):187-90.
[Article in French]
Stoebner PE, Michot C, Ligeron C, Durand L, Meynadier J, Meunier L.
Service de Dermatologie-Allergologie-Photobiologie, Hopital Saint-Eloi, 80,
avenue Augustin Fliche, 34295 Montpellier Cedex 5. [email protected]
INTRODUCTION: Simvastatin is a competitive inhibitor of the 3-hydroxy-3-methylglutaryl-coenzyme
A (HMG-CoA) reductase which is effective in the treatment of various
hyperlipidemia. We report a case of lichen planus pemphigoides induced by
simvastatin treatment. CASE REPORT: A 63-year-old man was treated for two months
with simvastatin for hypercholesterolemia. One month later he developed a
pruriginous and bullous lichenoid eruption. Histological and direct
immunofluorescent features were consistent with the diagnosis of lichen planus
pemphigoides. The Western blot analysis revealed antibodies directed against BP
180 kDa antigens. All the lesions progressively disappeared after treatment was
discontinued. DISCUSSION: Lichen planus pemphigoides may be due to the intake of
drugs such as cinnarizine, captopril, ramipril and furosemide. Simvastatin may
induce various drug eruptions such as pruritus, eczematous rash, cheilitis,
angio-oedema and urticaria, porphyria cutanea tarda, lupus-like syndrome,
dermatomyositis and lichenoid eruption. With the increasing use of HMG-CoA
reductase inhibitors, an association between simvastatin and lichen planus
pemphigoides should be kept in mind.
8.) Topical tacrolimus and pimecrolimus: future directions.
Semin Cutan Med Surg. 2001 Dec;20(4):268-74.
Ling MR.
Emory University School of Medicine, Atlanta, GA, USA.
Topical tacrolimus ointment and pimecrolimus cream represent the first members
of a new class of medications. Topical immunomodulators have been developed for
the treatment of atopic dermatitis. Their superb safety profiles and excellent
efficacy as anti-inflammatory agents make them attractive candidates to treat a
host of other skin disorders. This article reviews published experiences that
use them for psoriasis, seborrheic dermatitis, lichen planus, pyoderma
gangrenosum and other diseases. Possible modifications to these compounds and
novel untested applications are discussed.
9.)
[The topical treatment of atrophic-erosive oral lichen
planus with fluocinonide in a bioadhesive gel, chlorhexidine and miconazole gel.
A totally open trial]
Minerva Stomatol. 1996 Mar;45(3):61-8.
[Article in Italian]
Carbone M, Carrozzo M, Broccoletti R, Mattea A, Gandolfo S.
Istituto policattedra di Clinica, Universita degli Studi, Torino.
To evaluate the efficacy and long-term course of topical steroids treatment in
oral lichen planus (OLP), an open trial has been carried out in 30 patients with
atrophic-erosive or symptomatic varieties of OLP confirmed histologically with
relative contraindications for systemic steroid treatment (namely, liver disease,
peptic ulcer, diabetes, blood hypertension or osteoporosis). The treatment was
the following: Fluocinonide (Topsyn) 0.025% in 4% idrossiethylcellulose gel
applied 3 times/daily for two months, 2 times/daily for the next 2 months and 1
times/daily for other 2 months. Moreover, chlorhexidine (Plakout) 0.12%, 3
mouthwashes/daily and miconazole gel (Micotef) applied 1 times/daily were used
for the entire period of the steroid therapy as antimycotics. The clinical
evaluation of signs and symptoms was assessed on a scale of 0 to 5 and of 0 to
3, respectively. Twenty patients concluded the entire therapeutical scheme,
whereas 5 (17%) interrupted the treatment for the appearance of side-effects (namely,
gastroesophageal disturbances, mucosal bleeding and pruritus), 1 interrupted
voluntarily the treatment and 4 cases did not present at the controls. No cases
of oral candidiasis were seen. Eighteen patients (90%) had improvements of oral
lesions with significant statically reductions in the scores of signs (p <
0.002) and of symptoms (p < 0.02) (Wilcoxon test). We emphasize also that in 61%
of the responders the oral conditions were stable after 6 months of follow-up.
In conclusion our results suggest the following: a) fluocinonide is an effective
and safe drug for the treatment of OLP, especially in addition with
chlorehixidine and miconazole; b) the stability of our results demonstrates that
probably an adequate steroid therapeutical scheme is more useful than continuous
steroid administration in the treatment of OLP.
ugh a blood transfusion.
10.) [The efficacy of cyclosporin for topical use in oral
lichen planus]
Source: http://www.hairsite2.com/
[The efficacy of cyclosporin for topical use in oral lichen planus]
Minerva Stomatol. 1994 Apr;43(4):129-32.
[Article in Italian]
Pacor ML, Biasi D, Urbani G, Lombardo G, Lunardi C.
Clinica Medica, Universita degli Studi di Verona.
