clobetasol and Lichen-Planus--Oral

To compare the reported efficacy and costs of available interventions used for the management of oral lichen planus (OLP).. A systematic literature search was performed from database inception until March 2021 in MEDLINE via PubMed and the Cochrane library following PRISMA guidelines. Only randomized controlled trials (RCT) comparing an active intervention with placebo or different active interventions for OLP management were considered.. Seventy (70) RCTs were included. The majority of evidence suggested efficacy of topical steroids (dexamethasone, clobetasol, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus, cyclosporine), topical retinoids, intra-lesional triamcinolone, aloe-vera gel, photodynamic therapy, and low-level laser therapies for OLP management. Based on the estimated cost per month and evidence for efficacy and side-effects, topical steroids (fluocinonide > dexamethasone > clobetasol > triamcinolone) appear to be more cost-effective than topical calcineurin inhibitors (tacrolimus > pimecrolimus > cyclosporine) followed by intra-lesional triamcinolone.. Of common treatment regimens for OLP, topical steroids appear to be the most economical and efficacious option followed by topical calcineurin inhibitors. Large-scale multi-modality, prospective trials in which head-to-head comparisons interventions are compared are required to definitely assess the cost-effectiveness of OLP treatments.

Topics: Administration, Topical; Calcineurin Inhibitors; Clobetasol; Cyclosporins; Dexamethasone; Fluocinonide; Health Care Costs; Humans; Lichen Planus, Oral; Steroids; Tacrolimus; Treatment Outcome; Triamcinolone

To examine the comparative efficacy and safety of topical administration for oral lichen planus.. An electronic database search (1st January 1946 to 1st May 2020) for randomised controlled trials identified 34 studies involving eight interventions (clobetasol, betamethasone, triamcinolone, dexamethasone, fluocinolone, tacrolimus, pimecrolimus, and cyclosporine); these studies were subjected to network meta-analysis using direct and indirect comparisons [efficacy indicators: clinical response rate, symptom-reducing effect (visual analogue scale score), sign-reducing effect (Thongprasom-scale score) and relapse; safety indicator: adverse event occurrence].. Compared with placebo, tacrolimus had the best clinical response rate (odds ratio (OR), 57.78 [95% CI 3.15-1060.52]; P-score, 0.8654) and cyclosporine had the worst (OR, 3.61[95% CI 0.20-66.62]; P-score, 0.2236); tacrolimus had the best symptom-reducing effect (standardised mean difference (SMD), 1.06 [95% CI 0.41-1.71]; P-score, 0.9323) and fluocinolone had the worst (SMD, -0.54 [95% CI -1.44-0.36]; P-score, 0.0157); dexamethasone had the best sign-reducing effect (SMD, 3.60 [95% CI 1.74-5.45]; P-score, 0.8306) and clobetasol had the worst (SMD, 2.63 [95% CI 1.66-3.61]; P-score, 0.2581); and pimecrolimus performed best (OR, 0.04 [95% CI 0.00-0.64]; P-score, 0.9227) and clobetasol performed the worst [OR, 0.60; 95% CI 0.15-2.45; P-score, 0.2545] in reducing relapse. Regarding safety, dexamethasone was the safest compared with placebo [OR, 0.37; 95% CI 0.05-2.57; P-score, 0.9337), whereas fluocinolone ranked low for safety [OR, 9.48; 95% CI 1.50- 60.03; P-score, 0.1189].. The relative ranking of topical administration varies according to the different indicators. Based on the joint consideration of clinical response rate and adverse event occurrence, dexamethasone, triamcinolone and betamethasone are recommended for better efficacy and safety. The optimal treatment for oral lichen patients varies under different conditions.

Topics: Administration, Topical; Betamethasone; Clobetasol; Humans; Lichen Planus, Oral; Network Meta-Analysis; Tacrolimus; Treatment Outcome

The goal of this systematic review was to assess the efficacy of dexamethasone compared to other treatments in oral lichen planus (OLP). The literature search used the following inclusion criteria: randomized controlled trials (RCT) comparing dexamethasone and other treatment strategies in patients with OLP. The outcome measures included relief of symptoms, decrement of erosive area size, and changes in quality of life. A computer and manual search was performed in Pubmed, Web of Science, and Cochrane Library up to January 31, 2021. The risk of bias was measured with the Revised Cochrane risk-of-bias tool for randomized trials. Eight trials with 131 study participants and 132 controls were identified. The following interventions were compared dexamethasone mouthwash, and 5% methylene blue-mediated photodynamic therapy, low-level laser therapy, amlexanox, clobetasol mouthwash, ketoconazole with amitriptyline, and thalidomide 1% paste. The therapeutic outcomes were more advantageous for dexamethasone in comparison with photodynamic therapy (PDT) (2 RCT) and low-level laser therapy (LLLT). Comparable effects were observed for dexamethasone, amlexanox, thalidomide, and PDT (1 RCT). Clobetasol showed more effective action than dexamethasone. Given the small sample sizes, heterogeneity and the few studies included, there is limited evidence to support the selection of treatment for OLP.

Topics: Administration, Topical; Aminopyridines; Amitriptyline; Clobetasol; Dexamethasone; Humans; Ketoconazole; Lichen Planus, Oral; Methylene Blue; Mouthwashes; Thalidomide

Oral lichen planus (OLP) is a relatively common chronic T cell-mediated disease, which can cause significant pain, particularly in its erosive or ulcerative forms. As pain is the indication for treatment of OLP, pain resolution is the primary outcome for this review. This review is an update of a version last published in 2011, but focuses on the evidence for corticosteroid treatment only. A second review considering non-corticosteroid treatments is in progress.. To assess the effects and safety of corticosteroids, in any formulation, for treating people with symptoms of oral lichen planus.. Cochrane Oral Health's Information Specialist searched the following databases to 25 February 2019: Cochrane Oral Health's Trials Register, CENTRAL (2019, Issue 1), MEDLINE Ovid, and Embase Ovid. ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. There were no restrictions on language or date of publication.. We considered randomised controlled clinical trials (RCTs) of any local or systemic corticosteroid treatment compared with a placebo, a calcineurin inhibitor, another corticosteroid, any other local or systemic (or both) drug, or the same corticosteroid plus an adjunctive treatment.. Three review authors independently scanned the titles and abstracts of all reports identified, and assessed risk of bias using the Cochrane tool and extracted data from included studies. For dichotomous outcomes, we expressed the estimates of effects of an intervention as risk ratios (RR), with 95% confidence intervals (CI). For continuous outcomes, we used mean differences (MD) and 95% CI. The statistical unit of analysis was the participant. We conducted meta-analyses only with studies of similar comparisons reporting the same outcome measures. We assessed the overall certainty of the evidence using GRADE.. We included 35 studies (1474 participants) in this review. We assessed seven studies at low risk of bias overall, 11 at unclear and the remaining 17 studies at high risk of bias. We present results for our main outcomes, pain and clinical resolution measured at the end of the treatment course (between one week and six months), and adverse effects. The limited evidence available for comparisons between different corticosteroids, and corticosteroids versus alternative or adjunctive treatments is presented in the full review. Corticosteroids versus placebo Three studies evaluated the effectiveness and safety of topical corticosteroids in an adhesive base compared to placebo. We were able to combine two studies in meta-analyses, one evaluating clobetasol propionate and the other flucinonide. We found low-certainty evidence that pain may be more likely to be resolved when using a topical corticosteroid rather than a placebo (RR 1.91, 95% CI 1.08 to 3.36; 2 studies, 72 participants; I² = 0%). The results for clinical effect of treatment and adverse effects were inconclusive (clinical resolution: RR 6.00, 95% CI 0.76 to 47.58; 2 studies, 72 participants; I² = 0%; very low-certainty evidence; adverse effects RR 1.48, 95% 0.48 to 4.56; 3 studies, 88 participants, I² = 0%, very low-certainty evidence). Corticosteroids versus calcineurin inhibitors Three studies compared topical clobetasol propionate versus topical tacrolimus. We found very low-certainty evidence regarding any difference between tacrolimus and clobetasol for the outcomes pain resolution (RR 0.45, 95% CI 0.24 to 0.88; 2 studies, 100 participants; I² = 80%), clinical resolution (RR 0.61, 95% CI 0.38 to 0.99; 2 studies, 52 participants; I² = 95%) and adverse effects (RR 0.05, 95% CI 0.00 to 0.83; 2 studies, 100 participants; very low-certainty evidence) . One study (39 participants) compared topical clobetasol and ciclosporin, and provided only very low-certainty evidence regarding the rate of clinical resolution with clobetasol (RR 3.16, 95% CI 1.00 to 9.93), pain resolution (RR 2.11, 95% CI 0.76 to 5.86) and adverse effects (RR 6.32, 95% CI 0.84 to 47.69). Two studies (60 participants) that compared triamcinolone and tacrolimus found uncertain evidence regarding the rate of clinical resolution (RR 0.86, 95% CI 0.55 to 1.35; very low-certainty evidence) and that there may be a lower rate of adverse effects in the triamcinolone group (RR 0.47, 95% CI 0.22 to 0.99; low-certainty evidence). These studies. Corticosteroids have been first line for the treatment of OLP. This review found that these drugs, delivered topically as adhesive gels or similar preparations, may be more effective than placebo for reducing the pain of symptomatic OLP; however, with the small number of studies and participants, our confidence in the reliability of this finding is low. The results for clinical response were inconclusive, and we are uncertain about adverse effects. Very low-certainty evidence suggests that calcineurin inhibitors, specifically tacrolimus, may be more effective at resolving pain than corticosteroids, although there is some uncertainty about adverse effects and clinical response to tacrolimus showed conflicting results.

