DOI QR코드

DOI QR Code

Evaluation of Clinically Effective Doses of Triamcinolone Acetonide for Intralesional Injection in Oral Lichen Planus

  • Park, Su-Hyeon (Department of Oral Medicine, Dental Research Institute, Institute of Translational Dental Sciences, School of Dentistry, Pusan National University) ;
  • Lee, Hae-Ohk (Department of Oral Medicine, Dental Research Institute, Institute of Translational Dental Sciences, School of Dentistry, Pusan National University) ;
  • Ju, Hye-Min (Department of Oral Medicine, Dental Research Institute, Institute of Translational Dental Sciences, School of Dentistry, Pusan National University) ;
  • Lee, Ji-Yeon (Department of Oral Medicine, Dental Research Institute, Institute of Translational Dental Sciences, School of Dentistry, Pusan National University) ;
  • Jeon, Hye-Mi (Department of Oral Medicine, Pusan National University Hospital) ;
  • Ok, Soo-Min (Department of Oral Medicine, Dental Research Institute, Institute of Translational Dental Sciences, School of Dentistry, Pusan National University) ;
  • Ahn, Yong-Woo (Department of Oral Medicine, Dental Research Institute, Institute of Translational Dental Sciences, School of Dentistry, Pusan National University) ;
  • Jeong, Sung-Hee (Department of Oral Medicine, Dental Research Institute, Institute of Translational Dental Sciences, School of Dentistry, Pusan National University)
  • Received : 2018.10.19
  • Accepted : 2019.03.07
  • Published : 2019.03.30

Abstract

Purpose: The aim of this study was to evaluate the optimal doses of intralesional triamcinolone acetonide (TA) in the treatment of oral lichen planus (OLP). Methods: A randomized clinical trial was performed. Sixty-two lesions of OLP were received 12 mg (group A) or 20 mg (group B) of TA intralesionally weekly for 2 weeks. Subjective symptoms, lesion size, favorable conversion of clinical subtypes, and clinical response were evaluated at weeks 0, 1, 2, and 4. Results: After two consecutive injections of TA, group B showed significant reduction in burning sensation and reticular area (p<0.01). Favorable conversion and complete response were greater in group B. Mild oral candidiasis was developed in group B (10.7%). Conclusions: A 20-mg injection of TA was much more effective compared with 12-mg injection of TA in the treatment of OLP.

Keywords

Intralesional injections;Oral lichen planus;Triamcinolone acetonide

GGNGBC_2019_v44n1_1_f0001.png 이미지

Fig. 1. A method to determine the size of oral lichen planus lesion on buccal mucosa. (A) A Flexible, transparent ruler as measuring tool for lesion size. (B-D) The lesion size was measured at the lesion periphery of the (B) area of reticulation, (C) erythema, and (D) ulceration, independently. The lesion sizes are 19 mm, 14 mm, and 9 mm for reticulation, erythema, and ulceration, respectively, based on this method.

GGNGBC_2019_v44n1_1_f0002.png 이미지

Fig. 2. The favorable clinical forms of U-OLP and E-OLP. Changes in the clinical form from U-OLP or E-OLP to R-OLP or normal mucosa were recorded. U-OLP, ulcerative oral lichen planus (OLP); E-OLP, erythematous OLP; R-OLP, reticular OLP; Normal, normal mucosa.

GGNGBC_2019_v44n1_1_f0003.png 이미지

Fig. 3. Comparison of subjective symptoms. (A) The numeric rating scale (NRS) scores for pain or burning sensation were significantly decreased in both groups (p=0.000), and there were no intergroup differences (p=0.058). (B) After the first injection, the improvement of symptoms was significantly greater in group B (p=0.002).

GGNGBC_2019_v44n1_1_f0004.png 이미지

Fig. 4. Comparison of lesion size by the clinical type of oral lichen planus. The areas of reticulation, erythema, and ulceration were significantly decreased in both groups (p=0.000). Whereas erythema and ulceration did not significantly differ between the groups (p=0.595 and p=0.497, respectively), reticulation in group B was significantly decreased in each follow-up visit compared with reticulation in group A (p=0.002). R, reticulation; E, erythema; U, ulceration.

