Assessment of Lycopene and Levamisole in Management of Oral Lichen Planus-A Comparative Study

Abstract

Objective: Oral Lichen Planus (OLP) is known to be persistent and resistant to treatment. Corticosteroids are the preferred mode of intervention in OLP, long courses of which have been shown to cause adverse effects. The goal of this study was to compare the safety and efficacy of Lycopene and of Levamisole in the management of Oral Lichen Planus. Methods: 50 symptomatic OLP patients satisfying the inclusion criteria were randomly divided into two groups (A and B). Group A patients were administered lycopene 8mg / day in two divided doses for 8 weeks. Group B patients were administered levamisole 50mg in cyclic dosage i.e. thrice daily for 3 consecutive days followed by no drug for next four days; for 8 weeks. The patients were scored at baseline, 2 weeks, 4 weeks and 8 weeks using Visual Analog Scale (VAS) for symptoms and Tel-Aviv San Francisco (TASF) scale for overall response to treatment. Statistical analysis was performed using repeated measures of ANOVA, Z test and chi square test. Results: Substantial reduction in pain and burning sensation was observed in both the groups at the end of treatment. A more potent therapeutic effect was observed in lycopene group. Specifically, 18 out of 25 (72%) patients in this group showed 50% or more improvement while 12 out of 25 (48%) patients showed 70-100% improvement. In levamisole group, 11 out of 25 (44 %) and 1 out of 25 patients showed 50% or more, and 70-100% improvement. No adverse effects were reported in either group. Conclusion: When used as monotherapeutic agents, both lycopene and levamisole were found to be safe and effective alternatives for treatment of Oral Lichen Planus. Lycopene demonstrated a faster and more potent therapeutic effect compared to levamisole. The results of this research motivate further studies with larger sample size to evaluate these drugs in the treatment of OLP.

Clinical assessment of the effects of lycopene in the management of oral lichen planus

“…She observed that two (8%) patients had complete remission of lesions (score 4 = 90-100% remission of sign and symptoms), and the remaining patients (n = 23, 92%) had partial remission of lesions. The results of our study were more or less similar to the Pratibha et al [14] study. Similarly, a double-blinded, placebo controlled study was conducted by Saawarn et al, [6] using lycopene at a dose of 8mg/day for 8 consecutive weeks in 15 patients.…”

“…Complete remission of lesions was seen in two (15.5%) patients, while remaining (n = 11, 84.6%) had partial remission of lesions after 8 consecutive weeks of treatment with lycopene. A similar study was conducted by Pratibha et al, [14] who assessed the effect of lycopene 8 mg/day for 8 consecutive weeks in 25 patients using the Tel Aviv San Francisco Scale. She observed that two (8%) patients had complete remission of lesions (score 4 = 90-100% remission of sign and symptoms), and the remaining patients (n = 23, 92%) had partial remission of lesions.…”

“…Similar findings were reported by Saawarn et al, [6] where OLP was more common in the age group of 14-75 years with male predominance. However, studies by Agha-Hosseini et al, [5] Mansourian et al, [7] Pratibha et al, [14] and other various studies have reported that the common age group of OLP lesions was 19-75 years with female predominance. This difference may be due to the differences in patient selection and the prevalence of OLP in their setting.…”

“…Recent literature reported increased oxidative stress, an imbalance in the antioxidant defense system, increased lipid peroxidation, oxidative damage to DNA, and proteins as the causative factors in the genesis of OLP lesions. Some researchers have advocated the use of purslane, [5] A. vera, [7] and turmeric [13] along with lycopene [6,14] for the treatment of OLP lesions because of antioxidant properties. Even, Nagao et al [15] reported that there was a significant decrease in the level of lycopene in patients having atrophic and erosive forms of lesions.…”

The effect of herbal medicine in reducing the severity of oral lichen planus: A systematic review and meta-analysis

“…8 Corticosteroids are the main treatment for OLP, but due to their local (burning sensation and irritation) and systemic (immunosuppression) side effects, various studies have been carried out to find alternative treatments, such as herbal medicines, 9 which have been widely used because they are safe, easy to find and low cost. 10 Thus far, many studies have shown that herbal medicines may reduce the severity of OLP; for example, Liu Wei Di Huang, 9 Tripterygium glycosides, 9 Zeng Sheng Ping, 9 liquorice, 11 purslane, 12 lycopene, 13 raspberry, 14 propolis, 15 green tea, 16 Ignatia amara, 17 aloe vera, 18 quercetin 19 and Curcuma longa. 20 Different types of herbs have had varied results; for example, curcumin may reduce the inflammatory cytokine response caused by the activity of T lymphocytes in OLP.…”