Photobiomodulation versus corticosteroid in the management of erosive oral lichen planus: a randomized controlled clinical trial.

BACKGROUND: Oral lichen planus (OLP) is a chronic illness of immune origin that is typically treated with corticosteroids as a gold standard therapy. Photobiomodulation (PBM) may represent an alternative remedy that has the potential to treat a variety of pathological conditions by alleviating pain, reducing inflammation, and promoting tissue healing without the drawbacks of steroid therapies. Thus, the aim of the current study was to compare the effect of photobiomodulation to topical 0.1% triamcinolone acetonide on erosive oral lichen planus. METHODS: This randomized controlled clinical trial involved 44 patients complaining of erosive oral lichen planus. Patients were assigned to one of two groups: control group (n = 22) received 0.1% topical triamcinolone acetonide three times daily with miconazole oral gel once daily for 4 weeks, and photobiomodulation group (n = 22) received laser therapy by 980 nm diode laser utilizing output power 300 mW twice weekly for 5 weeks (a total of 10 sessions). The evaluation of patients was performed at baseline, 6 weeks, and 12 weeks postoperatively in terms of pain, clinical scores, and biochemical evaluation of salivary malondialdehyde levels. All recorded data were analyzed using Mann-Whitney test to compare the two studied groups regarding pain, lesion size, and salivary levels of malondialdehyde. Friedman test, followed by post hoc test, was used for comparison of the data within the same group along the 3 periods at baseline, 6 weeks, and 12 weeks. RESULTS: Both groups showed significant improvement in pain and clinical scores, with no statistical difference between them. Moreover, there was a significant improvement in salivary malondialdehyde levels for both groups, with no significant difference between them. CONCLUSIONS: Photobiomodulation could be a promising therapeutic modality for management of erosive oral lichen planus without the side effects of steroid therapy. The salivary malondialdehyde level could be used as a biomarker to evaluate the disease severity and its response to the treatment. TRIAL REGISTRATION: The study has been registered at ClinicalTrials.gov (NCT05951361) (19/07/2023).

Successful Treatment of Lichen Planus With Oral Upadacitinib.

Lichen planus is an auto-inflammatory skin disorder marked by intensely pruritic, violaceous papules that commonly affect the extremities of middle-aged adults.1 There are several treatment options available, but alternative therapies to target disease refractory to standard interventions remain necessary. Though they have not been FDA-approved for lichen planus, Janus kinase (JAK) inhibitors have demonstrated significant potential as a therapeutic intervention across an array of dermatoses. Herein, we present a case of refractory, biopsy-proven lichen planus successfully treated with the oral JAK1 inhibitor, upadacitinib. J Drugs Dermatol. 2023;22(10):1058-1060     doi:10.36849/JDD.7272.

Emerging potential of phototherapy in management of symptomatic oral lichen planus: A systematic review of randomised controlled clinical trials.

Phototherapy incorporating photobiomodulation therapy and antimicrobial photodynamic therapy has been utilised as antioxidants in symptomatic oral lichen planus (OLP) management; however, its role of intervention remains controversial. The aim of this systematic review of CRD42021227788 PROSPERO (an international prospective register of systematic reviews in health and social care) registration number was to oversee and determine phototherapy efficacy in patients with symptomatic OLP, identifying and bridging the literature gaps by proposing recommendations for future studies. A search strategy was developed in consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Various electronic databases were exercised to search for randomised controlled clinical trials (RCTs). Several search engines were employed to analyse a total of 177 studies of which nine included. A wide range of utilised laser and light-emitted diode wavelengths between 630 and 808 nm and irradiance ranged between 10 and 13 mW/cm2 were noted. 67% of studies reported a high risk of bias and a high heterogeneity obtained from numerical data for quantitative analysis, therefore meta-analysis was impossible to conduct. Despite inconsistency and diversity in phototherapy parameters, treatment protocols, photosensitiser (type, concentration and method of application) and outcome assessment tools, the majority of the studies showed positive results compared with standard care treatments. Hence, a necessity to perform well-designed RCTs with robust methodology is warranted, after acknowledging the current drawbacks and addressing the suggested recommendations highlighted in our review. Moreover, advanced knowledge in understanding further phototherapy-antioxidants molecular mechanistic in symptomatic OLP is required.

Single session of laser photobiomodulation for symptom management of oral lichen planus: a retrospective study.