Topics: Adrenal Cortex Hormones; Calcineurin Inhibitors; Clobetasol; Cyclosporine; Humans; Lichen Planus, Oral; Oral Health; Pain Management; Randomized Controlled Trials as Topic; Tacrolimus

This study was carried out to assess and compare the efficacy of tacrolimus and clobetasol in the treatment of oral lichen planus (OLP). The Cochrane Central Register of Controlled Trials, PubMed, Scopus, Science Direct, Springer Journals, and Elsevier databases were searched using specific keywords relevant to the research question for articles published from 1998 to December 31, 2012. Finally, 15 articles that assessed the effects of tacrolimus, clobetasol, and pimecrolimus on improvements in OLP were reviewed. In addition, a meta-analysis of odds ratios (ORs) was carried out for data in 10 of the 15 articles. The results showed that the ORs for improvements in OLP in patients taking clobetasol or tacrolimus, compared with those taking placebo or other drugs, were 1.19 and 8.00, respectively. It appears that topical tacrolimus is an effective alternative to topical clobetasol and may be considered as a first-line therapy in the management of OLP.

Topics: Administration, Topical; Calcineurin Inhibitors; Clobetasol; Female; Humans; Immunosuppressive Agents; Lichen Planus, Oral; Male; Prognosis; Severity of Illness Index; Tacrolimus; Treatment Outcome

Topical corticosteroids are considered first-line therapy in patients with chronic inflammatory oral mucosal diseases; among them, clobetasol propionate is one of the most widely used in oral medicine. Under physiological conditions, the transmucosal application is characterized by a significantly greater absorption than the skin application. Contrary to many publications about the side effects of topical corticosteroids in dermatology, few studies have investigated the systemic effects due to local application of these drugs on oral mucosa. Although topical steroid therapy for the management of oral diseases is generally associated with local adverse effects (candidiasis, stomatopyrosis, and hypogeusia), these drugs can also lead to systemic side effects, such as suppression of the hypothalamic-pituitary-adrenal axis and Cushing's syndrome. This review reports five cases of systemic adverse effects caused by clobetasol propionate topical treatment.

Topics: Administration, Topical; Clobetasol; Cushing Syndrome; Female; Glucocorticoids; Humans; Iatrogenic Disease; Lichen Planus, Oral; Middle Aged; Pemphigoid, Benign Mucous Membrane

Lichen sclerosus et atrophicus is a depigmenting mucocutaneous disease most frequently affecting the female genitalia. Genital lesions are symptomatic and may be functionally debilitating. Oral lesions are of little significance other than the esthetic concerns of perioral lesions. In view of the rarity of reported cases, one lesion of the labial mucocutaneous area and a second of the palate are presented along with a description of the disease's clinical and histopathologic findings and a brief review of the literature. The lip lesion was partially resolved with topical corticosteroids and was then fully eliminated with topical testosterone. Histologic verification and examination for the simultaneous occurrence or absence of oral and the more common genital-cutaneous lesions is essential if meaningful information in the medical-dental literature is to be obtained in the future.

Topics: Administration, Topical; Adolescent; Anti-Inflammatory Agents; Antineoplastic Agents, Hormonal; Clobetasol; Diagnosis, Differential; Glucocorticoids; Humans; Lichen Planus, Oral; Lichen Sclerosus et Atrophicus; Lip Diseases; Male; Mouth Diseases; Palate, Soft; Testosterone

To evaluate the serum and salivary levels of IL-1β, IL-6, IL-17A, TNF-α, IL-4, and IL-10 in patients with oral lichen planus (OLP) treated with Photobiomodulation (PBM) and clobetasol propionate 0.05%.. Thirty-four OLP patients were randomized into two groups: Control (clobetasol propionate 0.05%) and PBM (660 nm, 100 mW, 177 J/cm. IL-1β, IL-6, IL-17A, TNF-α, and IL-4 levels were higher in saliva in relation to serum. IL-1β was the most concentrated cytokine in saliva, and a positive correlation with the severity of OLP was noticed. After treatment with corticosteroid, IL-1β in saliva decreased significantly. No modulation of all cytokines was observed after PBM.. IL-1β appears to be an important cytokine involved in OLP pathogenesis. In addition, the mechanisms of action of PBM do not seem to be linked to the modulation of pro or anti-inflammatory cytokines at the end of treatment. It is possible that this events occurred early during treatment.

Topics: Clobetasol; Cytokines; Humans; Interleukin-17; Interleukin-4; Interleukin-6; Lichen Planus, Oral; Saliva; Tumor Necrosis Factor-alpha

Oral lichen planus (OLP) is a chronic inflammatory disorder of the oral mucosa. Currently there is no approved treatment for OLP. We report on the efficacy and safety of a novel mucoadhesive clobetasol patch (Rivelin. Rivelin

Topics: Administration, Topical; Clobetasol; Female; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Middle Aged; Quality of Life

To compare the efficacy of photobiomodulation to that of topical clobetasol 0.05% in patients with symptomatic oral lichen planus (OLP).. Thirty-four patients with symptomatic OLP were randomly allocated into two groups: (a) the Control group (n = 17), application of topical clobetasol propionate 0.05% three times a day for 30 consecutive days with laser placebo applied twice a week to mask the treatment, and (b) the photobiomodulation group (n = 17), laser application twice a week, totalling 8 sessions, and gel placebo for 30 consecutive days to mask the treatment. Evaluations were performed once a week during treatment and 30, 60 and 90 days after treatment. The following parameters were evaluated: pain, clinical scores, clinical resolution and recurrence rate.. Photobiomodulation and propionate clobetasol 0.05% were able to significantly decrease pain in oral lichen planus patients and improve clinical scores during treatment and follow-up. Both the Control and photobiomodulation groups presented similar clinical resolution and recurrence rates. Most importantly, no difference was observed between treatments during treatment and follow-up.. These findings indicate that photobiomodulation twice a week is as effective as corticoid therapy in treating oral lichen planus. Moreover, photobiomodulation is a safe and non-invasive therapy with the remarkable advantage of no adverse effects.

Topics: Administration, Topical; Clobetasol; Double-Blind Method; Glucocorticoids; Humans; Lichen Planus, Oral; Treatment Outcome

Oral lichen planus (OLP) is a chronic, inflammatory, immune-mediated disease, which can alter the quality of life of patients. The aim of this randomized clinical trial was to compare the therapeutic efficacy of clobetasol oral gel 0.05% versus an anti-inflammatory in oral solution (mouthwash) in the management of patients suffering from symptomatic OLP. The secondary objective was to analyze which one of the two treatments induced a greater risk of developing side effects. Forty patients were assigned (20 patients for group), through a randomized design, to receive clobetasol gel 0.05% or an anti-inflammatory mouthwash, which contains calcium hydroxide, hyaluronic acid, umbelliferone and oligomeric pro-anthocyanidins) for three months. At baseline (T0) and after 3 months (T1), patients underwent dental and dermatological examinations to assess their symptoms (Numerical Pain Scale (NRS) score) and signs (Thongprasom score). Data were calculated using

Topics: Administration, Topical; Aged; Anti-Inflammatory Agents; Clinical Protocols; Clobetasol; Double-Blind Method; Female; Humans; Lichen Planus, Oral; Male; Middle Aged; Mouthwashes; Quality of Life

To perform a randomized, placebo-controlled, double-blind study, with a follow-up period of 6 months, for the use of topical clobetasol in cases of symptomatic oral lichen planus (OLP).. Thirty-two participants were analyzed, with the aims of: (I) to compare the usefulness of topically applied clobetasol propionate 0.05% (mixed with 4% hydroxyethyl cellulose gel) and 4% hydroxyethyl cellulose gel alone (considered as placebo) in the management of OLP; (II) to describe which of them is quicker in decreasing signs and reported symptoms, and (III) which is able to give the proper longer remission in the follow-up.. Symptoms improved in all clobetasol-treated patients during the first 2 months of therapy, while only 50% of placebo control group (p = .005) displayed similar results; of the remaining half, 12.5% did experienced a worsening while 37.5% remained stable. Regarding clinical signs, 87.5% of clobetasol-treated patients improved, while only 62.5% of the placebo-treated patients had a positive response (p = .229).. It is possible to report that clobetasol, at this dosage, has been more effective than a placebo at provoking symptoms improvement in subjects affected by atrophic-erosive oral lesions.

Topics: Administration, Topical; Aged; Anti-Inflammatory Agents; Clobetasol; Double-Blind Method; Female; Humans; Lichen Planus, Oral; Male; Middle Aged; Treatment Outcome

Oral lichen planus (OLP) is an idiopathic chronic mucocutaneous disease with a wide range of clinical manifestations, including white reticular patches, erosive/ulcerative and atrophic lesions, both associated with intense symptomatology. Topical corticosteroids are commonly used as standard therapy. However, patients frequently present relapses after the discontinuation of treatment as well as developing resistance to corticosteroid therapy. Photobiomodulation (PBM) has been shown to be a potential therapeutic tool to treat inflammatory disorders, including OLP. The aim of this study was to compare the efficacy of PBM (660 nm) with corticosteroid therapy with clobetasol propionate 0.05% for the treatment of OLP.. This protocol was approved (#2.375.410) by the Nove de Julho University (UNINOVE) Research Ethics Committee. The data gathered using this protocol will be published in a peer-reviewed journal.. NCT03320460.

Topics: Administration, Topical; Anti-Inflammatory Agents; Clobetasol; Double-Blind Method; Germany; Glucocorticoids; Humans; Lichen Planus, Oral; Low-Level Light Therapy; Quality of Life; Randomized Controlled Trials as Topic; Treatment Outcome

Oral lichen planus (OLP) is a common, chronic inflammatory disease of the oral mucosa. Although several studies have shown the efficacy of different treatment modalities, a definitive cure has not yet been established. The present trial compares the effectiveness of topically-applied clobetasol and tacrolimus in the symptomatic management of OLP.. A randomized, comparative, double-blind study with 68 patients (43 females, 25 males; mean age: 46.76 years) was undertaken. Patients were randomly divided into two groups of 34 patients each to receive topical tacrolimus 0.1% cream or clobetasol propionate 0.05% cream for 3 weeks.. After 3 weeks of treatment, the mean pain score dropped by 1.59 (right) and 1.53 (left) in the tacrolimus group, while in clobetasol group these values were 0.94 and 0.85, respectively. The mean scores for clinical appearance reduced by 1.18 (right) and 1.0 (left) in the tacrolimus group compared with a reduction of 0.5 and 0.26, respectively, in the clobetasol group. These reductions were statistically significant (P < .05).. The results suggest that tacrolimus 0.1% cream is an effective alternative to topical steroid and can be considered a first-line therapy in OLP. However, further studies are needed to confirm the effectiveness of this treatment before it is recommended for use in clinical practice.