GGNGBC_2019_v44n1_1_f0005.png 이미지

Fig. 5. The favorable conversion of clinical form of U-OLP and E-OLP. The percentage of favorable conversion into R-OLP or normal mucosa was greatest in group B at week 1 for U-OLP lesions and week 4 for E-OLP lesions (p=0.001 for E-OLP). U-OLP, ulcerative oral lichen planus (OLP); E-OLP, erythematous OLP; R-OLP, reticular OLP; normal, normal mucosa.

GGNGBC_2019_v44n1_1_f0006.png 이미지

Fig. 6. Comparison of clinical response. The percentage of NR was decreased and the percentage of CR was increased in both groups. These changes were significantly greater in group B (p=0.269 and p=0.000 for group A and group B, respectively). CR, complete remission; PR, partial remission; NR, no response.

GGNGBC_2019_v44n1_1_f0007.png 이미지

Fig. 7. Clinical photographs of oral lichen planus lesions. (A) An ulcerative lesion at the right buccal mucosa of a 54-year-old female patient. (B) The same patient after the 1-week treatment with 0.5 mL of triamcinolone acetonide injection showed complete response. (C) The condition of normal mucosa was maintained at week 4 without additional injection.

GGNGBC_2019_v44n1_1_f0008.png 이미지

Fig. 8. Secondary candidiasis in group B. (A, B) The fungal colonies appeared after two consecutive injections of 0.5 mL of triamcinolone acetonide (arrows). (A’, B’) Underlying mucosa after wiping off the fungal colonies.