This study aimed to evaluate the effectiveness of a single session of laser photobiomodulation (PBM) with flat top handpiece in reducing painful symptoms in patients with Oral Lichen Planus (OLP). The clinical charts of 20 patients of the Dental Clinic of University of Padua (Italy) who underwent a single laser PBM to manage OLP symptomatology were retrospectively analyzed. A 980 nm diode laser and a flat top handpiece with a 1-cm2 spot area were employed to perform the PBM with a single session protocol. VAS pain scores were assessed before and after the laser PBM, the day after, and on the 7th and 30th days after the treatment. No adverse effects occurred within 30 days after treatment. The mean VAS-pain score was 3.8 (SD 2.3) before PBM; 2.6 (SD 2.0) after PBM; 1.9 (SD 2.2) on day 1; 2.0 (SD 2.3) on day 7; and 1.5 (SD 2.2) on day 30. VAS pain decreased significantly over time (p < 0.0001). A single session of laser PBM may be safe and effective in reducing pain for symptomatic OLP patients. Further investigations are required to include placebo or topical corticosteroids as comparators.

Is Curcumin a Safe and Effective Therapeutic in the Treatment against Oral Lichen Planus?

Oral lichen planus (OLP) is a chronic mucocutaneous, immunological disease that occurs more frequently in the buccal mucosa of middle-aged female patients. OLP's standard treatment is topical or systemic corticosteroids. Due to corticosteroids' numerous potential side effects, there is an effort to find an alternative treatment. One alternative treatment is curcumin. Several studies have investigated the effectiveness and safety of curcumin in OLP patients. In this review, we summarized the literature focusing on the effectiveness and safety of curcumin in OLP patients. Our review of clinical trials revealed that either 6000 mg/day curcumin, 80 mg/day nano-curcumin, or 1% curcumin oral gel 6 times/day offered benefits in the treatment of OLP.

Plant Extracts and Phytochemicals, a Promising Strategy Against Oral Lichen Planus: A Review on Clinical Trials.

BACKGROUND: Oral lichen planus (OLP) is an autoimmune disease that distress keratinized cells of the oral epithelium. Topical corticosteroids and other potential therapies like immunosuppressives, hydroxychloroquine, azathioprine, mycophenolate, dapsone, retinoids, biologic agents are used for the management of OLP. However, their effectiveness, best dose, duration of treatment and safety remain mostly unidentified. Moreover, recurrence of disease and dose-related side effects are the other issues. OBJECTIVE: The primary objective of the review is to explore the existing clinical trials for the efficacy of phytochemicals in treating OLP in comparison to corticosteroids. A comprehensive information about their mode of action is also discussed. METHODS: We have discussed different clinical trials conducted on various phytochemicals and plant extracts/formulations like curcumin, lycopene, quercetin, glycyrrhizin, purslane, raspberry, aloe vera gel and aloe vera mouthwash for the treatment of OLP. RESULTS: The current therapy for the management of OLP has numerous adverse effects and requires a long-term treatment. Phytochemicals can be a very good alternative in overcoming these side effects and reducing the course of treatment. CONCLUSION: Herbal extracts and their formulations can be an effective alternative to the current therapy due to their proven therapeutic effects, reduced side effects, long-term applicability, prevention of recurrence as well as progression into cancer.

Advancement in therapeutic strategies for immune-mediated oral diseases.

BACKGROUND: Immune-mediated diseases are a diverse group of conditions characterized by alteration of cellular homeostasis and inflammation triggered by dysregulation of the normal immune response. Several immune-mediated diseases exhibit oral signs and symptoms. Traditionally, these conditions are treated with corticosteroids or immunosuppressive agents, including azathioprine, cyclophosphamide, and thalidomide. Recent research into the developmental pathways of these diseases has led to the exploration of novel approaches in treatment. This review examines newer treatment modalities for the management of immune-mediated diseases with oral presentations. Topical calcineurin inhibitors (TCIs) such as tacrolimus and pimecrolimus have been employed successfully in managing oral lichen planus and pemphigus vulgaris. Biologic agents, comprising monoclonal antibodies, fusion proteins, and recombinant cytokines, can provide targeted therapy with fewer adverse effects. Neutraceutical agents comprising aloe vera, curcumin, and honey are commonly used in traditional medicine and offer a holistic approach. They may have a place as adjuvants to current standard therapeutic protocols. Photodynamic therapy (PDT) and low-level laser therapy (LLLT) utilize a specific wavelength of light to achieve desired cellular change. While the use of PDT in immune-mediated diseases is contentious, LLLT has shown positive results. Newer therapeutic modalities involve kinase inhibitors, S1P1 receptor modulators, MSCs, and iRNA providing targeted treatment of specific diseases.