Topics: Administration, Topical; Adult; Aged; Clobetasol; Double-Blind Method; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Lichen Planus, Oral; Male; Middle Aged; Sri Lanka; Tacrolimus; Young Adult

Epigenetics refers to changes in cell characteristics that occur independently of modifications to the deoxyribonucleic acid (DNA) sequence. Alterations mediated by epigenetic mechanisms are important factors in cancer progression. Although an exciting prospect, the identification of early epigenetic markers associated with clinical outcome in premalignant and malignant disorders remains elusive. We examined alterations in chromatin acetylation in oral lichen planus (OLP) with distinct clinical behavior and compared the alterations to the levels of DNA double-strand breaks (DSBs). We analyzed 42 OLP patients, who had different responses to therapy, for acetyl-histone H3 at lys9 (H3K9ac), which is associated with enhanced transcription and nuclear decondensation, and the presence of DSBs, as determined by accumulation of phosphorylated γH2AX foci. Patients with high levels of H3K9ac acetylation failed to respond to therapy or experienced disease recurrence shortly after therapy. Similar to H3K9ac, patients who responded poorly to therapy had increased accumulation of DNA DSB, indicating genomic instability. These findings suggest that histone modifications occur in OLP, and H3K9ac and γH2AX histones may serve as epigenetic markers for OLP recurrence.

Topics: Administration, Topical; Clobetasol; DNA Breaks, Double-Stranded; Epigenesis, Genetic; Female; Follow-Up Studies; Glucocorticoids; Histones; Humans; Lasers, Semiconductor; Lichen Planus, Oral; Low-Level Light Therapy; Male; Phosphorylation; Prognosis; Single-Blind Method; Time Factors; Young Adult

Oxidative stress is involved in oral lichen planus (OLP) pathogenesis; meanwhile anthocyanins are natural antioxidants present in grapes skin.. The aim of this research was to verify the utility of anthocyanins, extracted from grapes skin, for the local treatment of oral lichen planus and to compare it with clobetasol propionate- neomycin -nystatin cream (CP-NN).. Prospective, non-randomized study, with control group. Fifty-two patients with OLP were included. We divided patients into two categories: erosive oral lichen planus (EOLP) and non erosive oral lichen planus (NEOLP). 38 had EOLP (17 cases and 21 controls) and 14 presented NEOLP types (9 cases and 5 controls).Cases received local treatment with anthocyanins from grapes and controls, were treated with CP-NN. The clinical evolution of patients was followed up during six months.. The patients had a therapeutic response with anthocyanins. This was better than CP-NN treatment for patients with EOLP, in improving the involvement score of the oral mucosa and in the morphometric study of the affected areas. In EOLP there were no statistically significant differences in: therapeutic response time, the evolution of pain, or the relapse rate between the two groups. With respect to the treatment of NEOLP there was improved pain relief in the group treated with anthocyanins. This was not observed with CP-NN. The resting analized variables showed no significant difference with both treatments.. OLP has a favorable response to local treatment with anthocyanins from grapes. We found an equal to or better response than with CP-NN treatment. Many of our patients have systemic diseases, which may contraindicate the use of steroids. With regard to this particular group, the use of this natural antioxidant present in the diet is considered advantageous.

Topics: Administration, Topical; Anthocyanins; Clobetasol; Drug Combinations; Female; Humans; Lichen Planus, Oral; Male; Middle Aged; Neomycin; Nystatin; Prospective Studies

Oral lichen planus (OLP) is a relatively common chronic mucocutaneous inflammatory disease and a search for novel therapeutic options has been performed. We sought to compare the efficacy of laser phototherapy (LPT) to topical clobetasol propionate 0.05% for the treatment of atrophic and erosive OLP. Forty-two patients with atrophic/erosive OLP were randomly allocated to two groups: clobetasol group (n=21): application of topical clobetasol propionate gel (0.05%) three times a day; LPT group (n=21): application of laser irradiation using InGaAlP diode laser three times a week. Evaluations were performed once a week during treatment (Days 7, 14, 21, and 30) and in four weeks (Day 60) and eight weeks (Day 90) after treatment. At the end of treatment (Day 30), significant reductions in all variables were found in both groups. The LPT group had a higher percentage of complete lesion resolution. At follow-up periods (Days 60 and 90), the LPT group maintained the clinical pattern seen at Day 30, with no recurrence of the lesions, whereas the clobetasol group exhibited worsening for all variables analyzed. These findings suggest that the LPT proved more effective than topical clobetasol 0.05% for the treatment of OLP.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Clobetasol; Female; Glucocorticoids; Humans; Lichen Planus, Oral; Low-Level Light Therapy; Male; Middle Aged; Treatment Outcome

Clobetasol is the most potent topical corticosteroid used in oral medicine for muco-cutaneous diseases. Several papers reported about patients with cushingoid appearance, suggesting an adrenal suppression related to clobetasol systemic absorption after local application. Owing to the lack of studies, our goal is to assess whether transmucosal assimilation, after its application on oral mucosa, really occurs and to define clobetasol pharmacokinetics profile.. Data were recorded by collecting blood samples both on 10 patients in clobetasol therapy and on 14 healthy volunteers instructed about standardized clobetasol applications. A new technique of analytical chemistry was employed to detect its serum concentrations.. Clobetasol absorption was ascertained, showing a certain accumulation rate. Different levels have been found in relation to oral disease and individual features (as smoking habits and presence of oral mucosa erosion).. Our study validates clobetasol systemic transmucosal absorption, also recommending a careful monitoring of patients in corticosteroid therapy to avoid local and systemic adverse effects.

Topics: Absorption; Administration, Buccal; Aged; Anti-Inflammatory Agents; Chromatography, High Pressure Liquid; Clobetasol; Cross-Sectional Studies; Female; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Mouth Diseases; Mouth Mucosa; Pemphigoid, Benign Mucous Membrane; Smoking; Tandem Mass Spectrometry; Young Adult

Oral lichen planus (OLP) is a common disease of the oral mucosa with worldwide distribution and overall prevalence of 0.5-2.2%. Its etiology remains unclear, although the role of autoimmunity is supported by its association with other autoimmune diseases and the presence of auto-cytotoxic T cell clones in the lesions. Although many options for treating symptomatic OLP are available, no therapy is curative. This trial compared treatments with topical tacrolimus 0.1% ointment and topical clobetasol propionate 0.05% ointment. Forty patients with histologically proven symptomatic OLP were divided into two groups of 20 to receive clobetasol propionate (0.05%) ointment or tacrolimus (0.1%) ointment for eight weeks. Follow-up for all patients included three visits during the treatment course and one post-treatment visit. At each visit, objective improvement in the lesions was assessed by two independent investigators. The primary outcome measure was defined as the percentage of patients attaining complete response at eight weeks. Secondary outcome measures were the percentages of patients attaining complete or partial response at 8 and 12 weeks. Patient-observed improvement was evaluated at each visit. Demographic parameters and pretreatment disease characteristics were comparable between the groups. The mean net clinical score (NCS) declined progressively from baseline at each follow-up visit in both groups. In the clobetasol group, the mean NCS declined from 8.00 ± 2.65 at baseline to 2.00 ± 1.49 at 12 weeks. In the tacrolimus group, the mean NCS declined from 7.78 ± 3.25 at baseline to 1.31 ± 1.06 at 12 weeks. At each visit, the decline in mean NCS from baseline was statistically significant (P < 0.05) in both groups. Complete response rates of 40% and 70%, respectively, were achieved in the clobetasol and tacrolimus groups (P = 0.057). The percentages of patients reporting "good" or "very good" treatment responses at week 8 were 74% in the clobetasol group and 100% in the tacrolimus group (P > 0.05). No severe adverse events were reported. Tacrolimus 0.1% ointment is an effective alternative to topical steroid and may be considered as a first-line therapy in OLP.

Topics: Adult; Clobetasol; Double-Blind Method; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Lichen Planus, Oral; Male; Ointments; Tacrolimus

The work aimed at studying a new mucoadhesive prolonged release tablet containing 24 μg clobetasol-17 propionate (CP) suitable for the management of oral lichen planus. Low swellable dosage forms were designed by combining a mucoadhesive polymer, i.e. poly(sodium methacrylate, methylmethacrylate), with hydroxypropylmethylcellulose and MgCl₂. This formulation was selected to modify the tablet erosion rate in order to obtain a release of CP over a 6-h period. A double-blind, controlled study was performed using three groups of patient (n=16) who received three applications-a-day over 4 weeks of the developed CP tablets (group CP-T), placebo tablets (group CP-P) or commercial CP ointment for cutaneous application (123 μg/application) extemporary mixed with Orabase™ (group CP-O). At the end of the study, pain and ulceration resolved in 13/16 and 11/16 patients of group CP-T and group CP-O, respectively. In the group CP-O, a transient acute hyperaemic candidosis (n=2) and taste alteration (n=4) were also observed. No changes in clinical signs of patients in the group CP-P were evident. The application of mucoadhesive tablet containing 24 μg CP 3 times a day appeared to be effective, avoiding the side effects of the generally used treatment.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Aged; Clobetasol; Delayed-Action Preparations; Dosage Forms; Double-Blind Method; Drug Delivery Systems; Female; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Middle Aged

Oral lichen planus (OLP) is a chronic inflammatory disease that can be painful, mainly in the atrophic and erosive forms. Numerous drugs have been used with dissimilar results, but most treatments are empirical and do not have adequate control groups or correct study designs. However, to date, the most commonly employed and useful agents for the treatment of LP are topical corticosteroids. A randomized, double-blind, placebo-controlled trial has been designed to compare the efficacy and safety of two different formulations of clobetasol, a very potent topical steroid, in the topical management of OLP and to evaluate which gives the longest remission from signs and symptoms. Thirty-five consecutive patients were divided into two groups: the first received clobetasol propionate 0.025% and the second was given clobetasol propionate 0.05%. Both drugs were placed in 4% hydroxyethyl cellulose bioadhesive gel. Anti-mycotic prophylaxis was also added. After the end of therapy, patients received a 2-month follow-up. In all, 14 of the 15 clobetasol 0.025% patients (93%) and 13 of the 15 clobetasol 0.05% patients (87%), had symptoms improvement after 2 months of therapy (P = 0.001 in both groups). Also, 13 of the 15 clobetasol 0.025% patients (87%) and 11 of the 15 clobetasol 0.05% patients (73%) had clinical improvement after 2 months of therapy (P < 0.05 in both groups). No statistical differences were found in comparing the two different formulations. A larger concentration of the active molecules cannot further improve the therapeutic findings or optimize the obtained results in a significant manner.

