Oral lichen planus (OLP) is a chronic T cell-mediated inflammatory condition, with a global prevalence of 0.1 to 3.2%. It is more common in the fourth or fifth decade of life and has a predilection for the female sex. Clinically, OLP is characterized by white reticulations (Wickham’s striae), erythema, and/or ulcerations. Although there is no consensus on subtypes, OLP is often classified as reticular/keratotic, erythematous/erosive, or ulcerative.
OLP can be asymptomatic or symptomatic, and when symptomatic, it can range from mild tenderness to significant pain that affects quality of life. It is considered a potentially malignant oral disorder with a malignant transformation rate of 0.4 to 1.4.
The exact etiology of OLP is unknown and there is currently no known cure. The primary therapeutic goal is symptom control and current treatment options include corticosteroids, calcineurin inhibitors, retinoids, photodynamic therapy, and natural alternatives, although with varying degrees of effectiveness.
A recent meta-analysis of 55 RCTs compared different interventions and concluded that topical corticosteroids were the most effective treatment modality. However, there are multiple classes and preparations of topical corticosteroids, varying in cost and effectiveness. And not all patients respond favorably to steroids, making alternative treatment options necessary.
Despite the large number of possible treatment modalities, there are few comparisons regarding their costs, even at a time when the issue of rising health care expenses is a cause for concern.
Consequently, we think that an evaluation of OLP treatments in relation to reported efficacy and costs may be desirable to help guide clinical decision-making and innovative management approaches. The aim of this systemic review was to compare the various topical and systemic therapeutic interventions used for the treatment of oral lichen planus in terms of their reported efficacy and current estimated costs.
Aim
To compare the reported effectiveness and costs of available interventions used for the treatment of oral lichen planus (OLP).
Materials and methods
A systematic literature search was conducted from database inception to March 2021 in MEDLINE via PubMed and the Cochrane Library following PRISMA guidelines. Only randomized controlled trials (RCTs) that compared an active intervention with placebo or different active interventions for the treatment of OLP were considered.
Results
Seventy (70) RCTs were included. Most evidence suggested the efficacy of topical steroids (dexamethasone, clobetasol, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus, cyclosporine), topical retinoids, intralesional triamcinolone, aloe vera gel, photodynamic therapy and dosage lows of laser therapies for the management of OLP.
Based on estimated cost per month and evidence of 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 intralesional. triamcinolone.
Conclusion
Various therapies have been used for the treatment of OLP over the past five decades, but a consensus treatment guideline is still lacking. In this systematic review, topical steroids were found to be potentially the most cost-effective and effective treatment modality, followed by topical calcineurin inhibitors supporting the use of topical steroids as first-line treatment with escalation to other treatment modalities alone. as necessary.
Future standardized RCTs and meta-analyses are required to evaluate the efficacy of additional therapies, especially systemic therapies.
Discussion
Ideal therapies are cost-effective, effective, and carry a low risk of local or systemic toxicity. The preferred modality for the treatment of OLP is topical therapy due to the ease of application, the freedom to modify the frequency and duration of treatment, and the lack of systemic side effects.
Important considerations when choosing a topical regimen include location, extent of lesions, and patient tolerability. Gels, ointments and pastes are best used for focal lesions. For more diffuse and/or difficult-to-access lesions, solutions are preferable, although adequate contact time (3-5 min) must be ensured.
Consistent with other reviews, LPO was found to respond to a wide range of topically administered medications and procedures, including topical steroids (dexamethasone, clobetasol, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus, cyclosporine). , topical retinoids, triamcinolone, aloe vera gel, photodynamic therapy and low-level laser therapies in the management of OLP.
