Comparing the Effectiveness and Salivary Levels of TNF-alpha in Patients with oral Lichen Planus Treated with Topical Clobetasol Propionate and Fluocinolone Acetonide
Objectives: The purpose of this study was to compare the effectiveness and salivary levels of tumor necrosis factor-alpha (TNF-α) in patients with oral lichen planus (OLP) treated with topical clobetasol propionate (CP) and fluocinolone acetonide (FA).
Methods: A total of 26 patients diagnosed with erosive-atrophic OLP were randomlydivided into 2 groups: the first group received CP 0.05%, and the other received FA 0.1%. Pain scores, clinical scores, and saliva samples from the patients were collected for analysis both prior to treatment initiation and after 4 weeks. Salivary TNF-α levels were evaluated using an immunology multiplex assay. The Wilcoxon signed-rank test and the Mann-Whitney U test were used for intra-group and inter-group comparisons, respectively.
Results: Both treatments showed significant reductions in pain scores, clinical scores, and salivary TNF-α levels compared with the pre-treatment values (p<0.05). After 4 weeks of treatment, CP 0.05% demonstrated a greater reduction in clinical score compared with FA 0.1% (p<0.05).
Conclusions: CP 0.05% and FA 0.1% effectively treat OLP. CP 0.05% demonstrated a quicker clinical score reduction than FA 0.1% over four weeks. Additionally, both steroids reduced salivary TNF-α levels, which could indicate the possibility of using diseaserelated biomarkers for monitoring.
1. Alrashdan MS, Cirillo N, McCullough M. Oral lichen planus: a literature review and update. Arch Dermatol Res. 2016;308(8):539-51.
2. Manomaivat T, Pongsiriwet S, Kuansuwan C, Thosaporn W, Tachasuttirut K, Iamaroon A. Association between hepatitis c infection in Thai patients with oral lichen planus: a case-control study. J Investig Clin Dent. 2018;9(2):e12316.
3. González-Moles M, Warnakulasuriya S, González-Ruiz I, González-Ruiz L, Ayén Á, Lenouvel D, et al. Worldwide prevalence of oral lichen planus: a systematic review and meta-analysis. Oral Dis. 2021;27(4):813-28.
4. Gupta S, Jawanda MK. Oral lichen planus: an update on etiology, pathogenesis, clinical presentation, diagnosis and management. Indian J Dermatol. 2015;60(3):222-9.
5. Rotaru D, Chisnoiu R, Picos AM, Picos A, Chisnoiu A. Treatment trends in oral lichen planus and oral lichenoid lesions (review). Exp Ther Med. 2020;20(6):198.
6. Thongprasom K, Dhanuthai K. Steriods in the treatment of lichen planus: a review. J Oral Sci. 2008;50(4):377-85.
7. Lodi G, Manfredi M, Mercadante V, Murphy R, Carrozzo M. Interventions for treating oral lichen planus: corticosteroid therapies. Cochrane Database Syst Rev. 2020;2(2):Cd001168.
8. Al-Hashimi I, Schifter M, Lockhart PB, Wray D, Brennan M, Migliorati CA, et al. Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103 e1-12.
9. 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(1):42-5.
10. Thongprasom K, Luengvisut P, Wongwatanakij A, Boonjatturus C. Clinical evaluation in treatment of oral lichen planus with topical fluocinolone acetonide: a 2-year follow-up. J Oral Pathol Med. 2003;32(6):315-22.
11. Carbone M, Arduino PG, Carrozzo M, Caiazzo G, Broccoletti R, Conrotto D, et al. Topical clobetasol in the treatment of atrophic-erosive oral lichen planus: a randomized controlled trial to compare two preparations with different concentrations. J Oral Pathol Med. 2009;38(2):227-33.
12. Campisi G, Giandalia G, De Caro V, Di Liberto C, Aricò P, Giannola LI. A new delivery system of clobetasol-17-propionate (lipid-loaded microspheres 0.025%) compared with a conventional formulation (lipophilic ointment in a hydrophilic phase 0.025%) in topical treatment of atrophic/erosive oral lichen planus. a phase IV, randomized, observer-blinded, parallel group clinical trial. Br J Dermatol. 2004;150(5):984-90.
13. Melguizo-Rodríguez L, Costela-Ruiz VJ, Manzano-Moreno FJ, Ruiz C, Illescas-Montes R. Salivary biomarkers and their application in the diagnosis and monitoring of the most common oral pathologies. Int J Mol Sci. 2020;21(14):5173.
14. Othman NA, Shaker OG, Elshenawy HM, Abd-Elmoniem W, Eldin AM, Fakhr MY. The effect of diode laser and topical steroid on serum level of TNF-alpha in oral lichen planus patients. J Clin Exp Dent. 2016;8(5):e566-e70.
15. Agha-Hosseini F, Moosavi M, Sheykhbahaei N. Association of oral lichen planus and its treatment on tumor necrosis factor-alpha: a review literature and meta-analysis. Middle East J Rehabil Health Stud. 2021;8(3):e109577.
16. Mozaffari HR, Ramezani M, Mahmoudiahmadabadi M, Omidpanah N, Sadeghi M. Salivary and serum levels of tumor necrosis factor-alpha in oral lichen planus: a systematic review and meta-analysis study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;124(3):e183-e9.
