Oral lichen treatment options

Name: Oral lichen treatment options | Dermatology Games
Published: 2020-09-27T15:32:19+00:00

Dermatology Games

4 years ago

Oral lichen treatment

Oral mucosal lesions (OLP) occur in 50–70 % of the patients with LP.
Regular clinical follow up is advised because patients with oral lichen planus (OLP) are at increased risk for cancer, especially squamous cell carcinoma (SCC).
Oral lichen planus occurs without cutaneous disease in 23% of LP patients and commonly follows a chronic course.
It is more common in females than males.
Patients with oral LP should be questioned about symptoms related to esophageal involvement and examined for other mucosal lesions, particularly genital lesions, and vice versa, because ~70% of patients with mucosal vulvovaginal LP have clinical signs of oral LP.
Good oral hygiene and dental care are recommended.
Patient should be advised to avoid spicy foods, tobacco, alcohol and acidic drinks.
Candida infection was found in 17% to 25% of ulcerated and nonulcerated cases, consider antifungals.
If the patient is hepatitis C virus positive, immunosuppressive treatments should be avoided to prevent hepatocarcinoma to develop.
The treatment is mainly asymptomatic, asymptomatic lesions may not be treated.
Local anesthetics may be used to reduce the pain : lidocaine 2% gel

Mild to moderate cases
- Topical corticosteroids:
  - Clobetasol propionate 0.05% ointment three times daily with a gloved finger on erosive lesions.
    - Orabase formulation may be used.
    - Avoid drinking or eating for an hour after the application.
- Fluticasone propionate spray (50mcg per puff), directed to affected areas up to 3-4 times daily.
- Beclometasone spray (100mcg per puff), sprayed 3-4 times daily on affected sites.
- Betamethasone propionate 0.05% gel or ointment
- Dexamethasone: 5 mL [0.5 mg/5 mL] used as a mouth wash up to six times daily.
- Prednisolone tablet 5 mg dissolved in 15 mL water used as a mouthwash swish three times daily.

For severe cases
- Oral corticosteroids: Prednisolone: 0.5-1 mg/kg/day until remission then slow tapering the dose.

Topical retinoids alone or used with topical corticosteroids (For plaque type)
- Retinoic 0.05% acid.
- Isotretinoin 0.1 % gel.
- Tazarotene gel.

Oral corticosteroids : (For erosive lichen with no improvement on topical treatment)
- 1 mg/kg/day until remission ( about 4-6 weeks).
Intralesional corticosteroids:
- Triamcinolone acetonide: 0.5 mL of ( 40 mg/mL).
- Triamcinolone acetonide: 8 mg weekly for 2 wks.
- Betamethasone: 1.4 mg weekly for 2 wks.
- Methylprednisolone acetate (Depo-Medrol 40 mg/mL): 0.5 to 1.0 mL.

Topical calcineurin inhibitors
- Tacrolimus 0.1% oint: (4 times daily)
  - use for a limited duration(potential risk of cancer)
  - Burning sensation is the commonest side effect.
- Pimecrolimus (Elidel cream):2 times daily.
- Cyclosporin:5 mL of a 100 mg/mL solution as mouthwash twice daily.
Aloe Vera Gel and Juice.
Dapsone : 50 to 150 mg/day.
- Screening for G6PD deficiency is required.

Hydroxychloroquine sulfate (Plaquenil): 200 to 400 mg daily, is useful for oral LP. Erosions require 3 to 6 months of treatment before they resolve.
Mycophenolate mofetil : 1000 -2000 mg/day, effective in case of oral erosive lichen planus.
Azathioprine: 50–100 mg/day) may be used in erosive OLP with chronic active hepatitis.
Methotrexate: 2.5 to 15 mg a week.
Curcuminoids : 6000 mg/day in three divided doses.

http ://www.exodontia.info
Griffiths, C., Barker, J., Bleiker, T. O., Chalmers, R., & Creamer, D. (Eds.). (2016). Rook’s textbook of dermatology. John Wiley & Sons.‏
Dermatology , Edited by Jean L. Bolognia , Julie V. Schaffer , Lorenzo Cerroni Fourth edition: Elsevier, 2018, ISBN 978–0‐7020–6275–9
Braz. J. Pharm. Sci. vol.56 São Paulo 2020 Epub Apr 06, 2020.