The Effect of Topically Applied Hyaluronic Acid Gel Versus Topical Corticosteroid in the Treatment of Erosive Oral Lichen Planus

Abstract

INTRODUCTION: Oral lichen planus is a common chronic inflammatory muco-cutaneous disease. Although the cause of oral lichen planus is not well known, T-lymphocyte infiltrate suggests a cell mediated immunological damage to basal cell layer of the epithelium. Its suggested treatment is topical corticosteroid. A promising new treatment for oral lichen planus [OLP] is the topical application of hyaluronic acid [HA], which has shown beneficial effect on wound healing. OBJECTIVES: to evaluate the effect of hyaluronic acid gel in the treatment of erosive oral lichen planus in comparison with topically applied corticosteroids. MATERIALS AND METHODS: a randomized, parallel, controlled clinical study was conducted on twenty patients who were randomly divided into two groups. Group I received topical application of corticosteroid (triamcinolone acetonide) 4-5 daily, for 28 days and Group II was similarly treated using hyaluronic acid 0.2% gel. Subjective symptom and Visual Analogue Scale (VAS) were recorded at base line, after 10 days and at 3 months. The objective sign clinical score was recorded at baseline, 1 and 3 months post-treatment. RESULTS: Both groups showed decrease in the lesion size and symptoms of OLP. The HA treated group showed a significantly higher decrease in the pain score in comparison to the corticosteroid treated group. Regarding the healing score, the corticosteroid group showed superior results than that shown with the HA. CONCLUSIONS: HA 0.2% gel is effective in the treatment of OLP, it resulted in a decrease in symptoms and signs of the disease. HA resulted in more control of pain when compared to topical corticosteroid.

Effectiveness of hyaluronic acid in the management of oral lichen planus: a systematic review and meta-analysis

“…Five studies reported a high risk of bias [ 6 14 15 18 19 ] due to one or more risks owing to performance, detection, attrition, and reporting bias. Two other studies reported an unclear risk of bias in selection, performance, and detection [ 13 20 ].…”

“…A total of 199 participants from 6 studies were included in the analysis of OLP lesion symptoms [ 6 13 15 18 19 20 ]. The pooled overall mean difference was 0.65 [95% CI: -1.80 to 3.09] which was not statistically significant (Z = 0.52, P = 0.60).…”

“…3A ). Three studies compared HA with corticosteroids and two studies compared HA with a placebo [ 6 13 15 18 20 ]. Quantitative subgroup analysis comparing HA to placebo and corticosteroids yielded statistically non-significant results (Z = 0.09, P = 0.92 and Z = 1.03; P = 0.30, respectively) ( Fig.…”

“…It can be used in all grades of oral ulceration [ 10 11 12 ]. HA plays an important role in various biological processes, such as cell signalling, morphogenesis, matrix organization, tissue hydration, lubrication, wound healing, regulating gene expression, and cell proliferation [ 8 13 14 15 ]. HA is commercially available as sodium hyaluronate combined with polyvinylpyrrolidone (PVP) and glycyrrhetinic acid.…”

“…PVP is a hydrophilic polymer with mucoadherent and film-forming properties that enhance tissue hydration. Glycyrrhetinic acid is a breakdown product of glycyrrhizin, the active component of licorice, which has anti-inflammatory properties and aids ulcer healing [ 11 13 16 ].…”