Corticosteroids for treating oral lichen planus

Oral lichen planus is a non-infectious rash that can cause white patches on your gums, tongue or the insides of your cheeks. It is a common condition that can cause long‐term, painful areas on the lining of the mouth. The usual treatment is with drugs known as corticosteroids applied directly to the painful areas, or taken as a pill or a medicine. Treatment aims to reduce pain and improve healing of the mouth, but there is no cure for the disease.

What was the research?

A systematic review to find out if corticosteroids are effective and safe for the treatment of oral lichen planus that is causing pain.

Who conducted the research?

The research was conducted by a team led by Giovanni Lodiof the University of Milan, Italy, on behalf of Cochrane Oral Health. Maddalena Manfredi, Valeria Mercadante, Ruth Murphy, and Marco Carrozzo were also on the team.

What evidence was included in the review?

The evidence in this review is up‐to‐date as of 25 February 2019. We included 35 randomised controlled trials with 1474 participants, which tested several different corticosteroids, mostly delivered directly to the skin. Corticosteroids were compared with one of the following: a placebo (a dummy or fake treatment); a medicine from a category called calcineurin inhibitors; another medicine type; another corticosteroid or mode of delivery; the same corticosteroid plus an extra treatment; or an alternative treatment. Treatments were given for between one week and six months, with side effects measured throughout the treatment, and pain and healing measured at the end of treatment.

What did the evidence say?

Results from two studies showed that corticosteroids applied directly to the mouth in a sticky cream may be effective in reducing and stopping pain. These corticosteroids included clobetasol propionate, flucinonide, betamethasone and triamcinolone acetonide. We do not have the evidence that these corticosteroids can cure oral lichen planus lesions, and we are uncertain about side effects.

We found no consistent evidence that any particular corticosteroid was better than any other.

Three studies looked at tacrolimus, a type of medicine called a calcineurin inhibitor. This can also be applied directly to the mouth. These studies found that this medicine may be more effective than corticosteroids, but may be more likely to cause mild side effects.

Available evidence comparing corticosteroids with other treatments is very limited.

How good was the evidence?

The reliability of most of the evidence is very low.

What are the implications for dentists and the general public?

Corticosteroids applied directly to the mouth in a sticky cream may be effective in reducing and stopping pain. But we cannot be sure about the findings and future research may lead us to different conclusions.

What should researchers look at in the future?

Better intervention trials comparing different corticosteroids and corticosteroids with calcineurin inhibitors are still needed. Future trials should compare different doses and treatment lengths. We need more evidence on the adverse effects of these medicines.

Link

Lodi  G, Manfredi  M, Mercadante  V, Murphy  R, Carrozzo  M. Interventions for treating oral lichen planus: corticosteroid therapies. Cochrane Database of Systematic Reviews 2020, Issue 2. Art. No.: CD001168. DOI: 10.1002/14651858.CD001168.pub3.

This post is an extended version of the review’s plain language summary, compiled by Anne Littlewood at the Cochrane Oral Health Editorial Base.

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