Topics: Administration, Topical; Aged; Aged, 80 and over; Clobetasol; Dose-Response Relationship, Drug; Double-Blind Method; Female; Gels; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Middle Aged; Pain Measurement

The aim of this study was to evaluate the efficacy of a 0.05% clobetasol propionate ointment administered in trays to 22 patients with desquamative gingivitis in a double-blind, crossover, placebo-controlled trial. Patients received container number 1 and were instructed to apply the ointment 3 times a day for 2 weeks, and to reduce the application to once a day in the third week. Next, the patients were then instructed to discontinue the treatment for 2 weeks, and were then given container 2, used in the same way and for the same length of time as container 1. Regarding signs, 17 patients presented some improvement, while 5 experienced worsening with clobetasol propionate. With the placebo, 14 patients presented some improvement, and 8 patients presented worsening. For symptoms, there was complete improvement in 2 patients, partial improvement in 12, no response in 7, and worsening in 1 with clobetasol propionate. With the placebo, there was partial improvement in 8 patients, no response in 12 and worsening in 2. No statistically significant difference was found between clobetasol and placebo (p>0.05). Within the period designed to treat the gingival lesions of the patients, clobetasol propionate did not significantly outperform the placebo.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Cross-Over Studies; Double-Blind Method; Female; Gingivitis; Humans; Lichen Planus, Oral; Male; Middle Aged; Pemphigus; Severity of Illness Index; Treatment Outcome

Existing clinical trials have shown that topical corticosteroids are often effective in the management of oral lichen planus (OLP). However, tacrolimus has recently been shown to be an effective treatment of OLP.. To compare the effectiveness of clobetasol and tacrolimus in the topical management of OLP.. In this randomized comparative double-blind study, 30 consecutive patients with oral lesions consistent clinically and histologically with OLP were recruited. The patients were divided into 2 groups to receive clobetasol 0.05% or tacrolimus 0.1% ointment and were treated for 6 weeks.. The profiles of mean lesion sizes and mean pain measures did not differ between the tacrolimus and clobetasol treatment groups.. We found tacrolimus to be as useful as clobetasol in treatment of OLP. We believe that up-to-date evidence indicates the effectiveness of tacrolimus in treating OLP.

Topics: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Double-Blind Method; Female; Humans; Immunosuppressive Agents; Lichen Planus, Oral; Male; Middle Aged; Ointments; Tacrolimus; Treatment Outcome

Oral lichen planus (OLP) is considered to be an autoimmune disease of unknown aetiology that affects the mucosae, especially the oral cavity.. We compared tacrolimus 0.1% ointment and clobetasol 0.05% ointment for the treatment of OLP.. A total of 32 patients (20 females and 12 males; all white, Italian origin, mean age of 43.6+/-18.4 years; 16 patients per treatment group) were treated with tacrolimus or clobetasol ointment for 4 weeks in a randomized, double-blind, clinical trial. Pain severity, burning sensation, and mucosal lesion extension were assessed using a four-point scale.. At the end of the treatment period, symptom scores were significantly lower in the tacrolimus group than in the clobetasol group.. The results of this study suggest that tacrolimus 0.1% ointment is more effective than clobetasol propionate 0.05% ointment in the treatment of OLP. However, other studies are needed to confirm the effectiveness of this treatment before it can be recommended for use in clinical practice.

Topics: Adult; Anti-Inflammatory Agents; Clobetasol; Epidemiologic Methods; Facial Pain; Female; Humans; Immunosuppressive Agents; Lichen Planus, Oral; Male; Ointment Bases; Saliva; Tacrolimus

Topical steroids are the first choice for the treatment of oral lichen planus (OLP). Antifungal drugs are often employed together with them, to prevent secondary oral candidosis, although it has been suggested anecdotally that they can also be beneficial for OLP itself.. To compare the effect of clobetasol propionate with and without a topical antifungal drug (miconazole) on the symptoms and extension of OLP.. A randomized, parallel, double-blind trial was conducted at the Unit of Oral Medicine and Pathology of the University of Milan. Thirty-five outpatients with histologically proven OLP were randomly assigned to receive either clobetasol propionate and miconazole, or clobetasol propionate and placebo for 6 weeks. Primary outcomes included symptoms and extension of lesions; adverse effects were also recorded.. All the patients who concluded the study (30 of 35) showed clinical and subjective improvement within 3 weeks. The addition of miconazole did not affect in a significant way the signs and symptoms of OLP. No cases of clinical candidosis were seen in the patients taking miconazole, while one-third (five of 15) of the placebo group were affected.. Although effective in preventing iatrogenic candidosis, the addition of miconazole to topical steroid treatment does not improve the efficacy of the therapy.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Antifungal Agents; Candidiasis, Oral; Chemotherapy, Adjuvant; Clobetasol; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Lichen Planus, Oral; Male; Miconazole; Middle Aged; Treatment Outcome

Oral lichen planus (OLP) is a chronic inflammatory disease that can be painful, especially in the atrophic and erosive forms. Several drugs have been used with varying results, but most treatments are empirical, and do not have adequate control groups or correct study designs.. To compare the effectiveness of clobetasol and ciclosporin in the topical management of OLP and to evaluate which is more cost-effective and which gives the longest remission from signs and symptoms.. A randomized, comparative, double-blind study was designed. Forty consecutive patients were divided into two groups to receive clobetasol propionate or ciclosporin for 2 months. Both drugs were placed in 4% hydroxyethyl cellulose bioadhesive gel. Antimycotic prophylaxis was also given. After the end of therapy, patients underwent a 2-month follow-up.. Eighteen of 19 clobetasol-treated patients (95%) improved after 2 months of therapy, while 13 of 20 ciclosporin-treated patients (65%) had a clinical response (P = 0.04). Symptomatology improved in 18 clobetasol-treated patients (95%) and in 17 ciclosporin-treated patients (85%) (not statistically significantly different). Two months after the end of therapy, 33% of clobetasol-treated patients and 77% of ciclosporin-treated patients were stable (P = 0.04). Clobetasol produced significantly more side-effects than ciclosporin (P = 0.04). The daily cost of ciclosporin treatment was 1.82 compared with 0.35 for clobetasol therapy.. Clobetasol is more effective than ciclosporin in inducing clinical improvement, but the two drugs have comparable effects on symptoms. Conversely, clobetasol gives less stable results than ciclosporin when therapy ends and has shown a higher incidence of side-effects. The daily cost of ciclosporin is more than five times higher than clobetasol.

Topics: Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Clobetasol; Cyclosporine; Double-Blind Method; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Lichen Planus, Oral; Male; Middle Aged; Mouth Mucosa; Treatment Outcome

Topical application of clobetasol-17-propionate has been diffusely reported as an efficacious therapy in atrophic/erosive oral lichen planus (OLP), without exposing the patient to systemic side-effects. However, prolonged contact and respective topical effects on the oral mucosa should be avoided.. The aim of the present study was to evaluate efficacy and compliance of new lipid microspheres loaded with 0.025% of clobetasol propionate (formulation A) compared with a commonly used formulation (a sort of dispersion of a lipophilic ointment in a hydrophilic phase) with the same amount of drug (formulation B) in the topical treatment of OLP.. Fifty patients with symptomatic OLP were enrolled in a controlled single-blind phase IV clinical trial. After a dropout of five patients, a total of 45 patients [12 males and 33 females; mean age 61.1 years (+/- 12.3 SD; range 25-82)] were treated (17 with formulation A and 28 with formulation B, matched for gender and age; P > 0.2) with the same dosage regimen. At times T0, T1 and T2 we evaluated the following parameters: (i) pain score (by linear visual analogue scale; 0-100); (ii) clinical score; (iii) clinical resolution; and (iv) patient compliance. Statistical analysis was calculated using S-Plus 4.0 and SPSS 9.0 (Student's t-test, chi(2), Kolmogorov-Smirnow, Friedman, Student-Newman-Keuls, Mann-Whitney U-test and Spearman tests).. Both formulations were found to be similar for parameters ii, iii and iv, although with a better general trend for formulation A; a significant difference was registered for formulation A in terms of a reduction in painful symptoms (parameter i) at time T2 (P = 0.02).. Our results suggest that the new topical drug delivery system (formulation A) may enhance, at least in terms of symptom remission and compliance, the effectiveness of clobetasol propionate at a dose of 0.025% in OLP therapy.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Chemistry, Pharmaceutical; Clobetasol; Drug Delivery Systems; Female; Glucocorticoids; Humans; Lichen Planus, Oral; Lipids; Male; Microspheres; Middle Aged; Ointments; Patient Compliance; Single-Blind Method

Topical corticosteroids are the mainstay treatment for oral lichen planus (OLP), but some authors suggest that systemic corticosteroid therapy is the only way to control acute presentation of OLP.. Forty-nine patients with histologically proven atrophic-erosive OLP were divided into two groups matched for age and sex. The test group (26 patients) was treated systemically with prednisone (50 mg/day), and afterwards with clobetasol ointment in an adhesive medium plus antimicotics, whereas the control group (23 patients) was only treated topically with clobetasol plus antimycotics.. Complete remission of signs was obtained in 68.2% of the test group and 69.6% of the control group, respectively (P = 0.94). Similar results were obtained for symptoms. Follow-up showed no significant differences between the two groups. One-third of the patients of the test group versus none in the control group experienced systemic side-effects (P = 0.003).. The most suitable corticosteroid therapy in the management of OLP is the topical therapy, which is easier and more cost-effective than the systemic therapy followed by topical therapy.

