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MANAGEMENT OF ORAL
LICHEN PLANUS WITH
TOPICAL TACROLIMUS.
A PROSPECTIVE STUDY
IN 20 PATIENTS
INDIAN DENTAL ACADEMY
Leader ...
PRESENTED BY:
UNDER GUIDANCE OF:
DR. UPENDRA MALIK
PG FINAL YEAR STUDENT
DR. M.SRINIVASA RAJU
(PROFESSOR & HEAD)
DR. SATHE...
INTRODUCTION
 The term oral lichen planus was first coined by Erasmus
Wilson in 1869.
 Lichen planus is a relatively com...
 Mutiple systemic and topical treatments for
oral lichen planus have been reported to be
effective, including topical & s...
 Tacrolimus is a macrolide
immunosuppressant belonging to cyclosporin
group having the same mechanism of action
as cyclos...
AIMS & OBJECTIVES
www.indiandentalacademy.com
 TO ASSESS THE EFFICACY OF 0.1%
TOPICAL TACROLIMUS IN
SYMPTOMATIC PATIENTS WITH
LICHEN PLANUS.
 TO DETERMINE THE USE OF ...
MATERIALS & METHODS
 Tacrolimus ointment preparationTacrolimus ointment preparation: 500mg of
powder is mixed into 300gms...
 INCLUSION CRITERIA:
 Symptomatic patients having clinical evidence
of the lesion.
 Histopathological diagnosis of the ...
SAMPLING TECHNIQUE
 Samples for the study were selected among
the patients attending the OPD of Kothiwal
Dental College &...
 Drug was dispensed to the patients and
patients were recalled every 15 days for check
ups and reinforcement of instructi...
SUBJECTIVE ASSESSMENT
 A case history Performa was designed containing a
minimum set of information regarding patient’s
...
OBJECTIVE ASSESSMENT
 Clinical assessment by inspection (location,
size, color, surface condition, whether single
or mult...
Clinical scoring as follows:
0 – No lesion
1 – White striae only
2 – White striae & erosions < 1 sqcm
3 – White striae & e...
 All the patients underwent baseline
investigations which included complete blood
count, RBS, and Liver biochemistry.
www...
 The drug was given to the patient and patient
recalled for clinical assessment.
 Patients were told to apply the thrice...
SOME CLINICAL CASES
TREATED
www.indiandentalacademy.com
18yr old Female with papular
OLP
www.indiandentalacademy.com
45yrold female
with desquamative gingivitis
pre treatment post treatment
www.indiandentalacademy.com
PRE TREATMENT POST TREATMENT
www.indiandentalacademy.com
32 year male patient with erosive lichen
planus invloving buccal mucosa
www.indiandentalacademy.com
PRE TREATMENT POST TREATMENT
www.indiandentalacademy.com
44 year male patient having
symptomatic reticular lesions of buccal
mucosa
www.indiandentalacademy.com
PRE TREATMENT POST TREATMENT
www.indiandentalacademy.com
24 years old male patient with erosive
OLP of buccal mucosa
www.indiandentalacademy.com
PRE TREATMENT POST TREATMENT
www.indiandentalacademy.com
RESULTS
www.indiandentalacademy.com
 20 Patients participated in the study. (13 females 7
males)
 Average age of FEMALES: 37.92 years.
MALES: 38.86 years.
...
0
1
2
3
4
5
6
Male
Female
Male
Female
pre
treatment
Post
teatment
bar chart showing the average pre
treatment and post tre...
S.No.
Difference
in VAS
scale
(Mean±SD)
Paired t-
test t (19,.05)
p-value at
α=.05
Z at
α=.01
p-value at
α=.01
Visual anlo...
DISCUSSION
 The treatment of oral lichen planus is challenging. A number
of therapies are reported, none of which are hig...
 Majority of these drugs have toxicities that limit long term use and have
not been evaluated in rigorous controlled stud...
CONCLUSION
 Topical tacrolimus showed promising results in the
treatment of oral lichen planus lesions and is an
effectiv...
