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Meta-Analysis
. 2012 Feb 15;2012(2):CD008092.
doi: 10.1002/14651858.CD008092.pub2.

Interventions for erosive lichen planus affecting mucosal sites

Suzanne Cheng  1 , Gudula Kirtschig, Susan Cooper, Martin Thornhill, Jo Leonardi-Bee, Ruth Murphy
Affiliations
Meta-Analysis

Interventions for erosive lichen planus affecting mucosal sites

Suzanne Cheng et al. Cochrane Database Syst Rev. .

Abstract

Background: Erosive lichen planus (ELP) affecting mucosal surfaces is a chronic autoimmune disease of unknown aetiology. It is often more painful and debilitating than the non-erosive types of lichen planus. Treatment is difficult and aimed at palliation rather than cure. Several topical and systemic agents have been used with varying results.

Objectives: To assess the effects of interventions in the treatment of erosive lichen planus affecting the oral, anogenital, and oesophageal regions.

Search methods: We searched the following databases up to September 2009: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE (from 2005), EMBASE (from 2007), and LILACS (from 1982). We also searched reference lists of articles and online trials registries for ongoing trials.

Selection criteria: We considered all randomised controlled trials (RCTs) that evaluated the effectiveness of any topical or systemic interventions for ELP affecting either the mouth, genital region, or both areas, in participants of any age, gender, or race.

Data collection and analysis: The primary outcome measures were as follows:(a) Pain reduction using a visual analogue scale rated by participants; (b) Physician Global Assessment; and (c) Participant global self-assessment.Changes in scores at the end of therapy compared with baseline were analysed.

Main results: A total of 15 RCTs were identified, giving a total of 473 participants with ELP. All studies involved oral ELP only. Six of the 15 studies included participants with non-erosive lichen planus. In these studies, only the erosive subgroup was included for intended subgroup analysis. We were unable to pool data from any of the nine studies with only ELP participants or any of the six studies with the ELP subgroup, due to small numbers and the heterogeneity of the interventions, design methods, and outcome variables between studies. One small study involving 50 participants found that 0.025% clobetasol propionate administered as liquid microspheres significantly reduced pain compared to ointment (Mean difference (MD) -18.30, 95% confidence interval (CI) -28.57 to -8.03), but outcome data was only available in 45 participants. However, in another study, a significant difference in pain was seen in the small subgroup of 11 ELP participants, favouring ciclosporin solution over 0.1% triamcinolone acetonide in orabase (MD -1.40, 95% CI -1.86 to -0.94). Aloe vera gel was 6 times more likely to result in at least a 50% improvement in pain symptoms compared to placebo in a study involving 45 ELP participants (Risk ratio (RR) 6.16, 95% CI 2.35 to 16.13). In a study involving 20 ELP participants, 1% pimecrolimus cream was 7 times more likely to result in a strong improvement as rated by the Physician Global Assessment when compared to vehicle cream (RR 7.00, 95% CI 1.04 to 46.95).There is no overwhelming evidence for the efficacy of a single treatment, including topical steroids, which are the widely accepted first-line therapy for ELP. Several side-effects were reported, but none were serious. With topical corticosteroids, the main side-effects were oral candidiasis and dyspepsia.

Authors' conclusions: This review suggests that there is only weak evidence for the effectiveness of any of the treatments for oral ELP, whilst no evidence was found for genital ELP. More RCTs on a larger scale are needed in the oral and genital ELP populations. We suggest that future studies should have standardised outcome variables that are clinically important to affected individuals. We recommend the measurement of a clinical severity score and a participant-rated symptom score using agreed and validated severity scoring tools. We also recommend the development of a validated combined severity scoring tool for both oral and genital populations.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
'Risk of bias' graph ‐ review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies.
2
2
'Risk of bias' summary ‐ review authors' judgements about each 'Risk of bias' item for each included study.
1.1
1.1. Analysis
Comparison 1 Pimecrolimus versus placebo/vehicle cream, Outcome 1 Pain reduction using visual analogue scale (VAS).
1.2
1.2. Analysis
Comparison 1 Pimecrolimus versus placebo/vehicle cream, Outcome 2 Physician Global Assessment: Weighted sums of ulceration, erythema and reticulation (mm²).
1.3
1.3. Analysis
Comparison 1 Pimecrolimus versus placebo/vehicle cream, Outcome 3 Physician Global Assessment: Surface of erosive lesions.
1.4
1.4. Analysis
Comparison 1 Pimecrolimus versus placebo/vehicle cream, Outcome 4 Physician Global Assessment.
1.5
1.5. Analysis
Comparison 1 Pimecrolimus versus placebo/vehicle cream, Outcome 5 Clinical response: Complete clearance.
2.1
2.1. Analysis
Comparison 2 Clobetasol propionate versus active treatment, Outcome 1 Pain reduction using visual analogue scale (VAS).
2.2
2.2. Analysis
Comparison 2 Clobetasol propionate versus active treatment, Outcome 2 Improvement in pain symptoms by VAS (> = 50%).
2.3
2.3. Analysis
Comparison 2 Clobetasol propionate versus active treatment, Outcome 3 Physician Global Assessment (Thongprasom score).
2.4
2.4. Analysis
Comparison 2 Clobetasol propionate versus active treatment, Outcome 4 Physician Global Assessment (Thongprasom score).
3.1
3.1. Analysis
Comparison 3 0.1% Triamcinolone acetonide versus ciclosporin, Outcome 1 Pain reduction using visual analogue scale (VAS) (0 to 100 scale).
3.2
3.2. Analysis
Comparison 3 0.1% Triamcinolone acetonide versus ciclosporin, Outcome 2 Physician Global Assessment (Thongprasom score).
4.1
4.1. Analysis
Comparison 4 0.1% Tacrolimus versus 0.05% clobetasol, Outcome 1 Pain reduction using the VAS (0 to 10 score).
5.1
5.1. Analysis
Comparison 5 Aloe vera gel versus placebo, Outcome 1 Improvement in pain symptoms by VAS (> = 50%) (Complete or good response versus poor or no response).
5.2
5.2. Analysis
Comparison 5 Aloe vera gel versus placebo, Outcome 2 Physician Global Assessment (Thongprasom score).
6.1
6.1. Analysis
Comparison 6 Ciclosporin versus active treatment, Outcome 1 Improvement in pain symptoms by VAS (> = 50%) (no symptoms versus partial or no response).
6.2
6.2. Analysis
Comparison 6 Ciclosporin versus active treatment, Outcome 2 Physician Global Assessment (Thongprasom score).
6.3
6.3. Analysis
Comparison 6 Ciclosporin versus active treatment, Outcome 3 Physician Global Assessment: Severity of disease.
7.1
7.1. Analysis
Comparison 7 Radix tripterygium hypoglaucum (THT) vs tripterygium glucosides (TGT), Outcome 1 Physician Global Assessment: Cure of erosive lesions.
8.1
8.1. Analysis
Comparison 8 Flucinonide vs placebo, Outcome 1 Physician Global Assessment: Clinical signs (Complete vs good, partial, or no response).
9.1
9.1. Analysis
Comparison 9 Betamethasone versus 0.1% triamcinolone acetonide, Outcome 1 Physician Global Assessment: Clinical severity (0 to 12 score).
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD008092

References

References to studies included in this review

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Bouloc 2000 {published data only}
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Thongprasom 2003 {published data only}
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References to studies awaiting assessment

Agha‐Hosseini 2010 {published data only}
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References to ongoing studies

NCT00135733 {published data only}
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NCT01061853 {published data only}
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NCT01282515 {published data only}
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