Topics: Administration, Oral; Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Clobetasol; Female; Follow-Up Studies; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Middle Aged; Prednisone

We sought to analyze the results of topical treatment with a mouthwash of 0.05% clobetasol in aqueous solution in 30 patients with severe oral erosive lesions.. Over a 48-week period, we evaluated the evolution of pain, ulcerations, atrophy, and interference of the disease in the patient's daily life, classifying the response as complete (100% remission/recovery), excellent (75%), good (50%), poor (<50%), or failed.. The pain and ulceration totally disappeared in 93.3% of cases and 90% reported a full recovery in their daily life activities. Atrophy response was complete in 28.5%, excellent in 60.7%, and good in 3.5%. Two patients showed no response to the treatment. Five patients suffered mild adverse effects (moon face and hirsutism) between week 4 and week 6 of treatment, which were speedily reversed by reducing the frequency of mouthwash.. Clobetasol mouthwash is a safe and efficacious option for the treatment of severe oral erosive lesions.

Topics: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Drug Administration Schedule; Female; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Middle Aged; Mouth Mucosa; Mouthwashes; Pemphigoid, Benign Mucous Membrane; Stomatitis, Aphthous; Treatment Outcome

This study evaluated the clinical use of a corticosteroid in three preparations (topical clobetasol propionate ointment, clobetasol propionate in an oral analgesic base, and clobetasol propionate in an adhesive denture paste).. Fifty-four patients (34 males and 20 females) with a history of vesiculo-ulcero-erosive oral lesions were selected: 24 with oral erosive lichen planus and 30 with aphthae. The subjects enrolled were randomly divided into three groups, each of 18 patients (10 with aphthae and 8 with lichen planus): the first was treated with topical clobetasol propionate ointment (0.05%) directly on the lesion(s) three times a day; the second with clobetasol propionate in an adhesive denture paste in equal amounts (1:1) two times a day; the third with clobetasol propionate in an oral analgesic base (Orabase-B) in equal amounts (1:1) two times a day. Each subject scored his or her symptoms daily from most severe (7) to none (0) by verbal assessments using a categorical scale.. In all cases, the administration of the corticosteroid was effective in producing remission of symptoms in each group of patients. Significant differences (P<0.05) between groups were determined by the Kruskal-Wallis test. The Dunn test was used in order to detect which group differs from the others; clobetasol and adhesive denture paste correlated with an early remission of pain in lichen and apthous lesions.. The results suggest that topical application of clobetasol in an adhesive denture paste is an effective drug for symptomatic oral vesiculo-erosive and/or ulcerative lesions.

Topics: Adhesives; Administration, Topical; Adolescent; Adult; Anesthetics, Local; Anti-Inflammatory Agents; Benzocaine; Carboxymethylcellulose Sodium; Clobetasol; Female; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Middle Aged; Ointments; Pilot Projects; Stomatitis, Aphthous

To evaluate the efficacy of a combination of topical corticosteroids with topical antimycotic drugs in the therapy of atrophic-erosive forms of oral lichen planus (OLP).. The study population consisted of 60 patients with OLP subdivided into three groups matched for sex and age. The first group (25 patients) and the second group (24 patients) received respectively 0.05% clobetasol propionate ointment or 0.05% fluocinonide ointment in an adhesive medium (4% hydroxyethyl cellulose gel) plus in each case antimycotic treatment consisting of miconazole gel and 0.12% chlorhexidine mouthwashes. The third group (11 patients), placebo group, received only hydroxyethyl cellulose gel and antimycotic treatment as above. All the treatment regimens were carried out for 6 months. Each patient was examined every 2 months during the 6-month period of active treatment and for a further 6 months of follow-up. Objective and subjective clinical progress was scored and compared between the three groups. Plasma cortisol levels were monitored in half the patients using the topical corticosteroids.. All patients treated with clobetasol and 90% of the patients treated with fluocinonide witnessed some improvement, whereas in the placebo group only 20% of patients improved (P < 0.0001 and P = 0.00029, respectively. However, when considering complete responses, only clobetasol gave significantly better results than placebo. Clobetasol resolved 75% of the lesions whereas fluocinonide was effective in 25% of cases and placebo in none. Clobetasol achieved better results statistically than did fluocinonide (P = 0.00442) and placebo (P = 0.00049) whereas there was no statistical difference among fluocinonide and placebo (P = 0.140). Similar results were obtained for symptoms. Both drugs were shown to be effective in the treatment of erosive lesions, but clobetasol was considerably more efficacious than fluocinonide in the atrophic areas (75% vs 25% of total response, respectively) (P = 0.00442). None of the treated patients contracted oropharyngeal candidiasis. After 6 months of follow-up, 65% of the clobetasol-treated group and 55% of the fluocinonide group were stable. Estimation of plasma cortisol levels showed no significant systemic adverse effects of clobetasol or fluocinonide.. Our results suggest that a very potent topical corticosteroid such as clobetasol may control OLP in most cases, with no significant adrenal suppression or adverse effects. Moreover, a concomitant antimycotic treatment with miconazole gel and chlorhexidine mouthwashes is a useful and safe prophylaxis against oropharyngeal candidiasis.

Topics: Administration, Topical; Aged; Anti-Infective Agents, Local; Anti-Inflammatory Agents; Antifungal Agents; Chi-Square Distribution; Chlorhexidine; Clobetasol; Drug Therapy, Combination; Female; Fluocinonide; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Miconazole; Middle Aged

To compare topically applied mesalazine (5-aminosalicylic acid) to topically applied clobetasol propionate in the treatment of patients suffering from symptomatic oral lichen planus.. Randomized controlled longitudinal investigation.. Twenty-five out-patients suffering from oral lichen planus and referred to the Department of Oral Pathology and Oral Medicine of the University of Milan, Italy, during the period January to August 1997. Patients were randomly allocated (Group A and Group B) to treatment with mesalazine 5% or clobetasol propionate 0.05%. The drugs were topically applied twice daily for 4 weeks. Discomfort and pain were evaluated by the patient before and after treatment using a Visual Analogue Scale from zero (no pain) to 10 (extreme pain). Results were statistically evaluated by a Mann-Whitney U test.. The two pharmacological regimens obtained partial and complete absence of symptoms. In particular, the mesalazine tested group disclosed 57% complete absence of symptoms, 21.3% partial response and 9% no response. No statistically relevant difference has been detected between the two regimens.. The results of this preliminary study, if confirmed by further investigations, suggest that mesalazine might be considered an alternative to clobetasol propionate for treatment of symptomatic oral lichen planus.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Clobetasol; Female; Glucocorticoids; Humans; Lichen Planus, Oral; Longitudinal Studies; Male; Mesalamine; Middle Aged; Pain Measurement; Statistics, Nonparametric; Treatment Outcome

Because of their chronic nature treatment of oral vesiculoerosive diseases remains a challenge to the oral medicine specialist. Even though oral vesiculoerosive diseases respond well to systemic steroids, adverse side effects sometimes limit their use. Potent topical steroids are becoming increasingly useful to treat these chronic conditions with good control. The purpose of this double-blind clinical trial was to compare clobetasol propionate and fluocinonide ointment in orabase as treatments for controlling oral vesiculoerosive diseases. Sixty patients were asked to participate (43 women and 17 men). Data are reported for 55 patients. Each patient was seen at baseline and at days 7, 14, 21, and 28. Variables evaluated were pain, erythema, atrophy, and size of lesion. Overall, both medications had a beneficial effect in the control of symptoms and signs of oral vesiculoerosive diseases with minimal side effects. Clobetasol propionate was better than fluocinonide as measured by more rapid control of pain (within 7 days). Candidiasis was observed in 13 patients at the end of treatment (most of them carriers of Candida). Therefore normal carriers should be identified and treatment with antifungal therapy instituted before the patient begins using topical steroids.

Topics: Aged; Carboxymethylcellulose Sodium; Clobetasol; Double-Blind Method; Erythema Multiforme; Female; Fluocinonide; Humans; Lichen Planus, Oral; Linear Models; Male; Middle Aged; Mouth Diseases; Pemphigoid, Benign Mucous Membrane; Pemphigus

Cutaneous lichen planus is a highly pruritic dermatosis with an unmet need in its management. The aim of this study was to evaluate the short-term effect and tolerance of high doses of clobetasol propionate 0.05% in cutaneous lichen planus. We conducted a single-center retrospective cohort study from 2017 to 2021. All adults treated with high-dose (>5 g/day) clobetasol propionate 0.05% for cutaneous lichen planus were included. Patients with less than 10% affected body surface area at initial presentation or who received concomitant systemic therapy were excluded. The primary endpoint was the rate of complete remission by week 16. Secondary endpoints included maximum daily and median cumulative doses, reduction in pruritus and occurrence of adverse events. Fifty-seven patients, 60% female, with a mean age of 48 years (min-max,18-83) were included. Cutaneous lichen planus had been present for a median duration of 2 months at initial presentation (min-max, 1-4) and involved a median body surface area of 27%. Pruritus was reported by 55/57 (96%) patients. At week 16, 41/57 (72%) patients had achieved complete remission without treatment modification, among whom 25/41 (61%) had achieved it at week 6. The median daily and cumulative doses were, respectively, 20 g/day (IQR, 10-20) and 560 g (IQR, 320-925). Three patients experienced mild adverse events. No statistical association was demonstrated between the duration of the disease before treatment initiation and clinical response. In conclusion, high-dose clobetasol propionate 0.05% seems to be an effective, well-tolerated, and easy-to-implement treatment for cutaneous lichen planus.

