Topical clobetasol treatment for oral lichen planus can cause adrenal insufficiency.

OBJECTIVE: Glucocorticoids suppress the hypothalamic-pituitary-adrenal axis, which may lead to glucocorticoid-induced adrenal insufficiency. The study aimed to investigate the prevalence of this state in patients with oral lichen planus treated with topical clobetasol propionate. METHODS: In this cross-sectional study, 30 patients with oral lichen planus receiving long-term (>6 weeks) clobetasol propionate gel 0.025% were invited to participate. Adrenal function was assessed by measuring morning plasma cortisol after a 48-h withdrawal of clobetasol treatment. In patients with plasma cortisol <280 nmol/L, a cosyntropin stimulation test was performed. RESULTS: Twenty-seven patients were included. Twenty-one (78%) patients presented with plasma cortisol ≥280 nmol/L (range 280-570 nmol/L), and six (22%) <280 nmol/L (range 13-260 nmol/L). Five of these six patients underwent cosyntropin stimulation that revealed severe adrenal insufficiency in two patients (cortisol peak 150 nmol/L and 210 nmol/L) and mild adrenal insufficiency in three patients (cortisol peak 350-388 nmol/L). CONCLUSION: In this study, approximately 20% of patients receiving intermittent topical glucocorticoid treatment for oral lichen planus had glucocorticoid-induced adrenal insufficiency. It is essential for clinicians to be aware of this risk and to inform patients about the potential need for glucocorticoid stress doses during intercurrent illness.

Cancer and oral lichen planus in a Swedish population.

Oral lichen planus (OLP) is generally regarded as a premalignant condition. The objective of the present study was to assess the number of oral malignant tumours in a retrospective analysis of 1028 patients (mean age=55 years; range=18-86; female, n=667; men, n=351) who between 1978 to end of 1993 were diagnosed with OLP at the Faculty of Odontology, Göteborg University, Sweden. Patients with malignant tumours were identified through the Swedish Cancer Registry at the National Board of Health and Welfare, which annually reports the incidence of malignant neoplasms in the Swedish population. The incidence of oral squamous cancer (OSCC), other malignant tumours and survival in the study group was compared to the Swedish population. The total time with OLP in the study group amounted to 7009 person years, with a mean follow up of 6.8 years (SD=4.9). The observed incidence of OSCC was higher than the expected incidence in the study group. The difference was statistically significant (P<0.001). No statistically significant difference was found for any other malignant tumours than OSCC. Also, no statistically significant difference could be identified in survival between study group and the population. The results from the present study gives further support to the concept of a small but increased risk for development of squamous cell carcinoma in patients with OLP.