Efficacy of photodynamic therapy or low level laser therapy against steroid therapy in the treatment of erosive-atrophic oral lichen planus

https://doi.org/10.1016/j.pdpdt.2018.02.001Get rights and content

Highlights

  • To compare the effects of PDT and LLLT with topical corticosteroid.

  • Forty-five adult patients with erosive-atrophic biopsy-proven OLP were included.

  • PDT is effective in the treatment of erosive-atrophic forms of OLP in adult patients.

Abstract

Background

The efficacy of photodynamic therapy (PDT) or low level laser therapy (LLLT) in the treatment of oral lichen planus (OLP) is debatable. The aim of this study was to compare the effects of PDT, LLLT or topical corticosteroid application in the treatment of erosive-atrophic OLP.

Materials and methods

Forty-five adult patients with erosive-atrophic biopsy-proven OLP on the tongue or buccal mucosa (size ≤3 cm) were randomly divided into three groups. Group-1: patients receiving PDT topical application of 50 μl toluidine blue (1 mg/ml) with micropipette and after 10 min treated by laser irradiation using GaAlAs laser (630 nm, 10 mW/cm2, continuous wave, spot size: 1 cm2); Group-2: patients receiving LLLT using diode laser (630 nm, 10 mW, continuous wave, spot size: 1 cm2); and Group-3: patients receiving topical corticosteroid applications consisting of dexamethasone (0.5 mg in 5 ml water) mouthwash for 5 min. Demographic data, type, and severity of the lesions and pain were recorded before and after treatment and then at the 1 year follow-up.

Results

There was a significant difference in sign score changes before and after the treatment in the PDT group (p = 0.03), LLLT group (p = 0.04) and in the control group (p = 0.02). There was a statistically significant difference between group-1 (p = 0.001) and group-2 (p = 0.001) against group-3 before and after treatment. Mean amount of improvement in pain was significantly greater in the control group in comparison with the PDT and LLLT groups (p < 0.001). The efficacy index of the PDT group improved significantly more than the LLLT (p = 0.001) and corticosteroid groups (p = 0.001).

Conclusion

Within the limits of the present RCT, it is indicated that PDT and LLLT are effective in the treatment of erosive-atrophic forms of OLP in adult patients. However, further comparative clinical trials are needed to obtain strong conclusions in this regard.

Introduction

Lichen planus is a common chronic mucocutaneous inflammatory disorder which generally affects middle-aged adults. Oral lichen planus (OLP) occurs more frequently than cutaneous lesions and tends to be more resistant to treatment. On the basis of different clinical patterns, OLP is mainly classified as erosive, reticular, plaque-like, atrophic, or bullous type [1]. Reticular lesions are asymptomatic and require no treatment, but patients with erosive-atrophic forms of OLP experience significant discomfort; therefore, they often seek treatment [[2], [3]]. Erosive-atrophic OLP manifests as diffuse, erythematous patches surrounded by fine white lines (Wickham striae) where some lesions may undergo malignant transformation [4].

Therapeutic methods including topical and systemic corticosteroids for the treatment of OLP are suggested. Unlike cutaneous lesions, which generally improve spontaneously, OLP requires long-term treatment and follow-up [5]. However, long-term use of corticosteroids for chronic OLP have undesired local and systemic complications [6]. To surmount the side-effects of corticosteroid, photodynamic therapy (PDT) and laser therapy (LLLT) has been proposed as a treatment strategy for OLP [7]. Photodynamic therapy (PDT) is a procedure based on the activation of molecules of various chemical agents called photosensitizers by light emitting radiation using a selected wavelength. After activation, cytotoxic free radicals are released and subsequently result in the destruction of targeted cells [8]. On the other hand, the principle of laser application is based on its bio-stimulatory and anti-ablation effects. Laser therapy involves the intensification of electromagnetic fields excited by external source of energy such as light which emits coherent, well collimated and monochromatic laser beam which has the potential of tissue healing and tissue regeneration without systemic disturbances and undesirable effects on the healthy tissue [9].

Photodynamic therapy and LLLT has been used to treat various oral diseases [[10], [11], [12], [13], [14], [15], [16], [17], [18]]. In addition, PDT and LLLT have also been used in reducing signs and symptoms of symptomatic OLP lesions with conflicting results. For instance, recent clinical trials [[19], [20]] showed significant improvement in the signs and symptoms of OLP with PDT and LLLT as compared to corticosteroid therapy. However, other trials reported in their study that patients with OLP treated with both PDT and LLLT showed comparable improvement in clinical outcomes over the use of corticosteroids at follow-up [[21], [22]]. Similarly, recent systematic reviews by Akram et al. [[23], [24]] showed inconclusive findings with regards to the efficacy of PDT/LLLT in the symptomatic treatment of OLP. Therefore, there appears to be a controversy with regards to the role of PDT and LLLT in the management of OLP. Therefore, the aim of this randomized controlled clinical trial (RCT) was to compare the effects of PDT or LLLT to topical corticosteroid application in the treatment of erosive-atrophic OLP.

Section snippets

Ethical guidelines

The study was performed in accordance with the Declaration of Helsinki. This study was a 52-week parallel arm, examiner-masked, randomized controlled trial (RCT) designed, conducted and reported following the Consolidation Standards of Reporting Trials (CONSORT) Statement [25]. The study protocol was reviewed and approved by the research ethics committee, at Ziauddin University- ref No. FR-180. An information sheet (written in Arabic and English) that described the purpose and methods used was

Results

Statistical analysis showed no significant difference between the two groups regarding number of subjects, gender representation, age, and pretreatment duration of disease (Table 1).

There was a significant difference in sign score changes before and after the treatment in the PDT group (p = 0.03), LLLT group (p = 0.04) and in the control group (p = 0.02). Moreover, the Mann-Whitney test showed significant difference between group-1 and group-3 (p = 0.001) and between group-2 and group-3 (p

Discussion

To the best of our knowledge from indexed literature, this is the first study that evaluated the efficacy of PDT and LLLT together and compared with corticosteroid application in the treatment of OLP. The present study was based on the hypothesis that PDT and LLLT significantly improves clinical and patient-centered outcomes in OLP as compared to steroid therapy. The results of the present study indicated that PDT and LLLT both are effective in the treatment of erosive-atrophic forms of OLP in

Conclusion

Within the limits of the present RCT, it is indicated that PDT and LLLT are effective in the treatment of erosive-atrophic forms of OLP in adult patients. However, further comparative clinical trials are needed to obtain strong conclusions in this regard.

Conflict of interest statement

The authors declare that they have no conflict of interest and all authors have read and approved the final draft.

Acknowledgment

The authors would like to thank the College of Dentistry Research Center and Deanship of Scientific Research at King Saud University, Saudi Arabia for funding this research project.

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