MANAGEMENT OF ORAL LICHEN PLANUS WITH TOPICAL TACROLIMUS. A PROSPECTIVE STUDY IN 20 PATIENTS/ dental courses

MANAGEMENT OF ORAL
LICHEN PLANUS WITH
TOPICAL TACROLIMUS.
A PROSPECTIVE STUDY
IN 20 PATIENTS
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

PRESENTED BY:
UNDER GUIDANCE OF:
DR. UPENDRA MALIK
PG FINAL YEAR STUDENT
DR. M.SRINIVASA RAJU
(PROFESSOR & HEAD)
DR. SATHEESHA REDDY B.H
(PROFESSOR)
DR. GN SUMA (PROFESSOR)
DR. RAVI PRAKASH SM
(ASSOCIATE PROFESSSOR)
KOTHIWAL DENTAL COLLEGE & RESEARCH CENTRE,
MORADABAD, U.P

INTRODUCTION
 The term oral lichen planus was first coined by Erasmus
Wilson in 1869.
 Lichen planus is a relatively common mucocutaneous
disease estimated to affect 0.5-1% of the adult population,
with manifestation seen both on skin and oral mucosa.
 Clinical representation of oral lichen planus as previously
reported are reticular, plaque like, erosive, papular,
atrophic and bullous.

 Mutiple systemic and topical treatments for
oral lichen planus have been reported to be
effective, including topical & systemic
corticosteroids, griseofulvin, hydroxy
chlorquine, dapsone, topical retinoids and
topical cyclosporine.
 However some patients are resistant to
treatment with these therapies.

 Tacrolimus is a macrolide
immunosuppressant belonging to cyclosporin
group having the same mechanism of action
as cyclosporin but it is 10-100 times more
potent than cyclosporin.
 Topical tacrolimus have been reported to be
safe and effective in the treatment of oral
lichen planus especially in those forms which
are recalcitrant to treatment.

AIMS & OBJECTIVES

 TO ASSESS THE EFFICACY OF 0.1%
TOPICAL TACROLIMUS IN
SYMPTOMATIC PATIENTS WITH
LICHEN PLANUS.
 TO DETERMINE THE USE OF TOPICAL
TACROLIMUS AS A FIRST LINE
THERAPY FOR THE TREATMENT OF
ORAL LICHEN PLANUS.

MATERIALS & METHODS
 Tacrolimus ointment preparationTacrolimus ointment preparation: 500mg of
powder is mixed into 300gms of base which
is oraguard-B (colgate-palmolive U.S.A) to
attain a concentration of 0.1% of the drug.

 INCLUSION CRITERIA:
 Symptomatic patients having clinical evidence
of the lesion.
 Histopathological diagnosis of the lesion.
 EXCLUSION CRITERIA:
 Patients on medications for other ailments.

SAMPLING TECHNIQUE
 Samples for the study were selected among
the patients attending the OPD of Kothiwal
Dental College & Research Center &
satisfying the inclusion & exclusion criteria.
 A written consent was obtained from each
individual before giving the medication.

 Drug was dispensed to the patients and
patients were recalled every 15 days for check
ups and reinforcement of instructions.

SUBJECTIVE ASSESSMENT
 A case history Performa was designed containing a
minimum set of information regarding patient’s
 Chief complaint
 History of present illness
 Medical history
 Drug history
 Habits
 VAS.

OBJECTIVE ASSESSMENT
 Clinical assessment by inspection (location,
size, color, surface condition, whether single
or multiple).
 Palpation included consistency & pain
intensity.

Clinical scoring as follows:
0 – No lesion
1 – White striae only
2 – White striae & erosions < 1 sqcm
3 – White striae & erosions > 1 sqcm
4 – White striae & ulceration < 1sqcm
5 – White striae & ulceration > 1sqcm

 All the patients underwent baseline
investigations which included complete blood
count, RBS, and Liver biochemistry.

 The drug was given to the patient and patient
recalled for clinical assessment.
 Patients were told to apply the thrice daily
after meals and not to eat and rinse for 45
minutes after applying the medication.

SOME CLINICAL CASES
TREATED

18yr old Female with papular
OLP

45yrold female
with desquamative gingivitis
pre treatment post treatment

PRE TREATMENT POST TREATMENT

32 year male patient with erosive lichen
planus invloving buccal mucosa

44 year male patient having
symptomatic reticular lesions of buccal
mucosa

24 years old male patient with erosive
OLP of buccal mucosa

RESULTS

 20 Patients participated in the study. (13 females 7
males)
 Average age of FEMALES: 37.92 years.
MALES: 38.86 years.
 Average duration of treatment for
MALES: 77 days
FEMALES: 88.6 days

0
1
2
3
4
5
6
Male
Female
Male
Female
pre
treatment
Post
teatment
bar chart showing the average pre
treatment and post treatment VAS
Series1

S.No.
Difference
in VAS
scale
(Mean±SD)
Paired t-
test t (19,.05)
p-value at
α=.05
Z at
α=.01
p-value at
α=.01
Visual anlouge
scale
4.45 ±
2.1145 9.412 2.093 p<.05* p<.01**
Right buccal
mucosa 11 3.78 1.96 p<.05* 2.58 p<.01**
Left buccal
mucosa 12 4.01 1.96 p<.05* 2.58 p<.01**
Desquamative
gigivitis 5 2.99 1.96 p<.05* 2.58 p<.01**

DISCUSSION
 The treatment of oral lichen planus is challenging. A number
of therapies are reported, none of which are highly effective
and all of which are aimed at controlling the disease rather
than inducing remission. Topical corticosteroids, topical
tretinoin, and topical cyclosporin have all been used without
dramatic success. Systemic therapies including oral psoralens
UvA, etretinate, dapsone, & thalidomide have been reported
in the treatment of OLP.

 Majority of these drugs have toxicities that limit long term use and have
not been evaluated in rigorous controlled studies.
 Our result in all the 20 patients showed a positive response to treatment
with topical tacrolimus and reported a partial to complete resolution of
symptoms.
 13 of the 20 patients have complete healing of the lesions. Out of these 13
cases 10 have resolution of even the reticular component also.
 In rest seven cases partial response to treatment was present and the
patients came under the category of 1-2 clinical scoring.
5 patients reported increased burning sensation after first 3-4 application
which was not so severe as to discontinue the drug.

CONCLUSION
 Topical tacrolimus showed promising results in the
treatment of oral lichen planus lesions and is an
effective and safe therapy for lesions recalcitrant to
other modes of treatments.
 Our study also proved tacrolimus to effective in
patients who are seeking treatment for the first time
for this condition.
 Further double blinded studies are required with the
same drug to further establish the efficacy of topical
tacrolimus as modality of treatment in oral lichen
planus.

Picture slide
 Bullet 1
 Bullet 1

MANAGEMENT OF ORAL LICHEN PLANUS WITH TOPICAL TACROLIMUS. A PROSPECTIVE STUDY IN 20 PATIENTS/ dental courses

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MANAGEMENT OF ORAL LICHEN PLANUS WITH TOPICAL TACROLIMUS. A PROSPECTIVE STUDY IN 20 PATIENTS/ dental courses