Oral lichen planus: comparative efficacy and treatment costs-a systematic review

doi:10.1186/s12903-022-02168-4

. 2022 May 6;22(1):161.

doi: 10.1186/s12903-022-02168-4.

Oral lichen planus: comparative efficacy and treatment costs-a systematic review

Shaiba Sandhu^{1

2

3}, Brittany A Klein^{4

5}, Malak Al-Hadlaq^{4

5}, Prazwala Chirravur^{4

5}, Amal Bajonaid^{4

5}, Yuanming Xu^{4

5}, Rossella Intini^{4

5}, Mai Hussein^{6

7}, Piamkamon Vacharotayangul^{4

5}, Herve Sroussi^{4

5}, Nathaniel Treister^{4

5}, Stephen Sonis^{4

5}

Affiliations

¹ Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA. ssandhu@mgh.harvard.edu.
² Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA. ssandhu@mgh.harvard.edu.
³ Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. ssandhu@mgh.harvard.edu.
⁴ Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.
⁵ Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA.
⁶ Harvard Medical School, Boston, MA, USA.
⁷ Ministry of Health and Population, Cairo, Egypt.

PMID: 35524296
PMCID: PMC9074269
DOI: 10.1186/s12903-022-02168-4

Oral lichen planus: comparative efficacy and treatment costs-a systematic review

Shaiba Sandhu et al. BMC Oral Health. 2022.

. 2022 May 6;22(1):161.

doi: 10.1186/s12903-022-02168-4.

Authors

Affiliations

¹ Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA. ssandhu@mgh.harvard.edu.
² Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA. ssandhu@mgh.harvard.edu.
³ Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. ssandhu@mgh.harvard.edu.
⁴ Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.
⁵ Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA.
⁶ Harvard Medical School, Boston, MA, USA.
⁷ Ministry of Health and Population, Cairo, Egypt.

PMID: 35524296
PMCID: PMC9074269
DOI: 10.1186/s12903-022-02168-4

Abstract

Objective: To compare the reported efficacy and costs of available interventions used for the management of oral lichen planus (OLP).

Materials and methods: A systematic literature search was performed from database inception until March 2021 in MEDLINE via PubMed and the Cochrane library following PRISMA guidelines. Only randomized controlled trials (RCT) comparing an active intervention with placebo or different active interventions for OLP management were considered.

Results: Seventy (70) RCTs were included. The majority of evidence suggested efficacy of topical steroids (dexamethasone, clobetasol, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus, cyclosporine), topical retinoids, intra-lesional triamcinolone, aloe-vera gel, photodynamic therapy, and low-level laser therapies for OLP management. Based on the estimated cost per month and evidence for efficacy and side-effects, topical steroids (fluocinonide > dexamethasone > clobetasol > triamcinolone) appear to be more cost-effective than topical calcineurin inhibitors (tacrolimus > pimecrolimus > cyclosporine) followed by intra-lesional triamcinolone.

Conclusion: Of common treatment regimens for OLP, topical steroids appear to be the most economical and efficacious option followed by topical calcineurin inhibitors. Large-scale multi-modality, prospective trials in which head-to-head comparisons interventions are compared are required to definitely assess the cost-effectiveness of OLP treatments.

Keywords: Cost; Critical review; Efficacy; Oral lichen planus; Treatment.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
PRISMA flow chart for selection of studies in this systematic review

**Fig. 2**
Treatment recommendations for treatment of OLP based on expert opinion

See this image and copyright information in PMC

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References

1. Li C, Tang X, Zheng X, Ge S, Wen H, Lin X, Chen Z, Lu L. Global prevalence and incidence estimates of oral lichen planus: a systematic review and meta-analysis. JAMA Dermatol. 2020 doi: 10.1001/jamadermatol.2019.3797. - DOI - PMC - PubMed
1. Zhou XJ, Sugerman PB, Savage NW, Walsh LJ, Seymour GJ. Intra-epithelial CD8+ T cells and basement membrane disruption in oral lichen planus. J Oral Pathol Med. 2002 doi: 10.1046/j.0904-2512.2001.10063.x. - DOI - PubMed
1. Wang D, Sandhu S, Woo SB. A guide for dental practitioners of common oral potentially malignant disorders. CDA J 2021;49.
1. Oberti L, Gabrione F, Lucchese A, Di Stasio D, Carinci F, Lauritano D. Treatment of oral lichen planus: a narrative review. Front Physiol. 2019 doi: 10.3389/conf.fphys.2019.27.00004. - DOI
1. Lodi G, Manfredi M, Mercadante V, Murphy R, Carrozzo M. Interventions for treating oral lichen planus: corticosteroid therapies. Cochrane Database Syst Rev. 2020 doi: 10.1002/14651858.CD001168.pub3. - DOI - PMC - PubMed

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[1] Li C, Tang X, Zheng X, Ge S, Wen H, Lin X, Chen Z, Lu L. Global prevalence and incidence estimates of oral lichen planus: a systematic review and meta-analysis. JAMA Dermatol. 2020 doi: 10.1001/jamadermatol.2019.3797. - DOI - PMC - PubMed

[2] Li C, Tang X, Zheng X, Ge S, Wen H, Lin X, Chen Z, Lu L. Global prevalence and incidence estimates of oral lichen planus: a systematic review and meta-analysis. JAMA Dermatol. 2020 doi: 10.1001/jamadermatol.2019.3797. - DOI - PMC - PubMed

[3] Zhou XJ, Sugerman PB, Savage NW, Walsh LJ, Seymour GJ. Intra-epithelial CD8+ T cells and basement membrane disruption in oral lichen planus. J Oral Pathol Med. 2002 doi: 10.1046/j.0904-2512.2001.10063.x. - DOI - PubMed

[4] Zhou XJ, Sugerman PB, Savage NW, Walsh LJ, Seymour GJ. Intra-epithelial CD8+ T cells and basement membrane disruption in oral lichen planus. J Oral Pathol Med. 2002 doi: 10.1046/j.0904-2512.2001.10063.x. - DOI - PubMed

[5] Wang D, Sandhu S, Woo SB. A guide for dental practitioners of common oral potentially malignant disorders. CDA J 2021;49.

[6] Wang D, Sandhu S, Woo SB. A guide for dental practitioners of common oral potentially malignant disorders. CDA J 2021;49.

[7] Oberti L, Gabrione F, Lucchese A, Di Stasio D, Carinci F, Lauritano D. Treatment of oral lichen planus: a narrative review. Front Physiol. 2019 doi: 10.3389/conf.fphys.2019.27.00004. - DOI

[8] Oberti L, Gabrione F, Lucchese A, Di Stasio D, Carinci F, Lauritano D. Treatment of oral lichen planus: a narrative review. Front Physiol. 2019 doi: 10.3389/conf.fphys.2019.27.00004. - DOI

[9] Lodi G, Manfredi M, Mercadante V, Murphy R, Carrozzo M. Interventions for treating oral lichen planus: corticosteroid therapies. Cochrane Database Syst Rev. 2020 doi: 10.1002/14651858.CD001168.pub3. - DOI - PMC - PubMed

[10] Lodi G, Manfredi M, Mercadante V, Murphy R, Carrozzo M. Interventions for treating oral lichen planus: corticosteroid therapies. Cochrane Database Syst Rev. 2020 doi: 10.1002/14651858.CD001168.pub3. - DOI - PMC - PubMed

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Oral lichen planus: comparative efficacy and treatment costs-a systematic review

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Oral lichen planus: comparative efficacy and treatment costs-a systematic review

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