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Australian dental journal
09, 2021;66 (3): 295-303.

Interventions for oral lichen planus: A systematic review and network meta-analysis of randomized clinical trials.

K Sridharan, G Sivaramakrishnan
Author Information
  1. K Sridharan: Department of Pharmacology & Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain. ORCID
  2. G Sivaramakrishnan: Department of Dental Training, Ministry of Health, Manama, Kingdom of Bahrain. ORCID
PMID: 33682925 DOI: 10.1111/adj.12835

Abstract

BACKGROUND: Corticosteroids, calcineurin inhibitors, vitamin D, photodynamic therapy, herbal drugs are some of the interventions tried in clinical trials for treating oral lichen planus. We carried out the present network meta-analysis to compare the above-mentioned interventions.
METHODS: Electronic databases were searched for randomized clinical trials evaluating interventions in patients with symptomatic oral lichen planus. Clinical resolution, clinical score, pain resolution, pain score, and adverse effects were the outcomes evaluated.
RESULTS: Fifty-five (2831 patients) trials were included. Corticosteroids (OR: 13.6; 95% CI: 1.2, 155.4), pimecrolimus (OR: 14.7; 95% CI: 1.7, 125), purslane (OR: 18.4; 95% CI: 3.5, 97), and ozonized water/corticosteroids (OR: 52; 95% CI: 1.4, 1882.6) had better rates of clinical resolution compared to placebo. Corticosteroids (OR: 3.18; 95% CI: 1.2, 8.43), ozonized water/corticosteroids (OR: 9.9; 95% CI: 2.7, 36.2), aloe vera (OR: 13; 95%: 1.5, 111.8), pimecrolimus (OR: 18.8; 95% CI: 2, 177.4) and hyaluronic acid (OR: 24.8; 95% CI: 1.3, 457.6) were significantly associated with superior rates of pain resolution compared to placebo. Pimecrolimus and cyclosporine were associated with significantly higher risk of adverse effects than placebo.
CONCLUSION: Topical corticosteroids were the most effective drug class for treating oral lichen planus.

Keywords

Betamethasone corticosteroids cyclosporine dexamethasone tacrolimus triamcinolone