Curcumin and Curcuma longa Extract in the Treatment of 10 Types of Autoimmune Diseases: A Systematic Review and Meta-Analysis of 31 Randomized Controlled Trials.

Objective: To evaluate the randomized controlled trials (RCTs) of Curcumin and Curcuma longa Extract in the treatment of autoimmune diseases. Methods: Databases such as Embase, Web of Science, PubMed and The Cochrane Library were searched from the database establishment to February 2022 to collect RCTs of Curcumin and Curcuma longa Extract in the treatment of autoimmune diseases. Then the literature was screened and the data were extracted. Meta-analysis was performed using RevMan 5.3 software. Results: A total of 34 records were included, involving 31 RCTs and 10 types of autoimmune disease. Among them, ankylosing spondylitis (AS) involves one RCT, Behcet 's disease (BD) involves one RCT, Crohn 's disease involves two RCTs, multiple sclerosis (MS) involves two RCTs, oral lichen planus involves six RCTs, psoriasis involves two RCTs, rheumatoid arthritis (RA) involves five RCTs, systemic lupus erythematosus (SLE) involves two RCTs, arteritis involves one RCT, ulcerative colitis (UC) involves nine RCTs. Among them, most of the RCTs of ulcerative colitis (UC), oral lichen planus, RA showed that curcumin and curcumin extracts improved clinical or laboratory results. Crohn ' s disease, MS, SLE, psoriasis included two RCTs; they all showed improvements (at least one RCT reported improvements in clinical outcomes). AS, BD and arteritis included only one RCT, and the clinical results showed improvement. However, due to the small number of RCTs and the small number of patients involved in each disease, there is still a need for more high-quality RCTs. Conclusion: Curcumin and Curcuma longa Extract had good clinical efficacy in the treatment of Psoriasis, UC and RA, so Curcumin and Curcuma longa Extract could be used in the treatment of the above diseases in the future. The results of Meta-analysis showed that Curcumin and Curcuma longa Extract did not show efficacy in the treatment of oral lichen planus, while Takayasu arteritis, SLE, MS, AS, BD and CD did not report sufficient clinical data for meta-analysis. Therefore, large-sample, multi-center clinical trials are still needed for revision or validation.

Efficacy of Spirulina 500 mg vs Triamcinolone Acetonide 0.1% for the Treatment of Oral Lichen Planus: A Randomized Clinical Trial.

AIM: The present study aimed at evaluating the efficacy of spirulina 500 mg in reducing the burning sensation and lesion size in oral lichen planus (OLP). MATERIALS AND METHODS: A total of 60 subjects who attended the oral medicine specialty clinic with histopathologically confirmed OLP and having symptoms of burning sensation were recruited for the study. They were randomly divided into two groups: group A (30) subjects were prescribed Spirulina 500 mg twice daily along with only a week application of topical triamcinolone acetonide 0.1% thrice daily; group B subjects were prescribed topical triamcinolone acetonide 0.1% alone thrice daily for 8 weeks. Both the groups were followed up posttreatment monthly for three consecutive months. RESULTS: Data were recorded, and statistical analysis by using ANOVA one-way test, and Chi-square test were performed, which showed statistically significant p-value (<0.005) for the parameters "burning sensation" and "size of the lesion". When compared between groups, group A showed a favorable outcome of the intervention. CONCLUSION: Spirulina 500 mg supplementation twice daily could be effective adjunct therapy with steroids to treat OLP. CLINICAL SIGNIFICANCE: This research allowed us to delve into spirulina as one of the treatment modalities for OLP. Further studies are needed as it is a rich source of proteins and vitamins and demonstrates potent anti-inflammatory, immunomodulatory, and antioxidant actions.

Experimental and clinical trial investigations of phyto-extracts, phyto-chemicals and phyto-formulations against oral lichen planus: A systematic review.

