Hydroxychloroquine- A New Treatment Option for Erosive Oral Lichen Planus

Abstract

Context: Oral Lichen planus (OLP) is a chronic, debilitating, immune-mediated disease whose management is considered a challenge in medical science. Aims: To quantitatively evaluate the effect of administration of enteral hydroxychloroquine (HCQS) as a monotherapy for six months on the extent and severity of erosive OLP using reticular score, erythema score and ulcerative score (REU score), and to subjectively evaluate the success of HCQS as a therapeutic drug for OLP-e using Tel Aviv-San Francisco Scale, visual analogue scale (VAS) and severity of burning sensation (BURN score). Settings and Design: Prospective clinical trial. Methods and Material: A total of 45 subjects received 200 mg of HCQS bid for six months. REU, VAS, BURN scores and Tel Aviv-San Francisco Scale readings were taken at the beginning of the study (baseline) and three- and six-month intervals post administration of enteral HCQS. Subjects were examined for any adverse drug outcomes for one year after the cessation of enteric HCQS therapy. Data were analysed with SPSS version 25. Results: There was a stark reduction in REU, VAS and BURN scores during the study period, with a statistically significant reduction (P < 0.05) seen at three- and six-month time intervals as compared to baseline. Further, the mean of change in R, E and U scores showed a statistically significant difference, with the highest reduction seen at baseline to six-month time interval. The Tel Aviv-San Francisco Scale showed 70%–100% remission in disease in more than 70% of subjects. Conclusions: Enteral HCQS can be considered a viable treatment option for the enigma that is erosive OLP.

CD8+ tissue-resident memory T cells induce oral lichen planus erosion via cytokine network

“…Recurrent episodes of autoimmune diseases are believed to be due, in part, to the persistence of local Trm cells that are difficult to eliminate entirely ( Jiang et al, 2012 ; Owczarczyk Saczonek et al, 2020 ). Immunosuppressive medications and local, or systemic corticosteroids are the main treatments for symptomatic OLP ( García-Pola et al, 2017 ; Raj et al, 2021 ). We discovered that there was no statistically significant difference between medication therapy and repeated degradation of OLP in our cohort analysis.…”

Therapeutic strategies for oral lichen planus: State of the art and new insights

“…In a recent prospective clinical trial on 45 patients with erosive OLP, HCQ 200 mg p.o. twice daily as monotherapy was reported as effective and safe ( 59 ). In addition, Yeshurun et al reported a moderate to marked improvement in 57% and a complete remission in 24% patients with erosive OLP on HCQ 400 mg/day p.o.…”

Hydroxychloroquine is effective in oral lichen planus: A multicenter, randomized, controlled trial

“…The selection of dexamethasone as reference drug is due to its widely use and its status as first‐line drug to manage OLP (Carbone et al, 2003; Fu et al, 2012; Husein‐ElAhmed et al, 2019). The rational of its use is the stabilization of the lysosomal membrane, and reduction of the lymphocytic exudates (Raj et al, 2021).…”

“…Differences in VAS scores before and after treatment were regarded as the main evaluation index. Based on previous reports (Fu et al, 2012; Raj et al, 2021), we assumed the average of VAS score after treatment would be 2.03 of the hydroxychloroquine group and 1.05 of the dexamethasone group, with a standard deviation of 1.15 and 1.25. The required sample size was calculated to be 42 patients per group, with 90% statistical power at a 2‐sided α of 0.05.…”