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Oral lichen planus (OLP) is a chronic autoimmune mucosal disease characterized by abnormalities in the growth and differentiation of basal keratinocytes whose surface antigens are modified because of primary autoimmune damage. The autoimmune insult leads to a delay in the growth of mucosal epithelium which is responsible for hyperkeratosis and acanthosis.
Oral lichen planus may persist for many years, and tend to be difficult to treat, with relapses being common. Medical treatment of OLP is essential for the management of painful, erythematous, erosive lesions. The principal aims of therapy are the resolution of painful symptoms, the resolution of oral mucosal lesions, the reduction of the risk of oral cancer, and the maintenance of good oral hygiene. Topical corticosteroids are the mainstay of medical treatment of oral lichen planus.
Our study aimed at evaluation of the effectiveness and safety of using topical isotretinoin 0.1% in the treatment of patients with OLP in comparison to controls. The study contained 40 Patients whom were subdivided into 2 groups; 20 patients each: Group A: 20 patients were subjected to topical retinoids in the form of isotretinoin 0.1% in orabase (oracure gel Each 100 g contains: Lidocaine HCI 2.0g has a powerful anesthetic -action and
Cetylpyridinium chloride 0.1 g has a local antiseptic effect ) as a base twice daily for three months, andgroup B: 20 patients were subjected to topical application of a placebo (oracure gel) twice daily for three months.
Clinical examination and Digital photography were done for all studied patients at base line (first visit) and every 4 weeks and after 3 months (the end of study) to document visible changes. Follow up was done for 6 months after cessation of treatment.
The obtained data was tabulated and statistically analyzed.Regarding group A, the results revealed complete response in 5 (25.0%) patients, partial response in 8 (40.0%) patients, and no response in 7 (35.0%) patients. None of patients in group B showed clinical improvement. There was statistical significant difference regarding the clinical response (P=0.001).
Regarding group A, ten patients had reticular OLP type, complete response was found in (50.0%) patients, partial response in (40.0%) patients and no response in 1 (10.0%) patient. Ten patients had erosive OLP type, partial response was found in (40.0%) patients, and no response was found in (60.0%) patients.
Patients mentioned temporary stinging sensation and bad taste as a side effects. During the follow-up period
of the next 6 months, all responded patients (5 complete response and 8 partial response) showed relapse of OLP lesions after cessation of topical isotretinoin 0.1% treatment.
Based on our findings topical application of isotretinoin 0.1% showed a modest therapeutic effect on OLP lesions despite of patients with reticular OLP that showed complete or partial improvement.
We recommend further controlled large scale studies using different isotretinoin concentrations in other OLP variants.