ETHNOPHARMACOLOGICAL RELEVANCE: Bio-assay guided phytoextracts and derived phytoconstituents reported having multipotent biological activities and nearly 60-80% of the global population still using natural regimens as an alternative therapeutic source. This study focused on the ethnopharmacological and experimental evidence of natural remedies that are effective in treating oral lichen planus (OLP), a chronic T-cell mediated autoimmune disease that is associated with oral cancer transmission. AIM OF THE REVIEW: A number of studies have shown that antioxidants and antiinflammatory phytoextracts and phyto-constituents are effective against OLP. In this systematic review, we summarize the details of experimentally assessed ancient Traditional Chinese Medicine (TCM), Indian Ayurveda or Ayurvedic Medicine, and Japanese Kampo Medicine (JKM) regimens (crude extracts, individual phytochemicals, and phyto-formulations) that reduce oral lesion, severity index and pain associated with OLP based on studies conducted in vivo, in vitro, and in randomized controlled trials (RCTs). MATERIALS AND METHODS: Experimental, clinical and RCT investigation reports were gathered and presented according to PRISMA-2020 format. Briefly, the information was obtained from PubMed, ScienceDirect, Wiley journal library, Scopus, Google Scholar with ClinicalTrials.gov (a clinical trial registry database operated by the National Library of Medicine in the United States). Further, individual phytochemical structures were verified from PubChem and ChemSpider databases and visualized by ChemDraw 18.0 software. RESULTS: We summarized 11 crude phytoextracts, 7 individual phytochemicals, 9 crude formulations, 8 specific TCM and JKM herbal cocktails, and 6 RCTs/patents corroborated by multiple in vitro, in vivo and enzyme assay methods. Briefly, plants and their family name, used plant parts, reported phytochemicals and their chemical structure, treatment doses, and duration of each experiment were presented more concisely and scientifically. CONCLUSION: Documentation of evidence-based natural ethnomedicines or remedies could be useful for promoting them as potential, cost-effective and less toxic alternatives or as complementary to commonly prescribed steroids towards the control of OLP.

Oral lichen planus: comparative efficacy and treatment costs-a systematic review.

OBJECTIVE: To compare the reported efficacy and costs of available interventions used for the management of oral lichen planus (OLP). MATERIALS AND METHODS: A systematic literature search was performed from database inception until March 2021 in MEDLINE via PubMed and the Cochrane library following PRISMA guidelines. Only randomized controlled trials (RCT) comparing an active intervention with placebo or different active interventions for OLP management were considered. RESULTS: Seventy (70) RCTs were included. The majority of evidence suggested efficacy of topical steroids (dexamethasone, clobetasol, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus, cyclosporine), topical retinoids, intra-lesional triamcinolone, aloe-vera gel, photodynamic therapy, and low-level laser therapies for OLP management. Based on the estimated cost per month and evidence for efficacy and side-effects, topical steroids (fluocinonide > dexamethasone > clobetasol > triamcinolone) appear to be more cost-effective than topical calcineurin inhibitors (tacrolimus > pimecrolimus > cyclosporine) followed by intra-lesional triamcinolone. CONCLUSION: Of common treatment regimens for OLP, topical steroids appear to be the most economical and efficacious option followed by topical calcineurin inhibitors. Large-scale multi-modality, prospective trials in which head-to-head comparisons interventions are compared are required to definitely assess the cost-effectiveness of OLP treatments.

Mechanism of Huashi Xingyu Qingre recipe in treating oral lichen planus based on network pharmacology and clinical trial verification.

OBJECTIVE: To identify the main active components and targets of Huashi Xingyu Qingre recipe (, HXQR) and to investigate its mechanism in the treatment of oral lichen planus (OLP). METHODS: The Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform was searched to identify the active ingredients and corresponding targets of HXQR. Disease genes were obtained from the GeneCards database, and a "drug-disease regulatory network" was constructed using Cytoscape software and PERL programming language. The STRING database was used to build a protein-protein interaction network. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) terms were analyzed using R software with a Bioconducter plugin. Finally, the results and the efficacy of HXQR in treating OLP were validated in a clinical trial that included enzyme-linked immunosorbent assay (ELISA) testing and observations of the post-treatment changes in clinical symptoms. RESULTS: HXQR contained 167 active components and 261 targets, with 391 disease targets. The intersection of these two categories in a Venn diagram revealed 57 drug-disease common targets. A compound-target network was constructed and revealed that the six key pharmaceutical ingredients of HXQR were quercetin, luteolin, wogonin, kaempferol, beta-carotene, and baicalein. The protein-protein interaction network mainly involved core proteins such as ALB, interleukin-6, and AKT1. Drug-disease common targets were enriched in 1628 GO terms and 117 KEGG terms, mainly involving inflammatory responses, viral infections, and tumor-related pathways. ELISA testing indicated that HXQR inhibited the tumor necrosis factor (TNF) signaling pathway by reducing the expression of interleukin-6, matrix metalloproteinase-9, and intercellular adhesion molecule-1. The clinical symptoms of the patients with OLP were significantly improved after 8 weeks of treatment with HXQR. CONCLUSION: HXQR treats OLP by regulating the TNF signaling pathway, resulting in a marked treatment effect with few adverse effects.

