Dental and Medical Problems

Dent Med Probl
Index Copernicus (ICV 2021) – 132.50
MEiN – 70 pts
CiteScore (2021) – 2.0
JCI (2021) – 0.5
Average rejection rate (2022) – 79.69%
ISSN 1644-387X (print)
ISSN 2300-9020 (online)
Periodicity – quarterly

Download PDF

Dental and Medical Problems

2015, vol. 52, nr 2, April-June, p. 241–245

Publication type: clinical case

Language: English

Creative Commons BY-NC-ND 3.0 Open Access

Severe Oral Lichen Planus Responsive to Topical Cyclosporine A – Case Report

Ciężka postać liszaja płaskiego wrażliwego na miejscowe leczenie cyklosporyną A – opis przypadku

Ewa Krawiecka1,B,C,D, Elżbieta Szponar1,A,E, Barbara Dorocka-Bobkowska2,E,F

1 Department of Oral Mucosa Diseases, Poznań University of Medical Sciences, Poznań, Poland

2 Department of Prosthetic Dentistry, Poznań University of Medical Sciences, Poznań, Poland

Abstract

Oral lichen planus (OLP) is a chronic, inflammatory, mucocutaneous disease of an autoimmune origin. The disorder may be painful and debilitating and complete resolution is rarely observed. Although there are controversies in the management of symptomatic OLP, topical steroids are considered to be the first line of treatment. Topical cyclosporine (CS) therapy has shown conflicting results in many studies. This paper presents the case of a 70-yearold female patient with a history of hypertension, hypothyroidism and erosive OLP presented with a chief complaint of severe pain and burning sensation on the palate. The patient used acrylic removable partial dentures. OLP was resistant to standard treatment with topical steroids, but responded well to topical CS. Topical administration of the CS solution (“swish-and-spit” method) resulted in marked improvement in the degree of erythema, pain and discomfort. The follow-up showed longer remissions and milder lesions than prior to the therapy and no adverse systemic reactions.

Key words

oral cavity, lichen planus, cyclosporine, steroids

Słowa kluczowe

jama ustna, liszaj płaski, cyklosporyna, steroidy

References (25)

