isotretinoin and Gingival-Diseases

The aim of the present study is to verify the efficacy of isotretinoin in oral lichen planus (OLP). In a double-blind study, ten patients with biopsy-proven OLP were treated for 4 months with 0.1% isotretinoin gel and another ten patients with placebo. At the end of the first period of observation, the patients who had been given the placebo were given isotretinoin for a further 4 months. A complete response was defined as the disappearance of the lesions as assessed by inspection, whereas a partial response was defined as a 50% or more reduction in the size of the lesions. All patients treated with isotretinoin showed a significant improvement of the oral lesions, whereas in the patients who were given the placebo, the size of the lesions remained the same. The patients who were given isotretinoin after the placebo showed a reduction in lesions. In total, there were ten complete and ten partial responses. Lesions were analysed histologically and immunohistochemically with antibodies against bcl-2 and Ki-67. Ki-67 and bcl-2 have statistical significant increased values from before to after treatment, whereas apoptotic bodies decreased one. All these facts could have contributed to the partial or complete regression of OLP lesions. The increase in Ki-67 positive cells show that the epithelium requires for enhanced proliferation and healing. The present results revealed a disturbed cell death programme in OLP that could underline an abnormal epithelial differentiation. The results of this pilot study show that the topical use of isotretinoin is effective in treating OLP.

Topics: Adult; Aged; Apoptosis; Cell Proliferation; Cross-Over Studies; Double-Blind Method; Epithelium; Female; Gingival Diseases; Humans; Immunohistochemistry; Isotretinoin; Keratolytic Agents; Ki-67 Antigen; Lichen Planus, Oral; Male; Middle Aged; Mouth Mucosa; Pilot Projects; Placebos; Proto-Oncogene Proteins c-bcl-2; Remission Induction; Tongue Diseases

Topics: Female; Gingival Diseases; Humans; Isotretinoin; Lichen Planus; Lichenoid Eruptions; Middle Aged; Vaginal Diseases; Vulvar Diseases

Periodontal health in relation to systemic retinoid medication was evaluated retrospectively in patients with Papillon-Lefèvre Syndrome (PLS). The material consisted of 18 children/young adults ranging from 8 to 28 years of age, all with a confirmed diagnosis of PLS. 9 participants, comprising a medication group, had been on long-term (range 1.5-9 years) retinoid medication for their cutaneous lesions. The remaining 9 served as controls. Regardless of whether or not retinoid medication was received, every patient experienced an early and devastating periodontitis, with atypical edematous and erythematous gingiva, suppuration from deep gingival pockets and premature loss of teeth. No correlation could be found between the severity of skin involvement and the severity of periodontal involvement. An improvement with age could be seen for the cutaneous lesions but not for the periodontal condition. Systemic medication with retinoids had a favorable therapeutic effect on cutaneous lesions, and no severe complication/side effect could be seen after several years of continuous use. However, from the results of this study it can be concluded that, at least in a situation with poor compliance of daily oral home-care, no positive effect on the periodontal health in patients with PLS could be seen by the retinoid medication.

Topics: Adolescent; Adult; Child; Edema; Erythema; Etretinate; Female; Gingival Diseases; Gingival Pocket; Humans; Isotretinoin; Keratolytic Agents; Male; Papillon-Lefevre Disease; Patient Compliance; Periodontal Diseases; Periodontitis; Periodontium; Retrospective Studies; Skin; Suppuration; Tooth Exfoliation