The efficacy of henna (Lawsonia inermis L.) mouthwash versus chlorhexidine gluconate 0.2% mouthwash as adjuvant therapy of oral lichen planus: A randomized double-blind clinical trial.

ETHNOPHARMACOLOGICAL RELEVANCE: In modern medicine, some traditional remedies are introduced to be effective in treatment. Accordingly, the henna plant (Lawsonia inermis L.) is studied more than before. Previous studies have shown many medical properties for henna, such as anti-inflammatory and anti-fungal properties. AIM OF THE STUDY: Oral lichen planus (OLP) is a common mucocutaneous disease with chronic immunomodulatory disruptions. Topical corticosteroids are the first line of OLP treatment. Previous studies have suggested different adjunctive therapies for preventing the side effects of corticosteroids overuse. This study aimed to compare the effects of henna and chlorhexidine mouthwashes as adjunctive therapy. MATERIALS AND METHODS: This parallel-group, double-blind, randomized controlled study was conducted on forty OLP patients. Luteolin content was determined in Henna mouthwash composed of 2% aqueous extract of henna, 2% ethanol, 10% glycerol, and 0.1% methylparaben distilled water. Henna or chlorhexidine mouthwashes were prescribed twice daily as an adjuvant to the topical corticosteroid treatment. Visual analog scale (VAS) index and Thongprasom rating were used to measure pain intensity and clinical signs of patients at days 0,7, and 14. The collected data were analyzed using SPSS software (version 26.0; SPSS). Ordinal logistic regression was used to investigate the effect of independent variables on Thongprasom and VAS scores. RESULTS: In this clinical trial, 82.6% of the participants were women. There was no difference between the two study groups in terms of VAS scores (p = 0.404) and clinical features (p = 0.305) in the second follow-up visit. All drug regimens caused clinical signs and symptoms relief. CONCLUSIONS: There was no significant difference between the groups receiving topical corticosteroid supplementation, neither henna mouthwash nor chlorhexidine mouthwash. The therapeutic effects of henna mouthwash in the main or adjuvant treatment of OLP need more evaluation in future research. Henna mouthwash can be a good alternative to chlorhexidine mouthwash if no side effects are reported.

Reveals of quercetin's therapeutic effects on oral lichen planus based on network pharmacology approach and experimental validation.

Oral lichen planus (OLP) is a localized autoimmune disease of the oral mucosa, with an incidence of up to 2%. Although corticosteroids are the first-line treatment, they cause several adverse effects. Quercetin, a naturally occurring compound, has fewer side-effects and provides long-term benefits. Besides, it has powerful anti­inflammatory activities. Here, we combined network pharmacology with experimental verification to predict and verify the key targets of quercetin against OLP. First, 66 quercetin-OLP common targets were analyzed from various databases. The protein-protein interaction (PPI) network was constructed. Topology analysis and MCODE cluster analysis of common targets were conducted to identify 12 key targets including TP53, IL-6 and IFN-γ and their connections. Gene functions and key signaling pathways, including reactive oxygen species metabolism, IL-17 pathway and AGE-RAGE pathway, were enriched by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Then, in vitro experiments showed that quercetin interfered with Th1/Th2 balance by acting on IL-6 and IFN-γ to modulate the immune system in treating OLP. Quercetin considerably affected the apoptosis and migration of T lymphocytes in OLP patients. Our study reveals the potential therapeutic targets and signaling pathways of quercetin associated with OLP, and establishes the groundwork for future clinical applications.

Comparative efficacy of topical aloe vera and low-level laser therapy in the management of oral lichen planus: a randomized clinical trial.