References

  1. Omal P, Jacob V, Prathap A, Thomas NG. Prevalence of oral, skin, and oral and skin lesions of lichen planus in patients visiting a dental school in southern India. Indian J Dermatol. 2012;57:107-109.
  2. González-Moles MÁ, Warnakulasuriya S, González-Ruiz I, et al. Worldwide prevalence of oral lichen planus: a systematic review and meta-analysis. Oral Dis. 2020; https://doi.org/10.1111/odi.13323.
  3. Le Cleach L, Chosidow O. Clinical practice. Lichen planus. N Engl J Med 2012;366:723-732.
  4. Lavanya N, Jayanthi P, Rao UK, Ranganathan K. Oral lichen planus: an update on pathogenesis and treatment. J Oral MaxillofacPathol. 2011;15:127-132.
  5. Radwan-Oczko M, Zwyrtek E, Owczarek JE, Szcześniak D. Psychopathological profile and quality of life of patients with oral lichen planus. J Appl Oral Sci. 2018;26:e20170146.
  6. Ismail SB, Kumar SK, Zain RB. Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation. J Oral Sci. 2007;49:89-106.
  7. Oberti L, Gabrione F, Lucchese A, Di Stasio D, Carinci F, Lauritano D. Treatment of oral lichen planus: a narrative review. Front. Physiol. 2019. https://doi.org/10.3389/conf.fphys.2019.27.00004
  8. Lodi G, Manfredi M, Mercadante V, Murphy R, Carrozzo M. Interventions for treating oral lichen planus: corticosteroid therapies. Cochrane Database Syst Rev. 2020;(2):CD001168.
  9. Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162:777-784.
  10. Higgins JPT, Green S (editors). Cochrane handbook for systematic reviews of interventions. 5.1.0 edn. Available at: www.cochrane-handbook.org. Accessed 28 August 2020.
  11. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539-1558.
  12. Brown S, Hutton B, Clifford T, et al. A Microsoft-Excel-based tool for running and critically appraising network meta-analyses-an overview and application of NetMetaXL. Syst Rev 2014;3:110.
  13. Agha-Hosseini F, Borhan-Mojabi K, Monsef-Esfahani HR, Mirzaii-Dizgah I, Etemad-Moghadam S, Karagah A. Efficacy of purslane in the treatment of oral lichen planus. Phytother Res. 2010;24:240-244.
  14. Amanat D, Ebrahimi H, Zahedani MZ, Zeini N, Pourshahidi S, Ranjbar Z. Comparing the effects of cryotherapy with nitrous oxide gas versus topical corticosteroids in the treatment of oral lichen planus. Indian J Dent Res. 2014;25:711-716.
  15. Amirchaghmaghi M, Pakfetrat A, Delavarian Z, Ghalavani H, Ghazi A. Evaluation of the efficacy of curcumin in the treatment of oral lichen planus: a randomized controlled trial. J Clin Diagn Res. 2016;10:ZC134-ZC137.
  16. Arduino PG, Campolongo MG, Sciannameo V, et al. Randomized, placebo-controlled, double-blind trial of clobetasol propionate 0.05% in the treatment of oral lichen planus. Oral Dis. 2018;24:772-777.
  17. Arunkumar S, Kalappanavar AN, Annigeri RG, Kalappa SG. Relative efficacy of pimecrolimus cream and triamcinolone acetonide paste in the treatment of symptomatic oral lichen planus. Indian J Dent. 2015;6:14-19.
  18. Bakhtiari S, Azari-Marhabi S, Mojahedi SM, Namdari M, Rankohi ZE, Jafari S. Comparing clinical effects of photodynamic therapy as a novel method with topical corticosteroid for treatment of Oral Lichen Planus. PhotodiagnosisPhotodynTher. 2017;20:159-164.
  19. Campisi G, Giandalia G, De Caro V, Di Liberto C, Aricò P, Giannola LI. A new delivery system of clobetasol-17-propionate (lipid-loaded microspheres 0.025%) compared with a conventional formulation (lipophilic ointment in a hydrophilic phase 0.025%) in topical treatment of atrophic/erosive oral lichen planus. A Phase IV, randomized, observer-blinded, parallel group clinical trial. Br J Dermatol. 2004;150:984-990.
  20. Carbone M, Arduino PG, Carrozzo M, et al. Topical clobetasol in the treatment of atrophic-erosive oral lichen planus: a randomized controlled trial to compare two preparations with different concentrations. J Oral Pathol Med. 2009;38:227-233.
  21. Chainani-Wu N, Silverman S Jr, Reingold A, et al. A randomized, placebo-controlled, double-blind clinical trial of curcuminoids in oral lichen planus. Phytomedicine 2007;14:437-446.
  22. Choonhakarn C, Busaracome P, Sripanidkulchai B, Sarakarn P. The efficacy of aloe vera gel in the treatment of oral lichen planus: a randomized controlled trial. Br J Dermatol. 2008;158:573-577.
  23. Conrotto D, Carbone M, Carrozzo M, et al. Ciclosporin vs. clobetasol in the topical management of atrophic and erosive oral lichen planus: a double-blind, randomized controlled trial. Br J Dermatol. 2006;154:139-145.
  24. Sonthalia S, Singal A. Comparative efficacy of tacrolimus 0.1% ointment and clobetasol propionate 0.05% ointment in oral lichen planus: a randomized double-blind trial. Int J Dermatol. 2012;51:1371-1378.
