Dermagic Journal of MEDermatology

 

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                                              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 Two patients were withdrawn because of noncompliance; findings in 8 were available for evaluation.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.


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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.

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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.


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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.


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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.


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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.

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 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.


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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.

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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.

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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.

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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.


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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.

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DATA-MEDICOS/DERMAGIC-EXPRESS /SEPTEMBER JOURNAL 2.003/ DR. JOSE LAPENTA R. 
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Maracay Estado Aragua Venezuela 2.003  
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