This randomized clinical trial aimed to compare the efficacy of topical aloe vera with low-level laser therapy in patients with oral lichen planus (OLP). A randomized, parallel arm, single-blind study comprising of 60 patients with OLP was randomly divided into two groups. Group A was given topical aloe vera extract gel applied thrice daily for 2 months, and group B was given low-level laser therapy (LLLT) at 980 nm twice weekly for 2 months. Both groups were followed up for 9 months. Patients were assessed for various parameters according to the Escudier scale at baseline, after treatment at 9 months. Results were assessed using the McNemar-Bowker test and the Mann-Whitney U test. Both individual groups showed significant (p < 0.05) results at the end of the treatment period (0-2 months) and the follow-up period (2-7 months). Intergroup comparison showed significant results in the laser group (reduction of VAS by 44.1%, site score by 24.6%, and activity score by 50%) as compared with the aloe vera group (reduction of VAS by 26.7%, site score by 9.2%, and the activity score by 26%) in the treatment period. In the follow-up period, both groups showed insignificant differences in comparison to each other. Within the limitations of the study, LLLT was more effective as compared with topical aloe vera in managing oral lichen planus during the active treatment time, while both were equally effective during the follow-up period. The clinical study was registered under the Clinical Trials Registry India with the registration number CTRI/2018/04/013147.

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

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.

Photobiomodulation Therapy/Photodynamic Therapy Versus Steroid Therapy for Oral Lichen Planus: A Systematic Review and Meta-Analysis.

Objective: To evaluate the efficiency of photobiomodulation therapy (PBMT) or photodynamic therapy (PDT) in treating oral lichen planus (OLP) as well as identifiy the side effects when compared with steroid therapy. Background: Nowadays, PBMT and PDT are increasingly applied for treating OLP with minimal adverse effects. Methods: The electronic databases of PubMed, Cochrane Central Register of Controlled Trial, Web of Science, and Embase were searched until March 13, 2020. Randomized controlled trials (RCTs) with 1 month of follow-up period were selected. Two reviewers extracted data from selected studies independently. Cochrane collaboration's tool for assessing risk of bias was used for assessing the quality of the RCTs. The random-effects model was employed for meta-analysis. Results: One thousand fifteen studies were initially identified. Finally, nine RCTs were included for quality assessment and seven studies for meta-analysis. Four RCTs were of unclear risk of bias and five were assessed as high risk of bias. The comparison showed no significant differences for pain scores [visual analog scale (VAS)] [mean differences (MD) = 0.38, confidence interval (CI) = 95% -0.64 to 1.40] and severity scores (reticular-atrophic-erosive scores) (MD = 1.67, CI = 95% -1.13 to 4.46) between topical corticosteroid therapy and PBMT after 1 month. For PDT, no significant differences were observed for sign scores (Thongprasm sign scoring) (MD = -0.31, CI = 95% -1.52 to 0.91) and pain scores (VAS) (MD = -2.30, CI = 95% -5.88 to 1.28) of the lesions when compared with topical corticosteroid therapy after 1 month of follow-up period. One study reported the discomfort of the affected area in patients of the PDT group when probe tip was moved. Conclusions: PBMT and PDT could be reliable alternatives to topical corticosteroids for OLP with no or less severe complications in a short-term period. However, further well-designed RCTs with long-term period are recommended to consolidate the conclusions in this regard.

Efficacy and safety of traditional Chinese medicine for erosive oral lichen planus: A protocol for systematic review and meta analysis.

BACKGROUND: Oral lichen planus (OLP) is a common disease among oral mucous membrane diseases. Erosive oral lichen planus (EOLP) is a type of OLP, it has a potential tendency of cancerization. There have been some randomized controlled trials (RCTs) using Traditional Chinese Medicine (TCM) to treat EOLP. No systematic review on the RCTs of TCM for EOLP has been reported, so we would propose a study protocol that aims to evaluate the evidence the efficacy and safety of TCM for treating patients with EOLP. METHODS: The following databases from the inception to June 30, 2020 electronically, including PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, VIP, Wanfang database, China Biomedical Literature Database will be searched. RCTs that meet the pre-specified eligibility criteria will be included. RevMan software (V5.3) will be performed data synthesis following data extraction and publication risk assessment. Subgroup and sensitivity analysis will be performed according to the condition of included RCTs. The primary outcomes include visual analogy scale, laboratory immune indicators, and scores of oral lesions and signs. Additional outcomes are clinical effective rate, adverse event rate, and recurrence rate. The Grading of Recommendations Assessment, Development and Evaluation system will be used to assess the strength of the evidence. RESULTS: This study will provide a well-reported synthesis of RCTs on the efficacy and safety of TCM in the treatment of EOLP. CONCLUSION: This systematic review protocol will be helpful for providing evidence of whether TCM is an effective and safe therapeutic approach for patients with EOLP. ETHICS AND DISSEMINATION: Ethical approval is not necessary as this protocol is only for systematic review and it does not involve privacy data or conduct an animal experiment. This protocol will be disseminated by a peer-review journal or conference presentation. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020172366.