  25. Dillenburg CS, Martins MA, Munerato MC, et al. Efficacy of laser phototherapy in comparison to topical clobetasol for the treatment of oral lichen planus: a randomized controlled trial. J Biomed Opt. 2014;19:68002.
  26. Eisen D, Ellis CN, Duell EA, Griffiths CE, Voorhees JJ. Effect of topical cyclosporine rinse on oral lichen planus. A double-blind analysis. N Engl J Med. 1990;323:290-294.
  27. Ezzatt OM, Helmy IM. Topical pimecrolimus versus betamethasone for oral lichen planus: a randomized clinical trial. Clin Oral Investig. 2019;23:947-956.
  28. Fu J, Zhu X, Dan H, et al. Amlexanox is as effective as dexamethasone in topical treatment of erosive oral lichen planus: a short-term pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113:638-643.
  29. Ghabanchi J, Najafi RB, Haghnegahdar S. Treatment of oral inflammatory diseases with a new mucoadhesive prednisolone tablet versus triamcinolone acetonide paste. Iranian Red Crescent Medical Journal 2009;11:155-159.
  30. Gorouhi F, Solhpour A, Beitollahi JM, et al. Randomized trial of pimecrolimus cream versus triamcinolone acetonide paste in the treatment of oral lichen planus. J Am Acad Dermatol. 2007;57:806-813.
  31. Hashem AS, Issrani R, Elsayed TEE, Prabhu N. Topical hyaluronic acid in the management of oral lichen planus: a comparative study. J Investig Clin Dent. 2019;10:e12385.
  32. Hegarty AM, Hodgson TA, Lewsey JD, Porter SR. Fluticasone propionate spray and betamethasone sodium phosphate mouthrinse: a randomized crossover study for the treatment of symptomatic oral lichen planus. J Am Acad Dermatol. 2002;47:271-279.
  33. Hesen RR, Abuel-Ela HA, Helmy IM, El Sayed MH, Ezzatt OM. Glucosamine as a novel adjunctive therapy in symptomatic oral lichen planus. J Pharm Sci & Res. 2017;9:941-946.
  34. Hettiarachchi PVKS, Hettiarachchi RM, Jayasinghe RD, Sitheeque M. Comparison of topical tacrolimus and clobetasol in the management of symptomatic oral lichen planus: a double-blinded, randomized clinical trial in Sri Lanka. J Investig Clin Dent. 2017;8: https://doi.org/10.1111/jicd.12237.
  35. Kia SJ, Shirazian S, Mansourian A, Fard LK, Ashnagar S. Comparative efficacy of topical Curcumin and triamcinolone for oral lichen planus: a randomized, controlled clinical trial. J Dent Tehran Univ Med Sci 2015;12:789-796.
  36. Laeijendecker R, Tank B, Dekker SK, Neumann HA. A comparison of treatment of oral lichen planus with topical tacrolimus and triamcinolone acetonide ointment. Acta Derm Venereol. 2006;86:227-279.
  37. Liu C, Xie B, Yang Y, et al. Efficacy of intralesional betamethasone for erosive oral lichen planus and evaluation of recurrence: a randomized, controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:584-590.
  38. Malhotra AK, Khaitan BK, Sethuraman G, Sharma VK. Betamethasone oral mini-pulse therapy compared with topical triamcinolone acetonide (0.1%) paste in oral lichen planus: a randomized comparative study. J Am Acad Dermatol. 2008;58:596-602.
  39. Mostafa D, Moussa E, Alnouaem M. Evaluation of photodynamic therapy in treatment of oral erosive lichen planus in comparison with topically applied corticosteroids. Photodiagnosis Photodyn Ther. 2017;19:56-66.
  40. Mousavi F, Sherafati S, Mojaver YN. Ignatia in the treatment of oral lichen planus. Homeopathy. 2009;98:40-44.
  41. Nolan A, Badminton J, Maguire J, Seymour RA. The efficacy of topical hyaluronic acid in the management of oral lichen planus. J Oral Pathol Med. 2009;38:299-303.
  42. Pakfetrat A, Delavarian Z, Falaki F, Khorashadizadeh M, Saba M. The effect of pimecrolimus cream 1% compared with triamcinolone acetonide paste in treatment of atrophic-erosive oral lichen planus. Iran J Otorhinolaryngol. 2015;27:119-126.
  43. Passeron T, Lacour JP, Fontas E, Ortonne JP. Treatment of oral erosive lichen planus with 1% pimecrolimus cream: a double-blind, randomized, prospective trial with measurement of pimecrolimus levels in the blood. Arch Dermatol. 2007;143:472-476.
  44. Rödström P-O, Hakeberg M, Jontell M, Nordin P. Erosive oral lichen planus treated with clobetasol propionate and triamcinolone acetonide in Orabase: a double-blind clinical trial. J Dermatol Treat 1994;5:7-10.
  45. Salazar-Sánchez N, López-Jornet P, Camacho-Alonso F, Sánchez-Siles M. Efficacy of topical Aloe vera in patients with oral lichen planus: a randomized double-blind study. J Oral Pathol Med. 2010;39:735-740.
  46. Shetty RR, Burde KN, Guttal KS. The efficacy of topical hyaluronic acid 0.2% in the management of symptomatic oral Lichen Planus. J Clin Diagn Res. 2016;10:46-50.
  47. 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.