Topics: Adult; Anti-Inflammatory Agents; Clobetasol; Female; Humans; Lichen Planus; Lichen Planus, Oral; Male; Middle Aged; Pruritus; Retrospective Studies; Treatment Outcome

Oral lichen planus (OLP) and recurrent aphthous stomatitis (RAS) are common chronic inflammatory conditions, manifesting as painful oral lesions that negatively affect patients' quality of life. Current treatment approaches are mainly palliative and often ineffective due to inadequate contact time of the therapeutic agent with the lesions. Here, we developed the Dental Tough Adhesive (DenTAl), a bioinspired adhesive patch with robust mechanical properties, capable of strong adhesion against diverse wet and dynamically moving intraoral tissues, and extended drug delivery of clobetasol-17-propionate, a first-line drug for treating OLP and RAS. DenTAl was found to have superior physical and adhesive properties compared to existing oral technologies, with ~2 to 100× adhesion to porcine keratinized gingiva and ~3 to 15× stretchability. Clobetasol-17-propionate incorporated into the DenTAl was released in a tunable sustained manner for at least 3 wk and demonstrated immunomodulatory capabilities

Topics: Animals; Chronic Disease; Clobetasol; Dental Cements; Hydrogels; Lichen Planus, Oral; Propionates; Quality of Life; Swine

Abstract.

Topics: Administration, Topical; Clobetasol; Gingivitis; Humans; Lichen Planus, Oral; Tacrolimus; Treatment Outcome

Oral lichen planus (OLP) is an immune-mediated disease of the oral mucosa with idiopathic aetiology. It is frequently treated with topical corticosteroids (applied as gels, mouthwashes, or sprays); however, the mucosal exposure times of topical corticosteroids are short because of removal by the constant flow of saliva and mechanical forces. In this study we used cell monolayers, as well as oral mucosal equivalents (OMEs) containing activated T-cells, to examine corticosteroid potency and delivery of clobetasol-17-propionate from a novel electrospun mucoadhesive patch. The OMEs displayed tight junctions, desmosomes, hemidesmosomes, and an efficient permeability barrier. Following application of corticosteroids to cells cultured as monolayers, the degree of cytotoxicity measured correlated to the level of potency recognized for each corticosteroid; by contrast, OMEs were largely unaffected by corticosteroid treatment. Permeation of clobetasol-17-propionate into and through the OMEs was time- and dose-dependent, regardless of whether this corticosteroid was delivered in liquid form or from a mucoadhesive patch, and both liquid- and patch-delivered clobetasol-17-propionate significantly reduced the secretion of interleukin-2 by activated T-cells. This study confirms that OMEs are more suitable models than cell monolayers for evaluating toxicity and drug delivery. After topical exposure, clobetasol-17-propionate accumulated in OMEs at a higher level than betamethasone-17-valerate and hydrocortisone-17-valerate, and exerted its immunosuppressive actions following application via the patch delivery system, highlighting the efficacy of this mode of drug delivery to treat OLP.

Topics: Administration, Topical; Adrenal Cortex Hormones; Clobetasol; Glucocorticoids; Humans; Lichen Planus, Oral; Mouth Mucosa

To determine corticosteroid treatment effectiveness in patients with oral lichen planus/oral lichenoid lesions (OLP/OLL).. Twenty-one patients with OLP and eighty-one patients with OLL received 0.05% clobetasol propionate (CP) or 0.05% triamcinolone acetonide (TA) in aqueous solution (AS) or orabase (OB), evaluating responses to treatment and follow-up compliance.. Lesions were atrophic (72 of 102; 70.6%), extensive (58 of 100; 58%), producing eating difficulties (62 of 102; 60.8%), and spontaneous pain (30 of 102; 29.4%); 50 patients (49%) received CP-AS. The mean ± SD percentage of follow-ups attended was 43 ± 32%. Symptom remission was achieved in 46% of patients receiving CP-AS, 36.36% of those receiving TA-AS, 20% of those receiving CP-OB, and 25% of those receiving TA-OB. Follow-up compliance was poor in 66.7% of patients. Among 51 patients with continuous symptoms, 64.7% evidenced total remission at treatment completion; among 33 with intermittent symptoms, 73.1% had outbreaks 2-3 times/year and 51.5% controlled outbreaks with <6 corticosteroid applications. Adverse effects were observed in seven patients (6.8%) (moon face, hirsutism, capillary fragility) in induction stage, subsiding with dose; among 15 patients under maintenance treatment for >6 months, one showed hypothalamic-pituitary-adrenal (HPA) axis inhibition but not adrenal insufficiency.. Our treatment proved highly effective and safe. Recall programs are desirable to enhance follow-up compliance.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Carboxymethylcellulose Sodium; Clobetasol; Drug Combinations; Female; Humans; Lichen Planus, Oral; Male; Medication Adherence; Middle Aged; Treatment Outcome; Triamcinolone Acetonide

Scoring systems have been widely used to evaluate the severity and activity of oral lichen planus (OLP). The aim of the present study was to compare two existing (one modified) scoring systems in the evaluation of OLP severity and correlation with pain. Three differently experienced raters were involved.. Consecutive patients with OLP were assessed for pain using the Visual Analogue Scale and examined at 10 intraoral sites before starting (T0) and three weeks after (T1) steroid therapy (Clobetasol). Three differently experienced raters evaluated photographs using two scoring systems designated White-Erosive-Atrophic (WEA) modified from an older WEA system (WEA-MOD) and Reticular-erythematous-Ulcerative (REU) systems. WEA-MOD Kendall's W and interclass correlation coefficient were calculated and correlation between REU/WEA-MOD and pain was calculated using Spearman coefficient.. Most patients showed lesions on buccal mucosa (85-93,5%) and maxillary/mandibular gingivae (31,8-31,2%), predominantly reticular. At T0, Kendall-W coefficients of 0.89 and 0.74 were obtained for the REU and WEA respectively. At T1, Kendall-W coefficients of 0.83 and 0.58 were obtained for the REU and WEA respectively. Interclass correlation coefficient ranged from 0.87 to 0.90 for REU and from 0.58 to 0.87 for WEA. REU and WEA scores significantly decreased after therapy (p<0.000) as well as VAS (p<0.05). REU score showed correlation with VAS.. All the raters achieved comparable measures using REU whereas WEA and WEA-MOD seem less reproducible. REU seems to correlate to disease activity and pain.

Topics: Clobetasol; Female; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Middle Aged; Pain; Pain Measurement; Severity of Illness Index

Pubmed, the Cochrane library, Scopus, Science Direct and two publishing company journals between 1998 and 2012.. Randomised controlled trials (RCTs) where the population included patients having OLP and the interventions were the use of clobetasol or tacrolimus compared to another intervention, while the outcome was improvement in clinical status.. Two authors working independently assessed for inclusion and performed data extraction. Quality was evaluated using Critical Appraisal Skills Programme (CASP) worksheets (http://www.casp-uk.net/). The treatment effect was calculated using OR and then pooled using a fixed model since heterogeneity was calculated as very low.. Ten studies were included; five studies involved clobetasol and five involved tacrolimus. Two meta-analyses were presented. The odds ratio for improvement for clobetasol was 1.21 (95%CI; 0.48 - 3.05) and 8.09 (95%CI; 3.77 - 17.38) for tacrolimus.. The authors concluded that using clobetasol or tacrolimus increases the odds of improvement of OLP lesions and therefore they are effective treatment for the condition, and go on to recommend tacrolimus as first-line therapy.

Topics: Clobetasol; Female; Humans; Lichen Planus, Oral; Male; Tacrolimus

Oral lichen Planus (OLP) is a chronic inflammatory disease involving skin and mucous membranes. Its etiology is still uncertain whilst an autoimmune mechanism is known to be implicated. OLP is commonly considered a geriatric disease and gender differences in prevalence are clear, whereby females are generally more frequently affected than males more often during the 5th and 6th decades of life. Lesions are symmetrical and bilateral and the buccal mucosa is frequently involved. The risk of malignant transformation is extremely low. This study aims to describe both the clinical characteristics and the prevalence of OLP among a group of patients from Southern Italy. The results of the present study were compared to analogous retrospective studies.. Eighty-seven (31 man and 56 woman) cases of OLP were retrospectively reviewed and demographic and clinical data were collected. Data about OLP as clinical forms, oral and extraoral sites involved and Visual Analogue Scale were also recorded.. The average age of OLP onset was 59.2 years. The most common clinical presentation was the hyperkeratosic type. Symptomatic OLP was noted in 26.8 % of the patiens. The most frequently affected oral sites were buccal mucosa, tongue, gums. The most frequently associated systemic diseases were diabetes, hypertension, C hepatitis and thyroiditis. Only one patient developed a malignant transformation (1.2 %).. Previous retrospective studies report data partially comparable with our results. Different geographic area, number of enrolled patients and OLP classification criteria may justify the observed differences.