Comparison of oral Nano-Curcumin with oral prednisolone on oral lichen planus: a randomized double-blinded clinical trial.

BACKGROUND: Oral lichen planus (OLP) is a mucocutaneous autoimmune disease with T-cell mediation. Corticosteroids are considered as a first choice in OLP and should be used for a long period with a subsequent increase in dose since the disease has a chronic and recalcitrant nature. There have been efforts to use alternative therapies due to the Corticosteroid's side effects. Curcumin is a non-toxic natural product with different effects on various oral diseases. It demonstrates antioxidant, anti-inflammatory, antimicrobial, and anticarcinogenic activities. It seems that Curcumin can be used as a proper alternative for Corticosteroid treatments. To overcome limitations in the bioavailability of Curcumin, the therapeutic effect of oral Nano-Curcumin was evaluated for the first time. METHODS: Sixty OLP patients were included in this double-blinded randomized clinical trial. The patients were randomly divided into two groups and received either 'Nano-Curcumin 80 mg' or 'Prednisolone 10 mg' treatments for 1 month. The patients should take one capsule after having their breakfast. The VAS scale was used to analyze pain severity and burning sensation. To assess lesion size the Thongprasom scale was employed. Repeated measures and independent t-tests, as well as LSD paired-test, were used to analyze the data. RESULTS: Data from 57 patients were analyzed. The level of pain, burning sensation, and OLP lesions decreased in both groups of Curcumin and Prednisolone and no statistically significant difference was observed between the two groups. CONCLUSION: Despite many studies conducted to find an effective approach for managing OLP, the results have often been unsatisfactory. In comparison with previous studies, current results clarify the importance of Nano-Curcumin bioavailability in therapeutic effects. Pain VAS and lesion size were decreased with oral Curcumin. The results have shown that oral Curcumin can be used as an alternative therapy for OLP in patients with the contraindicated Corticosteroids or should be used with caution. Oral Curcumin can be used in preventing the recurrence of OLP lesions after the treatment and initial control. Moreover, the amount of Curcumin dose is more important than its use duration in improving OLP. TRIAL REGISTRATION: IRCT, IRCT20100101002950N5. Registered 9 February 2019, https://www.irct.ir/trial/36704 .

In silico evaluation of drugs used in treatment of oral lichen planus.

BACKGROUND: Oral lichen planus (OLP) is a chronic T cell-mediated, immunological, mucocutaneous disease with a number of genes and inflammatory mediators implicated in its pathogenesis. Heart shock protein 70 and the proinflammatory mediator TNFα have been predominantly involved in the etiopathogenesis of oral lichen planus. METHODS: In this study, the action of 27 commonly used drugs for treating OLP at HSP70 and TNFα were evaluated by molecular docking using Maestro Schrodinger version 10.1. X-ray crystallographic structures of the target proteins, that is, Heat Shock Protein 70 (PDB Code: 6FDT) and tumor necrosis factor alpha-1 (PDB Code: 1TNF) were obtained from Protein Data Bank (PDB). The structures of the ligands (27 drugs) were obtained from PubChem in.sdf format. Using Ligprep, pre-processing of the ligands was done. Extra-precision docking was performed with the prepared protein and the ligands. RESULTS: With respect to HSP70, the highest dock score (-4.768) and glide score (-4.818) were seen with hydroxychloroquine (HCQ), followed by epigallocatechin gallate (green tea), methotrexate, and curcumin. The highest dock (-9.525) and glide score (-9.584) in TNFα were seen in with epigallocatechin gallate, followed by HCQ, dapsone, and methotrexate. CONCLUSION: The results of the study tend to explain the clinical use of HCQ in recalcitrant and severe cases, as well as the anti-inflammatory property of epigallocatechin gallate. The results of the study open ventures for exploring the in silico behavior of drugs for effective pathological management.