  48. Sivaraman S, Santham K, Nelson A, Laliytha B, Azhalvel P, Deepak JH. A randomized triple-blind clinical trial to compare the e@ectiveness of topical triamcinolone acetonate (0.1%), clobetasol propionate (0.05%), and tacrolimus Orabase (0.03%) in the management of oral lichen planus. J Pharm Bioallied Sci 2016;8(Suppl 1):S86-89.
  49. Swift JC, Rees TD, Plemons JM, Hallmon WW, Wright JC. The effectiveness of 1% pimecrolimus cream in the treatment of oral erosive lichen planus. J Periodontol. 2005;76:627-635.
  50. Thomas AE, Varma B, Kurup S, et al. Evaluation of efficacy of 1% curcuminoids as local application in management of oral lichen planus - interventional study. J Clin Diagn Res 2017;11:89-93.
  51. Vathanasanti A, Kanchanabuch P. Fluocinolone acetonide 0.01% and dexamethasone 0.1% mouthwash in the treatment of symptomatic oral Lichen Planus. Adv Dent Oral. Health 2017;3:555611. https://doi.org/10.19080/ADOH.2017.03.555611.
  52. Velez I, Spielholz NI, Siegel MA, Gonzalez T. MuGard, an oral mucoadhesive hydrogel, reduces the signs and symptoms of oral mucositis in patients with lichen planus: a double-blind, randomized, placebo-controlled pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118(657-64):e2.
  53. Volz T, Caroli U, Lüdtke H, et al. Pimecrolimus cream 1% in erosive oral lichen planus-a prospective randomized double-blind vehicle-controlled study. Br J Dermatol. 2008;159:936-941.
  54. Voûte AB, Schulten EA, Langendijk PN, Kostense PJ. van der Waal I. Fluocinonide in an adhesive base for treatment of oral lichen planus. A double-blind, placebo-controlled clinical study. Oral Surg Oral Med Oral Pathol. 1993;75:181-185.
  55. Wei X, Li BQ, Zhou XD, Chen QM. Clinical effect of mycostatin paste plus dexamethasone paste in treatment of patients with OLP. Journal of Clinical Stomatology 2003;19:568-569.
  56. Xiong C, Li Q, Lin M, et al. The efficacy of topical intralesional BCG-PSN injection in the treatment of erosive oral lichen planus: a randomized controlled trial. J Oral Pathol Med 2009;38:551-558.
  57. Xu YZ, Geng Y, Liu YX, Fuan YQ, Li J. Clinical study on three step treatment of oral lichen planus by integrated traditional and western medicine. J Modern Stomatol 2002;16:344-346.
  58. Yoke PC, Tin GB, Kim M-J,, et al. A randomized controlled trial to compare steroid with cyclosporine for the topical treatment of oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:47-55.
  59. Bakhshi M, Gholami S, Mahboubi A, Jaafari MR, Namdari M. Combination therapy with 1% nanocurcumin gel and 0.1% triamcinolone acetonide mouth rinse for oral lichen planus: a randomized double-blind placebo controlled clinical trial. Dermatol Res Pract. 2020;2020:1-7.
  60. Nazeer J, Singh S, Jayam C, Singh R, Iqubal MA, Singh R. Assessment of the role of vitamin D in the treatment of oral lichen planus. J Contemp Dent Pract. 2020;21:390-395.
  61. Qataya PO, Elsayed NM, Elguindy NM, Ahmed Hafiz M, Samy WM. Selenium: A sole treatment for erosive oral lichen planus (randomized controlled clinical trial). Oral Dis. 2020;26:789-804.
  62. Razi A, Mohiuddin S, Abdulkarim A, Iqbal A. Vitamin D as an adjuvant therapy to cure oral lichen planus in peri-menopausal women. Pak. Oral and Dent. J 2018;38:399-403.
  63. Sadeghian R, Rohani B, Golestannejad Z, Sadeghian S, Mirzaee S. Comparison of therapeutic effect of mucoadhesive nano-triamcinolone gel and conventional triamcinolone gel on oral lichen planus. Dent Res J (Isfahan). 2019;16:277-282.
  64. Samiee N, Taghavi Zenuz A, Mehdipour M, Shokri J. Treatment of oral lichen planus with mucoadhesive mycophenolate mofetil patch: a randomized clinical trial. Clin Exp Dent Res. 2020;6:506-511. https://doi.org/10.1002/cre2.302.
  65. Suvarna C, Chaitanya NC, Ameer S, et al. A comparative evaluation on the effect of oral zinc 50 mg with or without 0.1% triamcinolone orabase on oral lichen planus. Int J Appl Basic Med Res. 2020;10:54-58.
  66. Veneri F, Bardellini E, Amadori F, Conti G, Majorana A. Efficacy of ozonized water for the treatment of erosive oral lichen planus: a randomized controlled study. Med Oral Patol Oral Cir Bucal. 2020;25:e675-e682.
  67. Villa A, Sankar V, Bassani G, Johnson LB, Sroussi H. Dexamethasone solution and dexamethasone in Mucolox for the treatment of oral lichen planus: a preliminary study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020;129:585-590.
  68. Ioannides D, Vakirlis E, Kemeny L, et al. European S1 guidelines on the management of lichen planus: a cooperation of the European Dermatology Forum with the European Academy of Dermatology and Venereology. J Eur Acad Dermatol Venereol. 2020;34:1403-1414.
  69. Billich A, Aschauer H, Aszódi A, Stuetz A. Percutaneous absorption of drugs used in atopic eczema: pimecrolimus permeates less through skin than corticosteroids and tacrolimus. Int J Pharm. 2004;269:29-35.