Topics: Adrenal Cortex Hormones; Aged; Aged, 80 and over; Calcineurin Inhibitors; Clobetasol; Drug Therapy, Combination; Female; Humans; Italy; Lichen Planus, Oral; Male; Middle Aged; Pain Measurement; Retrospective Studies; Treatment Outcome

Oral hairy leukoplakia (OHL) is an EBV-associated condition of the oral mucosa, which is often painless. It is found predominantly in HIV-positive patients and is considered a clinical indicator of immunosuppression. OHL has rarely been described in HIV-negative patients, being found most often in association with iatrogenic immunosuppression. OHL induced by topical steroids remains extremely rare.. An 81-year-old HIV-negative woman, treated for 3 months with topical steroids for oral lichen planus, developed an asymptomatic white, corrugated, non-removable plaque with vertical folds on the lateral edge of the tongue. Associated oral candidiasis was noted. Based upon histological findings and in situ hybridisation showing numerous EBV-infected epithelial cells, a diagnosis of oral hairy leucoplakia was made.. To our knowledge, we report herein only the second recorded case of OHL induced strictly by topical steroids. Self-medication and poor adherence to dosage recommendations were noted in the patient's medical history. Physicians must be aware of the rare but nevertheless possible adverse events associated with topical steroid use, particularly when such medication is prescribed over a long period for inflammatory diseases of the oral mucosa.

Topics: Administration, Topical; Aged, 80 and over; Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Betamethasone Valerate; Candidiasis, Oral; Clobetasol; Epithelial Cells; Female; Herpesvirus 4, Human; HIV Seronegativity; Humans; Leukoplakia, Hairy; Lichen Planus, Oral; Self Medication; Tongue

Oral lichen planus is a common, chronic mucosal disease associated with T-cell-mediated immunological dysfunction. The disease is classified in a painful red form with erosions and ulcerations and a less painful to painless white form with reticular, papular and plaque lesions. In a small proportion of cases, the lesions may develop into a squamous cell carcinoma. Corticosteroids are the mainstay of the therapy; the combination of systemic and topical corticosteroids is often very effective. Topical calcineurin inhibitors, especially tacrolimus, have produced long-term responses in clinical studies. We describe a patient with excellent response to therapy with tacrolimus mouthrinse and systemic corticosteroids.

Topics: Administration, Oral; Administration, Topical; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Clobetasol; Drug Therapy, Combination; Humans; Injections, Intravenous; Lichen Planus, Oral; Male; Middle Aged; Mouth Diseases; Tacrolimus; Treatment Outcome

Oral candidiasis is an important side effect of topical corticotherapy. The purpose of this study was to assess oral mucosa colonization by five Candida species during topical corticotherapy and to investigate Candida spp. pathogenicity and in vitro susceptibility to fluconazole and amphotericin B.. Oral swabbing samples from 11 erosive oral lichen planus (OLP) patients were collected before (day 0) and at days 7 and 30 of topical corticotherapy. Conventional methods for identification and quantification of Candida species, quantitative PCR (qPCR), pathogenicity tests and in vitro susceptibility to fluconazole and amphotericin B assays were performed.. Candida albicans was the most prevalent species in the oral mucosa after corticotherapy. Increased number of colony-forming units (CFU) and Candidaalbicans DNA copies were observed at day 30 of corticotherapy, despite no clinical evidence of candidiasis in any patient. Colony-forming units’ count of Candida species was less sensitive than qPCR, but both methods positively correlated. No resistance to fluconazole or amphotericin B was observed.. Topical corticoid used for oral erosive lichen planus treatment was associated with increase in Candida spp., in particular, C. albicans, in the oral cavity, independent of clinical manifestation of the disease.

Topics: Administration, Topical; Adult; Aged; Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candida glabrata; Candida tropicalis; Candidiasis, Oral; Clobetasol; Colony Count, Microbial; Drug Resistance, Fungal; Female; Fluconazole; Follow-Up Studies; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Middle Aged; Mouth; Peptide Hydrolases; Phospholipases

To examine whether oral lichen planus (OLP) affects the success rate of dental implants and if the manifestations of OLP are altered by implant-borne prostheses.. OLP patients, treated in the oral medicine department, with (the study group) and without (control group) dental implants were included. Pocket depth, mobility, bleeding on probing, erythema, pain and radiolucency around the implants, as well as clinical findings and OLP symptoms were recorded. Follow-up ranged from 12-24 months. Ordinal variables and visual analog scale score were compared using the Mann-Whitney test. The significance of the trend within each of the groups was assed using the Friedman test. Categorical variables were compared using Pearson chi-squared test and Fisher's exact test.. Fourteen patients in the study group with 1-15 implants per patient and 15 in the control group were included. No implant failures were recorded. Comparison between the clinical manifestations of OLP in both groups did not reveal any significant differences.. Success of implant rehabilitation among treated OLP patients does not seem to be different from the success rate in the general population. Nor does implant placement influence the disease manifestations.

Topics: Anti-Inflammatory Agents; Case-Control Studies; Clobetasol; Dental Implants; Dental Prosthesis Retention; Dental Prosthesis, Implant-Supported; Dexamethasone; Erythema; Female; Follow-Up Studies; Gingival Diseases; Gingival Hemorrhage; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Middle Aged; Mouth Mucosa; Pain Measurement; Periodontal Pocket; Retrospective Studies; Treatment Outcome; Triamcinolone

To evaluate disease dynamics, treatment results, and frequency of malignant transformation. Ten-year single center retrospective study. The study included 171 patients, 28-99 years old. Follow-up was 1-16 years. 49.5% exhibited changes in clinical presentation, with 19% yearly increase of probability for type shift. Index of extent (number of oral locations) showed a mean 40% decrease and 94.1% reported improvement. There were significant differences between treated and untreated patients (P=0.012). Patients with or without systemic diseases had identical treatment requirements for oral lesions. The prevalence of SCC was 5.8%. Oral lichen planus constantly changes presentation and extent of involvement. The effect of systemic diseases was insignificant in the present study. There is a clear value for treatment to reduce the extent of lesions. The results indicate that all clinical forms of the disease need to be equally followed since the clinical presentation typically changes over time, while malignant transformation can occur in all forms.

Topics: Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Carcinoma, Squamous Cell; Cell Transformation, Neoplastic; Clobetasol; Dexamethasone; Female; Humans; Lichen Planus, Oral; Male; Middle Aged; Mouth Neoplasms; Precancerous Conditions; Prednisone; Prevalence; Retrospective Studies; Tacrolimus; Tretinoin; Triamcinolone

The presence of atrophic-erosive lesions among gingival tissues makes oral hygiene procedures difficult for several reasons. Plaque control and rigorous oral hygiene are a fundamental requisite for the treatment of any oromucosal disease.. A patient suffering from a mixed atrophic-erosive form of oral lichen planus (OLP), with serious gingival involvement, was also treated with the topical application of clobetasol propionate 0.05% using gingival trays. The highest hygiene standards of both patient and trays were of fundamental importance.. The management of the patient suffering from gingival atrophic-erosive OLP requires the synergic treatment of both dentist and dental hygienist, whose contribution supports the corticosteroid and/or immunosuppressive treatment.

Topics: Administration, Topical; Anti-Inflammatory Agents; Clobetasol; Dental Care for Chronically Ill; Gingival Diseases; Humans; Lichen Planus, Oral; Male; Middle Aged; Oral Hygiene; Patient Education as Topic; Treatment Outcome

Oral topical corticosteroids have potential to produce inhibition of the hypothalamus-pituitary-adrenal (HPA) axis.. To assess whether clobetasol propionate (CP) in aqueous solution causes HPA inhibition.. Sixty-two patients with oral lichen planus or oral lichenoid lesions presenting with severe lesions were treated with topical oral 0.05% CP plus 100,000 IU/cm(3) nystatin in aqueous solution. Initial treatment of three 5-min mouthwashes (10 mL) daily was reduced, when the response was deemed complete or excellent, to a maintenance treatment of one 5-min mouthwash on alternate days for 6 months; treatment was then withdrawn and patients were followed up for 1 year. HPA function was assessed by plasma cortisol measurement and adrenocorticotropin (ACTH) stimulation at the end of the initial and maintenance treatment regimens.. The HPA axis was more frequently inhibited during initial (53/62; 85.5%) vs. maintenance (2/49; 4%) regimens of aqueous CP.. In patients with morning plasma cortisol levels between 3 and 18 microg/dL, a normal result for the ACTH stimulation test only moderately reduces the possibility that a patient has secondary adrenal insufficiency. This can be considered a minor limitation in our study, as only three patients required additional assessment with the ACTH stimulation test.. Hypothalamus-pituitary-adrenal inhibition is substantial during initial treatment with aqueous CP three times daily.

Topics: Administration, Oral; Anti-Inflammatory Agents; Clobetasol; Humans; Hypothalamo-Hypophyseal System; Lichen Planus, Oral; Pituitary-Adrenal System; Retrospective Studies

Oral lichen planus (OLP) is a chronic mucosal disorder of unclear etiology. The mainstay of therapy is topical use of steroids but other immuno-modulating therapies have also been tried. One such example is topical application of tacrolimus. Tacrolimus was in 2000 approved for treatment of atopic dermatitis, but in 2005 a boxed warning was included because of a potential risk of cancer development and for lack of long-term studies of the safety of the drug. The present study describes a patient who in 2003 was diagnosed with OLP and where treatment has included an intermittent use of tacrolimus. Five years after diagnosis, the patient developed a squamous cell carcinoma in the region where tacrolimus had been applied. The possible relationship between the use of tacrolimus and cancer development and rationale to include tacrolimus in OLP treatment is discussed.