17. Pezelj-Ribaric S, Prso IB, Abram M, Glazar I, Brumini G, Simunovic-Soskic M. Salivary levels of tumor necrosis factor-alpha in oral lichen planus. Mediators Inflamm. 2004;13(2):131-3.
18. Lu R, Zhang J, Sun W, Du G, Zhou G. Inflammation-related cytokines in oral lichen planus: an overview. J Oral Pathol Med. 2015;44(1):1-14.
19. 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(9):507-12.
20. Rhodus NL, Cheng B, Myers S, Bowles W, Ho V, Ondrey F. A comparison of the pro-inflammatory, NF-kappaB-dependent cytokines: TNF-alpha, IL-1-alpha, IL-6, and IL-8 in different oral fluids from oral lichen planus patients. Clin Immunol. 2005;114(3):278-83.
21. Ghallab NA, el-Wakeel N, Shaker OG. Levels of salivary IFN-gamma, TNF-alfa, and TNF receptor-2 as prognostic markers in (erosive) oral lichen planus. Mediators Inflamm. 2010;2010:847632.
22. Santos M, Diniz MB, Guaré RO, Ferreira MCD, Gutierrez GM, Gorjão R. Inflammatory markers in saliva as indicators of gingival inflammation in cerebral palsy children with and without cervical motor control. Int J Paediatr Dent. 2017;27(5):364-71.
23. Zhu ZD, Ren XM, Zhou MM, Chen QM, Hua H, Li CL. Salivary cytokine profile in patients with oral lichen planus. J Dent Sci. 2022;17(1):100-5.
24. Lodi G, Carrozzo M, Furness S, Thongprasom K. Interventions for treating oral lichen planus: a systematic review. Br J Dermatol. 2012;166(5):938-47.
25. Lodi G, Tarozzi M, Sardella A, Demarosi F, Canegallo L, Di Benedetto D, et al. Miconazole as adjuvant therapy for oral lichen planus: a double-blind randomized controlled trial. Br J Dermatol. 2007;156(6):1336-41.
26. Kanjanabuch P. Comparative effectiveness of 0.1% fluocinolone acetonide in orabase with 0.05% clobetasol propionate in orabase for the topical treatment of the oral lichen planus [dissertation on the Internet]. Bangkok, Thailand: Chulalongkorn University; 2003. Available from: http://cuir.car.chula.ac.th/handle/123456789/26833.
27. Carbone M, Conrotto D, Carrozzo M, Broccoletti R, Gandolfo S, Scully C. Topical corticosteroids in association with miconazole and chlorhexidine in the long-term management of atrophic-erosive oral lichen planus: a placebo-controlled and comparative study between clobetasol and fluocinonide. Oral Dis. 1999;5(1):44-9.
28. Lozada-Nur F, Miranda C, Maliksi R. Double-blind clinical trial of 0.05% clobetasol propionate (corrected from proprionate) ointment in orabase and 0.05% fluocinonide ointment in orabase in the treatment of patients with oral vesiculoerosive diseases. Oral Surg Oral Med Oral Pathol. 1994;77(6):598-604.
29. Sandhu S, Klein BA, Al-Hadlaq M, Chirravur P, Bajonaid A, Xu Y, et al. Oral lichen planus: comparative efficacy and treatment costs-a systematic review. BMC Oral Health. 2022;22(1):161.
30. Rhodus NL, Cheng B, Bowles W, Myers S, Miller L, Ondrey F. Proinflammatory cytokine levels in saliva before and after treatment of (erosive) oral lichen planus with dexamethasone. Oral Dis. 2006;12(2):112-6.
31. Thongprasom K, Dhanuthai K, Sarideechaigul W, Chaiyarit P, Chaimusig M. Expression of TNF-alpha in oral lichen planus treated with fluocinolone acetonide 0.1%. J Oral Pathol Med. 2006;35(3):161-6.
32. Uva L, Miguel D, Pinheiro C, Antunes J, Cruz D, Ferreira J, et al. Mechanisms of action of topical corticosteroids in psoriasis. Int J Endocrinol. 2012;2012:561018.
33. Hyrich KL, Silman AJ, Watson KD, Symmons DP. Anti-tumour necrosis factor alpha therapy in rheumatoid arthritis: an update on safety. Ann Rheum Dis. 2004;63(12):1538-43.
34. Andrade P, Lopes S, Albuquerque A, Osório F, Pardal J, Macedo G. Oral lichen planus in IBD patients: a paradoxical adverse effect of anti-TNF-α therapy. Dig Dis Sci. 2015;60(9):2746-9.
35. Abdelghaffar AA, Kandeel MM, Yassin HH, Abdelmonem W, Shaker OG. Evaluation of serum and salivary transforming growth factor beta, vascular endothelial growth factor and tumor necrosis factor alpha in oral lichen planus. J Oral Res (Impresa). 2020;9(2):86-92.
36. Elsayed M, Elsayed N, Riad S, Mahmoud S. Estimation salivary tumor necrosis factor-alpha level in patients with erosive oral lichen planus (a case control study). Alex Dent J. 2019;44:52-6.