Table 1. Baseline characteristics of the study lesions

GGNGBC_2019_v44n1_1_t0001.png 이미지

Acknowledgement

Supported by : Pusan National University

References

  1. Mollaoglu N. Oral lichen planus: a review. Br J Oral Maxillofac Surg 2000;38:370-377. https://doi.org/10.1054/bjom.2000.0335
  2. Scully C, el-Kom M. Lichen planus: review and update on pathogenesis. J Oral Pathol 1985;14:431-458. https://doi.org/10.1111/j.1600-0714.1985.tb00516.x
  3. Al-Hashimi I, Schifter M, Lockhart PB, et al. Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103 Suppl:S25.e1-e12.
  4. Lodi G, Scully C, Carrozzo M, Griffiths M, Sugerman PB, Thongprasom K. Current controversies in oral lichen planus: report of an international consensus meeting. Part 1. Viral infections and etiopathogenesis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:40-51. https://doi.org/10.1016/j.tripleo.2004.06.077
  5. Lodi G, Carrozzo M, Furness S, Thongprasom K. Interventions for treating oral lichen planus: a systematic review. Br J Dermatol 2012;166:938-947. https://doi.org/10.1111/j.1365-2133.2012.10821.x
  6. Andreasen JO. Oral lichen planus. 1. A clinical evaluation of 115 cases. Oral Surg Oral Med Oral Pathol 1968;25:31-42. https://doi.org/10.1016/0030-4220(68)90194-1
  7. Eisen D, Carrozzo M, Bagan Sebastian JV, Thongprasom K. Number V Oral lichen planus: clinical features and management. Oral Dis 2005;11:338-349. https://doi.org/10.1111/j.1601-0825.2005.01142.x
  8. Dissemond J. Oral lichen planus: an overview. J Dermatolog Treat 2004;15:136-140. https://doi.org/10.1080/09546630410030720
  9. Radfar L, Wild RC, Suresh L. A comparative treatment study of topical tacrolimus and clobetasol in oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:187-193. https://doi.org/10.1016/j.tripleo.2007.07.029
  10. Carbone M, Goss E, Carrozzo M, et al. Systemic and topical corticosteroid treatment of oral lichen planus: a comparative study with long-term follow-up. J Oral Pathol Med 2003;32:323-329. https://doi.org/10.1034/j.1600-0714.2003.00173.x
  11. Sonthalia S, Singal A. Comparative efficacy of tacrolimus 0.1% ointment and clobetasol propionate 0.05% ointment in oral lichen planus: a randomized double-blind trial. Int J Dermatol 2012;51:1371-1378. https://doi.org/10.1111/j.1365-4632.2012.05459.x
  12. Petruzzi M, Lucchese A, Lajolo C, Campus G, Lauritano D, Serpico R. Topical retinoids in oral lichen planus treatment: an overview. Dermatology 2013;226:61-67. https://doi.org/10.1159/000346750
  13. McCreary CE, McCartan BE. Clinical management of oral lichen planus. Br J Oral Maxillofac Surg 1999;37:338-343. https://doi.org/10.1054/bjom.1999.0131
  14. Agarwal R, Saraswat A. Oral lichen planus: an update. Drugs Today (Barc) 2002;38:533-547. https://doi.org/10.1358/dot.2002.38.8.820094
  15. Kumar S, Singh RJ, Reed AM, Lteif AN. Cushing's syndrome after intra-articular and intradermal administration of triamcinolone acetonide in three pediatric patients. Pediatrics 2004;113:1820-1824. https://doi.org/10.1542/peds.113.6.1820
  16. Jeal W, Faulds D. Triamcinolone acetonide. A review of its pharmacological properties and therapeutic efficacy in the management of allergic rhinitis. Drugs 1997;53:257-280. https://doi.org/10.2165/00003495-199753020-00006
  17. Xia J, Li C, Hong Y, Yang L, Huang Y, Cheng B. Short-term clinical evaluation of intralesional triamcinolone acetonide injection for ulcerative oral lichen planus. J Oral Pathol Med 2006;35:327-331. https://doi.org/10.1111/j.1600-0714.2006.00441.x
  18. Kuo RC, Lin HP, Sun A, Wang YP. Prompt healing of erosive oral lichen planus lesion after combined corticosteroid treatment with locally injected triamcinolone acetonide plus oral prednisolone. J Formos Med Assoc 2013;112:216-220. https://doi.org/10.1016/j.jfma.2012.01.014
  19. Lee YC, Shin SY, Kim SW, Eun YG. Intralesional injection versus mouth rinse of triamcinolone acetonide in oral lichen planus: a randomized controlled study. Otolaryngol Head Neck Surg 2013;148:443-449. https://doi.org/10.1177/0194599812473237
  20. Vincent SD. Diagnosing and managing oral lichen planus. J Am Dent Assoc 1991;122:93-94, 96.
  21. Sleeper HR. Intralesional and sublesional injection of triamcinolone acetonide for oral lichen planus. Yale J Biol Med 1967;40:164-165.
  22. Setterfield JF, Black MM, Challacombe SJ. The management of oral lichen planus. Clin Exp Dermatol 2000;25:176-182. https://doi.org/10.1046/j.1365-2230.2000.00607.x
  23. Sugerman PB, Savage NW, Zhou X, Walsh LJ, Bigby M. Oral lichen planus. Clin Dermatol 2000;18:533-539.
  24. Yoke PC, Tin GB, Kim MJ, et al. A randomized controlled trial to compare steroid with cyclosporine for the topical treatment of oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:47-55. https://doi.org/10.1016/j.tripleo.2005.09.006