  1. Edwards P.C, Kelsch R.: Oral lichen planus: clinical presentation and management. J. Can. Dent. Assoc. 2002, 68, 494–499.
  2. Langlais R.P., Miller C.S., Nield-Gehrig J.S.: Color atlas of common oral diseases. 4th ed., Lippincott Williams & Wilkins, Philadelphia 2009, 142.
  3. Thongprasom K., Chaimusig M., Korkij W., Sererat T., Luangjarmekorn L., Rojwattanasirivej S.: A randomizedcontrolled trial to compare topical cyclosporin with triamcinolone acetonide for the treatment of oral lichen planus. J. Oral Pathol. Med. 2007, 36, 142–146.
  4. Sharma S., Saimbi C.S., Koirala B.: Erosive oral lichen planus and its management: a case series. J. Nepal Med. Assoc. 2008, 47, 86–90.
  5. Robledo-Sierra J., Mattsson U., Jontell M.: Use of systemic medication in patients with oral lichen planus – a possible association with hypothyroidism. Oral Dis. 2013, 19, 313–319.
  6. Lodi G., Scully C., Carrozzo M., Griffiths M., Sugerman P.B., Thongprasom K.: Current controversies in oral lichen planus: report of an international consensus meeting. Part 1. Viral infections and etiopathogenesis. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2005, 100, 40–51.
  7. Lodi G., Scully C., Carrozzo M., Griffiths M., Sugerman P.B., Thongprasom K.: Current controversies in oral lichen planus: report of an international consensus meeting. Part 2. Clinical management and malignant transformation. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2005, 100, 164–178.
  8. Peterson-Jęckowska R., Dudko A., Kurnatowska A.J.: Diagnostic and treatment difficulties in chronic erosive lesions in oral cavity – case report. Dent. Med. Probl. 2004, 41, 783–788 [in Polish].
  9. Epstein J.B., Truelove E.L.: Topical cyclosporine in a bioadhesive for treatment of oral lichenoid mucosal reactions. Oral Surg. Oral Med. Oral Pathol. 1996, 82, 532–536.
  10. Eisen D., Ellis C.N., Duell E.A., Griffiths E.M.C., Voorhees J.J.: Effect of topical cyclosporine rinse on oral lichen planus – a double-blind analysis. N Eng. J. Med. 1990, 323, 290–294.
  11. Cheng S., Kirtschig G., Cooper S., Thornhill M., Leonardi-Bee J., Murphy R.: Interventions for erosive lichen planus affecting mucosal sites. Cochrane Databese Syst. Rev. 2012, 2, art no: CD008092.
  12. Yoke P.C., Tin G.B., Kim M.J., Rajaseharan A., Ahmed S., Thongprasom K., Chaimusik M., Suresh S., Machin D., Bee W.H., Seldrup J.: A randomized controlled trial to compare steroid with cyclosporine for the topical treatment of oral lichen planus. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2006, 102, 47–55.
  13. Sahebjamee M., Arbabi-Kalati F.: Management of oral lichen planus. Arch. Iranian Med. 2005, 8, 252–256.
  14. Dorocka-Bobkowska B., Zozulinska-Ziolkiewicz D., Wierusz-Wysocka B., Hedzelek W., Szumala-Kakol A., Budtz-Jörgensen E.: Candida-associated denture stomatitis in type 2 diabetes mellitus. Diab. Res. Clin. Pract. 2010, 90, 81–86.
  15. Emami E., de Grandmont P., Rompré P.H., Barbeau J., Pan S., Feine J.S.: Favoring trauma as an etiological factor in denture stomatitis. J. Dent. Res. 2008, 87, 440–444.
  16. Gebremedhin S., Dorocka-Bobkowska B., Prylinski M., Konopka K., Duzgunes N.: Miconazole activity against Candida biofilms developed on acrylic discs. J. Physiol. Pharmacol. 2014, 65, 593–600.
  17. Demitsu T., Sato T., Inoue T., Okada O., Kubota T.: Corticosteroid-resistant erosive oral lichen planus successfully treated with topical cyclosporine therapy. Int. J. Dermatol. 2000, 39, 79–80.
  18. Conrotto D., Carbone M., Carozzo M., Arduino P., Broccoletti R., Pentenero M., Gandolfo S.: Cyclosporine vs. clobetasol in the topical management of atrophic and erosive oral lichen planus: a double-blind, randomized controlled trial. Br. J. Dermatol. 2006, 154, 139–145.
  19. Itin P., Surber C., Buchner S.: Lack of effect after local treatment with a new cyclosporine formulation in recalcitrant erosive oral lichen planus. Dermatol. 1992, 185, 262–265.
  20. Levell N.J., MacLeod R.I., Marks J.M.: Lack of effect of cyclosporine mouthwash in oral lichen planus. Lancet 1991, 337, 796–797.
  21. Lodi G., Carozzo M., Furness S., Thongprasom K.: Interventions for treating oral lichen planus: a systematic review. Br. J. Dermatol. 2012, 166, 938–947.
  22. Ho V.C., Gupta A.K., Ellis C.N., Nickoloff B.J., Voorhees J.J.: Treatment of severe lichen planus with cyclosporine. J. Am. Acad. Dermatol. 1990, 22, 64–68.
  23. Eisen D., Ellis C.N.: Topical cyclosporine for oral mucosal disorders. J. Am. Acad. Dermatol. 1990, 23, 1259–1263.
  24. Porter S.R., Scully C., Eveson J.W.: The efficacy of topical cyclosporine in the management of desquamative gingivitis due to lichen planus. Br. J. Dermatol. 1993, 129, 753–755.
  25. Williamson M.S., Miller E.K., Plemons J., Rees T., Iacopino A.M.: Cyclosporine A upregulates interleukine6 gene expression in human gingiva: possible mechanism of gingival overgrowth. J. Periodontol. 1994, 65, 895–903.