Oral lichen planus is a disease characterized by long symptomatic phases
unresponsive to the usual therapy. Many groups have used different drugs in the
treatment of lichen planus: topically applied retinoic acid, temarotene,
antimycotic agents corticosteroids and immunosuppressive agents, with
unsatisfactory results. Recently it has been suggested that topical cyclosporine
might improve the lesions of oral lichen planus. The aim of this study was to
evaluate the usefulness of this therapy in our patients. Fourteen patients, 6
males and 8 females, mean age 47 years, with oral lichen planus were enrolled in
the study. All the patients were instructed to swish 5 ml of solution (500 mg)
of cyclosporine in the mouth three times a day for three months. Clinical
evaluation was performed before therapy and every two weeks afterwards. At each
visit serum levels of cyclosporine, creatinine, total and direct bilirubin and
complete blood count were performed. No side effects or blood test alterations
were detected in any patient and cyclosporine serum level was always
undetectable. Symptoms and oral lesions had a beneficial effect already after
one month of therapy. Our results confirm that cyclosporine is useful in the
treatment of oral lichen planus.
11.)
Levamisole and/or Chinese medicinal herbs can modulate the
serum level of squamous cell carcinoma associated antigen in patients with
erosive oral lichen planus.
J Oral Pathol Med. 2001 Oct;30(9):542-8.
Sun A, Chiang CP.
School of Dentistry, College of Medicine, National Taiwan University, No. 1
Chang-Te Street, Taipei, Taiwan.
The serum levels of squamous cell carcinoma associated antigen (SCCA) were
determined by a microparticle enzyme immunoassay in a group of patients with
stage I oral squamous cell carcinoma (OSCC), major or minor type erosive oral
lichen planus (EOLP), recurrent aphthous stomatitis (RAS), Behcet's disease (BD),
oral leukoplakia (OL), or oral submucous fibrosis (OSF), and in normal control
subjects. About 97% of the normal control subjects and the patients with minor
type EOLP, RAS, BD, OL or OSF had a serum level of SCCA within the normal limit
of 1.2 ng/ml. However, 6 of the 12 (50%) patients with stage I OSCC and 14 of
the 31 (45.2%) patients with major type EOLP had a serum level of SCCA greater
than 1.2 ng/ml. The mean serum level of SCCA in stage I OSCC patients
(1.38+/-1.16 ng/ml) or in major type EOLP patients (1.32+/-1.23 ng/ml) was
significantly higher than that in normal control subjects (P<0.001) and that in
the patients with minor type EOLP (P<0.001), RAS (P<0.001), BD (P<0.05), OL
(P<0.05), or OSF (P<0.05). Either major or minor type EOLP patients could obtain
a significant mean reduction of the serum SCCA level of 0.34-0.63 ng/ml after
treatment with levamisole and/or Chinese medicinal herbs for 1-30 months.
Combination therapy with levamisole plus Chinese medicinal herbs could achieve a
shorter duration of treatment to get complete remission than the single therapy
with either levamisole only or Chinese medicinal herbs only. We conclude that
levamisole and/or Chinese medicinal herbs can modulate the serum SCCA level in
EOLP patients. SCCA may be a useful marker in evaluating therapeutic effects and
in monitoring the disease status of EOLP. For EOLP patients, the combination
therapy is superior to the single therapy of levamisole or of Chinese medicinal
herbs.
12.) Efficacy of fluocinolone acetonide
gel in the treatment of oral lichen planus.
Oral Surg Oral Med Oral Pathol Oral
Radiol Endod. 2000 Jan;89(1):42-5.
Buajeeb W, Pobrurksa C, Kraivaphan P.
Department of Oral Medicine, Mahidol University, Bangkok, Thailand.
OBJECTIVE: The purpose of this study was to compare the efficacy of fluocinolone
acetonide gel 0.1% in 2 base forms (numbers 1 and 2) with fluocinolone acetonide
in an oral base 0.1%. STUDY DESIGN: Forty-eight patients with histologically
confirmed oral lichen planus were enrolled in the study. Lesions were scored
ranging from 0 (no lesion) to 5 (large erosion) according to the severity.
Patients were randomly given fluocinolone acetonide in an oral base,
fluocinolone acetonide gel no. 1 or no. 2. They were asked to apply the
medication on dried lesions 4 times a day. The lesions were evaluated after 2
and 4 weeks of treatment. The severity scores were analyzed by the Kruskal-Wallis
k-sample test. RESULTS: Patients who received fluocinolone acetonide in an oral
base and those who received fluocinolone acetonide gel no. 1 and no. 2 improved
from the average score of 3.0, 3.0, and 2.9 to 1.5, 1.5, and 1.6, respectively.
There were no statistically significant differences in score changes noted in
the 3 groups. The results indicate that fluocinolone acetonide gel no. 1 and no.
2 and fluocinolone acetonide in an oral base provide similar efficacy in the
treatment of oral lichen planus. CONCLUSION: Fluocinolone acetonide gel 0.1% is
a safe and effective alternative therapy to fluocinolone acetonide in an oral
base 0.1% in the treatment of oral lichen planus.
=======================================================================
DATA-MEDICOS/DERMAGIC-EXPRESS /SEPTEMBER JOURNAL 2.003/ DR. JOSE
LAPENTA R.
=======================================================================
|