  25. van der Meij EH, van der Waal I. Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications. J Oral Pathol Med 2003;32:507-512. https://doi.org/10.1034/j.1600-0714.2003.00125.x
  26. Sankar V, Hearnden V, Hull K, et al. Local drug delivery for oral mucosal diseases: challenges and opportunities. Oral Dis 2011;17 Suppl 1:73-84. https://doi.org/10.1111/j.1601-0825.2011.01793.x
  27. Khanna JN, Andrade NN. Oral submucous fibrosis: a new concept in surgical management. Report of 100 cases. Int J Oral Maxillofac Surg 1995;24:433-439. https://doi.org/10.1016/S0901-5027(05)80473-4
  28. Skedros JG, Hunt KJ, Pitts TC. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians. BMC Musculoskelet Disord 2007;8:63. https://doi.org/10.1186/1471-2474-8-63
  29. Chang KH, Rojhirunsakool S, Goldberg LJ. Treatment of severe alopecia areata with intralesional steroid injections. J Drugs Dermatol 2009;8:909-912.
  30. Weshahy AH, Abdel Hay R. Intralesional cryosurgery and intralesional steroid injection: a good combination therapy for treatment of keloids and hypertrophic scars. Dermatol Ther 2012;25:273-276. https://doi.org/10.1111/j.1529-8019.2012.01456.x
  31. Prasetyono TO, Djoenaedi I. Efficacy of intralesional steroid injection in head and neck hemangioma: a systematic review. Ann Plast Surg 2011;66:98-106. https://doi.org/10.1097/SAP.0b013e3181d49f52
  32. Osterne RL, Araujo PM, de Souza-Carvalho AC, Cavalcante RB, Sant'Ana E, Nongueira RL. Intralesional corticosteroid injections in the treatment of central giant cell lesions of the jaws: a metaanalytic study. Med Oral Patol Oral Cir Bucal 2013;18:e226-e232.
  33. Zegarelli DJ. Ulcerative and erosive lichen planus. Treated by modified topical steroid and injection steroid therapy. N Y State Dent J 1987;53:23-24.
  34. Hegarty AM, Hodgson TA, Lewsey JD, Porter SR. Fluticasone propionate spray and betamethasone sodium phosphate mouthrinse: a randomized crossover study for the treatment of symptomatic oral lichen planus. J Am Acad Dermatol 2002;47:271-279. https://doi.org/10.1067/mjd.2002.120922
  35. Kaliakatsou F, Hodgson TA, Lewsey JD, Hegarty AM, Murphy AG, Porter SR. Management of recalcitrant ulcerative oral lichen planus with topical tacrolimus. J Am Acad Dermatol 2002;46:35-41. https://doi.org/10.1067/mjd.2002.120535
  36. Fu J, Zhu X, Dan H, et al. Amlexanox is as effective as dexamethasone in topical treatment of erosive oral lichen planus: a short-term pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:638-643. https://doi.org/10.1016/j.oooo.2011.10.013
  37. Sun A, Chia JS, Chang YF, Chiang CP. Serum interleukin-6 level is a useful marker in evaluating therapeutic effects of levamisole and Chinese medicinal herbs on patients with oral lichen planus. J Oral Pathol Med 2002;31:196-203. https://doi.org/10.1034/j.1600-0714.2002.310402.x
  38. Thongprasom K, Luangjarmekorn L, Sererat T, Taweesap W. Relative efficacy of fluocinolone acetonide compared with triamcinolone acetonide in treatment of oral lichen planus. J Oral Pathol Med 1992;21:456-458. https://doi.org/10.1111/j.1600-0714.1992.tb00974.x
  39. Chen HM, Shih CC, Yen KL, et al. Facial Candida albicans cellulitis occurring in a patient with oral submucous fibrosis and unknown diabetes mellitus after local corticosteroid injection treatment. J Oral Pathol Med 2004;33:243-245. https://doi.org/10.1111/j.0904-2512.2004.00058.x
  40. Malhotra AK, Khaitan BK, Sethuraman G, Sharma VK. Betamethasone oral mini-pulse therapy compared with topical triamcinolone acetonide (0.1%) paste in oral lichen planus: a randomized comparative study. J Am Acad Dermatol 2008;58:596-602. https://doi.org/10.1016/j.jaad.2007.11.022
  41. Gonzalez-Garcia A, Diniz-Freitas M, Gandara-Vila P, Blanco-Carrion A, Garcia-Garcia A, Gandara-Rey J. Triamcinolone acetonide mouth rinses for treatment of erosive oral lichen planus: efficacy and risk of fungal over-infection. Oral Dis 2006;12:559-565. https://doi.org/10.1111/j.1601-0825.2006.01238.x
  42. Buajeeb W, Pobrurksa C, Kraivaphan P. Efficacy of fluocinolone acetonide gel in the treatment of oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:42-45. https://doi.org/10.1016/S1079-2104(00)80012-8
  43. Camisa C, Rindler JM. Diseases of the oral mucous membranes. Curr Probl Dermatol 1996;8:43-96. https://doi.org/10.1016/S1040-0486(05)80005-5
  44. Scully C, Beyli M, Ferreiro MC, et al. Update on oral lichen planus: etiopathogenesis and management. Crit Rev Oral Biol Med 1998;9:86-122. https://doi.org/10.1177/10454411980090010501
  45. Xiong C, Li Q, Lin M, et al. The efficacy of topical intralesional BCG-PSN injection in the treatment of erosive oral lichen planus: a randomized controlled trial. J Oral Pathol Med 2009;38:551-558. https://doi.org/10.1111/j.1600-0714.2009.00796.x
  46. Dusek JJ, Frick WG. Lichen planus: oral manifestations and suggested treatments. J Oral Maxillofac Surg 1982;40:240-244. https://doi.org/10.1016/0278-2391(82)90321-4