Title

No Clear Best Treatment for Oral Lichen Planus

Clinical Question

Which intervention is the best for the treatment of Oral Lichen Planus?

Clinical Bottom Line

No specific intervention for oral lichen planus is proven more beneficial than another intervention.

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
16086745	Zakrewska/2005	223 Symptomatic Oral Lichen Planus confirmed by histopathology analysis.	Systematic Review
Key results	There is lack of strong evidence to show effectiveness of topical Ciclosporin, topical/systemic retinoids, phototherapy, and topical steroids in treating oral lichen planus (OLP).
21735381	Thongprasom/2011	patients with Oral Lichen Planus	Systematic review with meta analysis
Key results	This review found no research evidence to show that one type of steroid is better or worse than another. There is no evidence that a group of treatments called calcineurin inhibitors (e.g., pimecrolimus) are more effective than placebo. There is weak evidence to show that cylcosporins may be effective in reducing pain of OLP. Aloe vera may reduce pain and clinical signs of OLP. Possible side effects of steroids treatments is candidiasis.
21330164	Gorsky/2011	Not known	Systematic Review
Key results	The authors cautioned that OLP therapy may influence viral reactivation and malignant transformation.

Evidence Search

(interventions[All Fields] AND ("lichen planus"[MeSH Terms] OR ("lichen"[All Fields] AND "planus"[All Fields]) OR "lichen planus"[All Fields])) AND ("humans"[MeSH Terms] AND (Meta-Analysis[ptyp] OR Randomized Controlled Trial[ptyp]) AND English[lang])

Comments on
The Evidence

Oral lichen planus (OLP) is an immunological disorder and in rare cases develops malignant transformation. Topical steroids and immunosuppressant/immunomodulator drugs are usually used to treat the symptomatic OLP pain. There is still a lack of strong evidence supporting the effectiveness of any specific palliative treatment for symptomatic OLP based on a recent systematic review. The quality of the evidence is weak due to a lack of well controlled high quality trials, missing placebo group in trails, small size of the trials, and lack of uniform outcome measures to assess treatment efficacy. It is difficult to compare the effectiveness of drugs within and between individual patients and different institutions. There is a need to standardize the methodology of OLP intervention trails mainly in relation to the assessment used for determining pain. The adverse effects should be carefully documented. Long-term evaluation may be warranted since OLP may present a risk of transformation.

Applicability

Topical steroid treatment is considered by many to be the first line treatment for OLP. However, systemic reviews indicate that the steroid efficacy studies are often lacking placebo. There is no evidence to show that any specific steroid drugs or immunosuppressant/immunomodulator treatment is superior to other drugs/therapies.

Specialty

(Oral Medicine/Pathology/Radiology) (General Dentistry)

Keywords

Lichen Planus, Interventions, steroid therapy

ID#

2091

Date of submission

10/07/2011

E-mail

mullanes@livemail.uthscsa.edu

Author

Shane Mullane

Co-author(s)

Co-author(s) e-mail

Faculty mentor

Chih-ko Yeh, BDS, PhD

Faculty mentor e-mail

YEH@uthscsa.edu

Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)

None available

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

by Alex Dougherty, Chelsea Reid (San Antonio, TX) on 11/28/2017
A PubMed search was completed in November 2017 to search for new research related to this CAT. A systematic review was recently published (Akram 2017, PMID 28766756) that concluded that there is not yet enough evidence to conclude that low-level laser therapy or corticosteroid therapy is more effective in treating OLP, and the authors recommended further RCTs. This review agreed with the CAT's previously published answer to the clinical question. However, there have been RCTs (Chauhan 2017, PMID 29124831; Gonzalez-Moles 2017, PMID 29121431) and case studies (Derikvand 2017, PMID 29123636) published since the most recently published systematic review that may influence the answer to the clinical question and be included in future systematic reviews. A systematic review from 2012 (Lodi, PMID 22242640) also found no evidence suggesting any one treatment was more effective at managing symptoms of OLP.