MeSH Term

Administration, Topical
Adrenal Cortex Hormones
Calcineurin Inhibitors
Humans
Lichen Planus, Oral
Network Meta-Analysis
Randomized Controlled Trials as Topic

Chemicals

Adrenal Cortex Hormones
Calcineurin Inhibitors
Journal Article Meta-Analysis Systematic Review
Article has an altmetric score of 5

Word Cloud

Created with Highcharts 10.0.0OR:95%CI:1clinical2trialsorallichenresolution48Corticosteroidsinterventionsplanuspain67183placebotreatingnetworkmeta-analysisrandomizedpatientsscoreadverseeffects13pimecrolimus5ozonizedwater/corticosteroidsratescompared9significantlyassociatedcyclosporinecorticosteroidsBACKGROUND:calcineurininhibitorsvitaminDphotodynamictherapyherbaldrugstriedcarriedpresentcompareabove-mentionedMETHODS:ElectronicdatabasessearchedevaluatingsymptomaticClinicaloutcomesevaluatedRESULTS:Fifty-five2831included15514125purslane97521882better4336aloevera95%:111177hyaluronicacid24457superiorPimecrolimushigherriskCONCLUSION:TopicaleffectivedrugclassInterventionsplanus:systematicreviewBetamethasonedexamethasonetacrolimustriamcinolone

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