Clinical Evaluation of Efficacy of Triamcinolone Acetonide with Tacrolimus in the Management of Oral Lichen Planus

Abstract

Introduction: Lichen planus (LP) is a relatively common chronic, mucocutaneous disease of autoimmune origin, involves oral mucosa, skin, scalp, nails, and genital mucosa. The prevalence of oral LP (OLP) varies worldwide, commonly seen in middle-aged and elderly people. It usually presents as symmetrical and bilateral or multiple lesions with burning sensation (BS) sometimes accompanied by pain. Corticosteroids and calcineurin inhibitors have shown promising results in the treatment of OLP, but its chronic course and unpredictable exacerbations/remission continues to result in a high degree of morbidity. The study aimed to evaluate the efficacy of intralesional triamcinolone acetonide (injection TA) combined with topical application of TA orabase and Tacrolimus (TAC) ointment for symptomatic cases of OLP. Materials and Methods: The prospective study included 52 symptomatic OLP patients to receive (0.5 ml) intralesional injection of TA once a week for the first 4 weeks followed by one injection in the 6th week along with TA mucosal paste (0.1%.) and TAC ointment (0.03%) in tapering dose till 8th week. The subjective symptoms including BS and pain were assessed on a 10 cm visual analog scale (VAS) and objective signs like size and site of the lesion were scored according to criterion scale modified by Thongprasom et al. Differences were compared after 8 weeks treatment course and follow-up observations were performed at 20th week to record any recurrent lesion. Results: 41 patients (78.8%) had complete remission of disease and 11 (21%) had shown partial improvement. The VAS scores for BS and pain improved significantly. Improvement was also noted with decrease in the average size of active lesions and the number of sites with treatment. The relapse was seen in 17 patients (41%) in the 20th week. Conclusion: TA combined with TAC is a valuable therapeutic option for the treatment of symptomatic OLP. Our findings suggest that patients have shown statistically significant improvement.

Impact of exosomes in oral lichen planus: A review with insights into pathogenesis and biomarkers

“… Skin thinning 27 Triamcinolone acetonide Prevent erythema and ulceration. Inflammation of hair follicles 28 Fluocinonide Prevents itching, burning, and discomfort. Loss of skin pigmentation 29 Betamethasone Anti-inflammatory and immunosuppressive to OLP.…”

Side Effects of Steroidal and Non-Steroidal Anti-Inflammatory Drugs on The Oral Cavity.

“…18 Topical corticosteroids are also commonly prescribed in dentistry as triamcinolone which is used for achieving relief from symptoms of mouth sores due to injury and autoimmune lesions as oral lichen planus, oral candidiasis was the most frequently reported oral side effect, with swelling, bruising or discoloration, slow wound healing and itching all being observed less commonly. 19 Prednisolone and Prednisone are also commonly used as a systemic medication for the treatment of severe allergies, inflammatory and auto-immune conditions, and their use was associated with increased risk of infections; additionally, ulcerations; particularly with the adjunct use of an NSAID is another common finding. Bone thinning, bruising and slower wound healing can also be seen less commonly.…”