A prospective observational study to compare efficacy of topical triamcinolone acetonide 0.1% oral paste, oral methotrexate, and a combination of topical triamcinolone acetonide 0.1% and oral methotrexate in moderate to severe oral lichen planus

Chauhan, Payal; De, Dipankar; Handa, Sanjeev; Narang, Tarun; Saikia, Uma Nahar

doi:10.1111/dth.12563

Cited by 25 publications

(16 citation statements)

References 20 publications

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“…Intermittent therapy may be helpful here. In certain situations, the use of topical steroids can be associated with other systemic drugs to speed up the clinical response: accordingly, a prospective observational study has shown the combination of topical triamcinolone acetonide 0.1% in combination with oral methotrexate has better outcomes than the two drugs independently in patients with moderate‐to‐severe oral LP …”

Section: High‐potency Topical Steroidsmentioning

confidence: 99%

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Lichen planus: a comprehensive evidence‐based analysis of medical treatment

Husein‐ElAhmed

Gieler

Steinhoff

2019

Acad Dermatol Venereol

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Lichen planus (LP) is a chronic-relapsing inflammatory skin disease. Although many drugs have been used for the management of LP, some of them lack the backup by strong therapeutic evidence, while others are not suitable for some patients due to safety profile issues. The aim of this study was to review the recent status of available medical therapies for LP to help physicians make better decisions upon best medical practice while facing patients with this condition. A review of published articles on management of LP was conducted with the MEDLINE and PubMed databases. The quality of the evidence was graded as high, moderate, low or very low. A total of 1366 articles were retrieved, and 219 (16%) were included in the final analysis. Twenty-one different treatment modalities were analysed. The quality of evidence was high for topical steroid and calcineurin inhibitor, while it was moderate for oral steroids. All the other modalities reached low or very low quality of evidence. Topical steroids and calcineurin inhibitors are the current first-line therapies, while for other therapies the strength of recommendation is not so evident. Unfortunately, larger randomized, controlled trials to support the efficacy, safety and tolerability of other therapies in LP are lacking, and many of them are recommended based on studies with small sample sizes, lack of standardized outcome measures or lack of controlled duration or even in anecdotal evidence. Thus, large-scale randomized clinical trials are still warranted to establish the exact benefits of other topical treatments, phototherapy, immunosuppressant and new immunomodulators for an optimized treatment of LP.

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Section: High‐potency Topical Steroidsmentioning

confidence: 99%

“…Alongside with the use as single therapy, systemic methotrexate may be used in combination with topical steroids and tacrolimus, which resulted in higher efficacy . In case of a combinated therapy, it was suggested that methotrexate can be reduced to 2.5–7.5 mg weekly …”

Section: Methotrexatementioning

confidence: 99%

Lichen planus: a comprehensive evidence‐based analysis of medical treatment

Husein‐ElAhmed

Gieler

Steinhoff

2019

Acad Dermatol Venereol

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“…This percentage is relatively lower than our results of 73.3% complete resolution. Another study revealed that combination of low dose methotrexate and triamcinolone is a better treatment modality in Oral lichen planus 19 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of low dose oral Methotrexate vs Systemic Corticosteroids for treatment of Oral Lichen Planus

Saeed¹,

Firdous²,

Malik³

et al. 2021

PJMHS

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Background: Oral Lichen Planus (OLP) is a relatively common chronic inflammatory mucocutaneous disorder. WHO considers OLP a premalignant lesion. This makes management of OLP important to avoid its malignant transformation. Corticosteroids are considered as the first-line of treatment. Different other treatment modalities are also in use for OLP. But there is no statistically significant data available for a particular therapy. The recent evidences suggest methotrexate may effectively be used in low dose in the treatment of OLP. Aim: To compare the frequency of complete resolution of mucosal lesions of oral lichen planus with low dose oral methotrexate versus systemic corticosteroids. Methods: It was a randomized control trial conducted at Oral & Maxillofacial Surgery Department, King Edward Medical University/Mayo Hospital Lahore in six months. A sample of 60 patients was divided into two sub groups namely Group -A (methotrexate) and Group - B (corticosteroid) using lottery method. More than 75% resolution of mucosal lesions clinically was considered as complete resolution at the end of 8th week. Results: The mean age of the patients was 44.55±12.38 years. On 8th week, frequency of complete resolution of mucosal lesions was 73.3% in Group A and 60% in Group B with an insignificant difference (p-value<0.05). Conclusion: Methotrexate group A showed more complete resolution of mucosal lesions than corticosteroid group B with insignificant statistical difference. Keywords: Oral Lichen Planus, Mucosal lesions, Malignant transformation, Methotrexate, Corticosteroids

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“…Authors reported partial response or better in 15 (83.3%) patients, with pain reduction assessed by Visual Analogue scale (VAS) score (18). Chauhan et al (19) compared efficacy of triamcinolone acetonide 0.1% oral paste, oral methotrexate, and combination of the 2 in moderate to severe OLP. Fortyfive patients were treated for 16 weeks.…”

Section: Methotrexatementioning

confidence: 99%

Systemic Medical and Procedural Therapies for Mucosal Lichen Planus: Update and Review of Challenges and Successes

et al. 2021

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Context: Mucosal lichen planus is a chronic inflammatory debilitating condition that commonly affects the oral mucosa, but other sites such as the genital and ocular mucosae, esophagus and ear canal may also be involved, with risk of scarring and functional compromise. Spontaneous remission is rare and the condition tends to be recalcitrant to therapy, which makes management challenging. Topical therapies are often ineffective in severe cases and official treatment guidelines including systemic agents and procedural interventions are currently not available. Methods: We performed a literature review on current systemic therapies for mucosal lichen planus using PubMed, MEDLINE and Cochrane databases, with 74 publications identified including retrospective and prospective studies, case reports, and clinical trials. Therapies reviewed included biologics, immunosuppressive therapies, immunomodulating and anti-inflammatory drugs, vitamin A derivatives, devices and interventional therapies, and non-prescription drugs. Results: Reported treatments were classified into the following categories: biologics, anti-metabolic immunosuppressives, direct anti-T cell agents, other immunodulatory agents, antibiotics, retinoids, and procedure based interventions. Most studies on mucosal lichen planus are descriptive in nature and demonstrate low levels of evidence. Randomized controlled trials are lacking, which makes it difficult to directly compare different grading scales and outcome. Conclusions: The authors suggest clinical criteria for initiation of therapy in mucosal lichen planus, such as severe disease, lack of response to topical therapy, mucous membranes involvement and involvement of organs at risk of non-function. The authors also propose a stepwise treatment algorithm based on data from this review and their personal experience in an academic tertiary referral center.

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A prospective observational study to compare efficacy of topical triamcinolone acetonide 0.1% oral paste, oral methotrexate, and a combination of topical triamcinolone acetonide 0.1% and oral methotrexate in moderate to severe oral lichen planus

Cited by 25 publications

References 20 publications

Lichen planus: a comprehensive evidence‐based analysis of medical treatment

Lichen planus: a comprehensive evidence‐based analysis of medical treatment

Comparison of low dose oral Methotrexate vs Systemic Corticosteroids for treatment of Oral Lichen Planus

Systemic Medical and Procedural Therapies for Mucosal Lichen Planus: Update and Review of Challenges and Successes

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