Topics: Administration, Buccal; Carcinoma, Squamous Cell; Clobetasol; Follow-Up Studies; Glucocorticoids; Humans; Immunosuppressive Agents; Lichen Planus, Oral; Male; Middle Aged; Mouth Neoplasms; Tacrolimus; Triamcinolone Acetonide

The purpose of this paper is to describe two cases of desquamative gingivitis (DG) that were treated with a topic gel containing clobetasol propionate and Calendula officinalis L in an acetate tray over two years.. Two patients with a diagnosis of lichen planus presenting as DG who had undergone previous treatments for this condition with no significant results, were treated by a handling gel containing clobetasol, nystatin, Calendula officinalis L and pectin in custom trays.. Both patients had remission of symptoms while using the trays and after they stopped the treatment, the symptomatic outbreaks were delayed and presented as less severe symptoms in the two years follow-up. The treatment is aimed primarily at reducing the length and severity of symptomatic outbreaks desquamative gingivitis.. This handling gel using a tray may be an efficacious treatment of desquamative gingivitis.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Calendula; Clobetasol; Drug Delivery Systems; Female; Gels; Gingivitis; Humans; Lichen Planus, Oral; Male; Phytotherapy; Remission Induction

Topics: Administration, Topical; Aged; Clobetasol; Cushing Syndrome; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Gels; Glucocorticoids; Humans; Lichen Planus, Oral; Mouth Mucosa; Risk Assessment

Lichen planus pemphigoides (LPP) is a rare, acquired, immunobullous disorder of skin that occasionally involves oral mucous membranes. Clinical, histologic, and immunopathologic findings of the oral manifestations of LPP are described. Clinical features are lichenoid striae, erosions, and ulcerations involving gingiva and buccal mucosae. Histopathologic features are similar to those of ora lichen planus. Direct immunofluorescence demonstrates linear deposits of immunoglobulin G and complement component C3 along the basement membrane with fibrillar deposits of fibrin at the epithelial/lamina propria junction. Fluorescence overlay antigen mapping and laser scanning confocal microscopy of the biopsy specimen exhibits colocalization of in situ antibodies with beta4 integrin, a marker of the keratinocyte basal plasma membrane and upper lamina lucida, consistent with the location of the bullous pemphigoid antigens. This case report describes a case of LPP that presented exclusively as an oral condition. Lichen planus pemphigoides should be considered in the clinical differential diagnosis of vesiculoerosive oral mucosal diseases.

Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Chlorhexidine; Clobetasol; Complement C3; Doxycycline; Female; Fluorescent Antibody Technique; Gingival Diseases; Humans; Immunoglobulin G; Keratinocytes; Lichen Planus, Oral; Microscopy, Confocal; Middle Aged; Mouth Mucosa; Ointments; Oral Ulcer; Pemphigoid, Bullous

The objective of the present study was to compare a new type of symptomatic lichenoid reaction, specifically located on the mucosal side of the lips, and associated with microorganisms, with a matched group presenting with reticular oral lichen planus (OLP) of the buccal mucosa.. The mean age for both groups was 66 years with a predominance of women (62%). The lichenoid reaction group (n = 25) presented with a reticular reaction pattern embracing various degrees of erythema. Patients presenting with OLP had similar lesions confined to the buccal mucosa but not on the mucosal side of the lips.. In both groups, 80% were on any type of medication. However, 56% of the patients with lichenoid reactions medicated with more than three drugs compared with 29% (P < 0.05) in the OLP group. The former group more often used medicaments prescribed for cardiovascular diseases (48%vs 25%). Twenty-two of the patients with lichenoid reactions were treated with chlorhexidine. In 80% of these patients (n = 18), the lesions improved or completely healed, indicating a microbial association.. Lichenoid reactions present on the mucosal side of the lips may be initiated by microbial plaque precipitated on the buccal surfaces of the anterior teeth.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Anti-Inflammatory Agents; Cardiovascular Agents; Case-Control Studies; Chlorhexidine; Clobetasol; Composite Resins; Dental Calculus; Dental Restoration, Permanent; Erythema; Female; Glucocorticoids; Humans; Lichen Planus, Oral; Lichenoid Eruptions; Lip Diseases; Male; Middle Aged; Retrospective Studies; Risk Factors

Topics: Anti-Inflammatory Agents; Clobetasol; Cyclosporine; Humans; Immunosuppressive Agents; Lichen Planus, Oral; Research Design; Treatment Outcome

Lichen planus with simultaneous oral and genital involvement in males is a quite rare condition and often difficult to diagnose. The prevalence, treatment options, and management for this condition are far from being established, and research in this area primarily relies on anecdotes. We present the clinical features of eight cases of peno-gingival lichen planus and propose a management algorithm for this condition based on the best available published evidence.. Personal medical history was collected for all cases. Following careful examination of the oral and genital mucosae, pathology was obtained, previous treatments and duration of mucosal lesions ascertained, treatment initiated, and response evaluated at 8 weeks on both oral and genital lesions. The first-line drug was topical clobetasol propionate 0.05% cream in all cases; in case of failure, topical cyclosporin was used. A review of the literature on treatment options for this rare condition was performed based upon standard literature review practices.. Five cases presented gingival lesions that clinically resembled lichen planus. Glans penis was involved in all patients. All patients responded to treatment except for one. Oral candidiasis was the only observed side effect.. Genital lichen planus may be suspected in males when atrophic-erosive gingival lichen planus is found. A thorough multidisciplinary medical management and active early treatment are necessary to improve symptoms and prevent genital sequelae and, given the risk of squamous cell carcinoma, as a preventative strategy, although this area still needs investigation. Therapeutic trials relating to the treatment of peno-gingival lichen planus may be undertaken considering that current management relies exclusively on observations of case reports.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Candidiasis, Oral; Cheek; Clobetasol; Cohort Studies; Follow-Up Studies; Gingival Diseases; Glucocorticoids; Humans; Lichen Planus; Lichen Planus, Oral; Lip Diseases; Male; Medical History Taking; Middle Aged; Penile Diseases; Remission Induction; Tongue Diseases; Treatment Outcome

We sought to describe the response of patients with severe erosive gingival lesions to treatment with clobetasol propionate in Orabase paste administered in trays. The adverse effects were also recorded.. A descriptive pretest/posttest clinical study with no control group (33 patients total) was developed. All patients received repeated applications of 0.05% clobetasol propionate plus 100,000 IU/cc of nystatin in Orabase paste. Over the 48-week period, the pain levels, ulcerations, presence of atrophy, and the patients' daily activities were recorded, and Likert scales were used to classify each outcome as either a complete recovery, excellent, good, poor, or failed. The presence of any adverse effect was also noted.. At the end of the study period, the pain and ulceration had disappeared (complete response) in 100% of the sample (33/33; 95% confidence interval = 89.4%-100%), and there was a complete recovery of daily activities and remission of atrophy in 93.9% (31/33; 95% confidence interval = 79.8%-99.3%) and 21.2% (7/33; 95% confidence interval = 9.0%-38.9%) of the patients, respectively. No adverse effects related to the treatment were observed.. The application of an Orabase paste of 0.05% clobetasol 17-propionate plus 100,000 IU/cc of nystatin by means of a tray appears to be an efficacious treatment for severe erosive gingival lesions.

Topics: Activities of Daily Living; Administration, Topical; Adult; Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents; Autoimmune Diseases; Clobetasol; Confidence Intervals; Drug Combinations; Female; Follow-Up Studies; Gingival Diseases; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Middle Aged; Nystatin; Pain Measurement; Patient Satisfaction; Pemphigoid, Benign Mucous Membrane; Stomatitis, Aphthous

Desquamation of the gingiva is a sign that may be encountered in clinical practice. Various diseases can affect the gingival tissues. Mild desquamation that is localized may be associated with mechanical irritation or induced by trauma. Moderate to severe generalized desquamation associated with ulceration and erythema may be indicative of a more serious systemic condition. Although often overlooked, mucocutaneous diseases frequently present with gingival desquamation as an early presenting symptom. The most common mucocutaneous diseases that affect the oral cavity are lichen planus, pemphigus, and mucous membrane pemphigoid. This article reviews the etiology, signs and symptoms, and therapies for these disorders. Increased knowledge of mucocutaneous diseases can help the clinician recognize these disorders and enable the patient to receive appropriate therapy.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Autoimmune Diseases; Biopsy; Clobetasol; Dapsone; Diagnosis, Differential; Fluocinonide; Gingivitis; Glucocorticoids; Humans; Immunosuppressive Agents; Lichen Planus, Oral; Pemphigoid, Benign Mucous Membrane; Pemphigus; Prednisone

Topics: Clobetasol; Female; Hepatitis C, Chronic; Humans; Lichen Planus; Lichen Planus, Oral; Middle Aged

Topics: Adhesives; Administration, Topical; Anti-Inflammatory Agents; Clobetasol; Drug Carriers; Follow-Up Studies; Glucocorticoids; Humans; Lichen Planus, Oral; Recurrence; Stomatitis, Aphthous; Treatment Outcome

Oral lichen planus, or OLP, is a common mucocutaneous immunological disease. The objective of this study was to describe the patient profile, disease progression and treatment responses.. The authors conducted a retrospective, descriptive study using information from patient records at a tertiary referral center. The study included 229 patients with OLP who were seen in the oral medicine clinic at the University of California, San Francisco, between September 1996 and August 2000, for the first time or for a follow-up visit. Signs and symptoms at various clinic visits were quantified. Responses to treatment and disease progression were determined by comparing scores with baseline scores.. The mean age at onset of the disease was 55 years, and 154 (67 percent) of the patients were female. Symptoms generally correlated directly with the severity of OLP forms, which ranged from reticular to erosive. Corticosteroids were effective in reducing symptoms, healing ulcers and reducing erythema. At last follow-up, 65 percent of the patients had the same type of OLP seen initially or the disease had progressed to a more severe type, while 35 percent of patients had less-severe forms than that seen at the initial visit. Four patients (1.7 percent) developed oral squamous-cell carcinoma during the follow-up period.. OLP is a chronic disease with no known cure. Symptoms can improve with corticosteroids; however, the lack of long-term (that is, lifetime) treatment compliance and the adverse side effects of the drugs limit optimal results.. Patients with OLP should be treated if symptoms are significant. Follow-up--including supervision of medication use and monitoring of side effects, as well as periodic examinations for possible malignant transformation--is necessary.

Topics: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents; Azathioprine; Carcinoma, Squamous Cell; Cell Transformation, Neoplastic; Chronic Disease; Clobetasol; Disease Progression; Female; Fluocinonide; Follow-Up Studies; Glucocorticoids; Humans; Immunosuppressive Agents; Lichen Planus, Oral; Male; Middle Aged; Mouth Neoplasms; Prednisone; Retrospective Studies; Statistics, Nonparametric; Treatment Outcome