Picture slide
 Bullet 1
 Bullet 1
www.indiandentalacademy.com
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MANAGEMENT OF ORAL LICHEN PLANUS WITH TOPICAL TACROLIMUS. A PROSPECTIVE STUDY IN 20 PATIENTS/ dental courses

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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MANAGEMENT OF ORAL LICHEN PLANUS WITH TOPICAL TACROLIMUS. A PROSPECTIVE STUDY IN 20 PATIENTS/ dental courses

  1. 1. MANAGEMENT OF ORAL LICHEN PLANUS WITH TOPICAL TACROLIMUS. A PROSPECTIVE STUDY IN 20 PATIENTS INDIAN DENTAL ACADEMY Leader in continuing Dental Education www.indiandentalacademy.com
  2. 2. PRESENTED BY: UNDER GUIDANCE OF: DR. UPENDRA MALIK PG FINAL YEAR STUDENT DR. M.SRINIVASA RAJU (PROFESSOR & HEAD) DR. SATHEESHA REDDY B.H (PROFESSOR) DR. GN SUMA (PROFESSOR) DR. RAVI PRAKASH SM (ASSOCIATE PROFESSSOR) KOTHIWAL DENTAL COLLEGE & RESEARCH CENTRE, MORADABAD, U.P www.indiandentalacademy.com
  3. 3. INTRODUCTION  The term oral lichen planus was first coined by Erasmus Wilson in 1869.  Lichen planus is a relatively common mucocutaneous disease estimated to affect 0.5-1% of the adult population, with manifestation seen both on skin and oral mucosa.  Clinical representation of oral lichen planus as previously reported are reticular, plaque like, erosive, papular, atrophic and bullous. www.indiandentalacademy.com
  4. 4.  Mutiple systemic and topical treatments for oral lichen planus have been reported to be effective, including topical & systemic corticosteroids, griseofulvin, hydroxy chlorquine, dapsone, topical retinoids and topical cyclosporine.  However some patients are resistant to treatment with these therapies. www.indiandentalacademy.com
  5. 5.  Tacrolimus is a macrolide immunosuppressant belonging to cyclosporin group having the same mechanism of action as cyclosporin but it is 10-100 times more potent than cyclosporin.  Topical tacrolimus have been reported to be safe and effective in the treatment of oral lichen planus especially in those forms which are recalcitrant to treatment. www.indiandentalacademy.com
  6. 6. AIMS & OBJECTIVES www.indiandentalacademy.com
  7. 7.  TO ASSESS THE EFFICACY OF 0.1% TOPICAL TACROLIMUS IN SYMPTOMATIC PATIENTS WITH LICHEN PLANUS.  TO DETERMINE THE USE OF TOPICAL TACROLIMUS AS A FIRST LINE THERAPY FOR THE TREATMENT OF ORAL LICHEN PLANUS. www.indiandentalacademy.com
  8. 8. MATERIALS & METHODS  Tacrolimus ointment preparationTacrolimus ointment preparation: 500mg of powder is mixed into 300gms of base which is oraguard-B (colgate-palmolive U.S.A) to attain a concentration of 0.1% of the drug. www.indiandentalacademy.com
  9. 9.  INCLUSION CRITERIA:  Symptomatic patients having clinical evidence of the lesion.  Histopathological diagnosis of the lesion.  EXCLUSION CRITERIA:  Patients on medications for other ailments. www.indiandentalacademy.com
  10. 10. SAMPLING TECHNIQUE  Samples for the study were selected among the patients attending the OPD of Kothiwal Dental College & Research Center & satisfying the inclusion & exclusion criteria.  A written consent was obtained from each individual before giving the medication. www.indiandentalacademy.com
  11. 11.  Drug was dispensed to the patients and patients were recalled every 15 days for check ups and reinforcement of instructions. www.indiandentalacademy.com
  12. 12. SUBJECTIVE ASSESSMENT  A case history Performa was designed containing a minimum set of information regarding patient’s  Chief complaint  History of present illness  Medical history  Drug history  Habits  VAS. www.indiandentalacademy.com
  13. 13. OBJECTIVE ASSESSMENT  Clinical assessment by inspection (location, size, color, surface condition, whether single or multiple).  Palpation included consistency & pain intensity. www.indiandentalacademy.com
  14. 14. Clinical scoring as follows: 0 – No lesion 1 – White striae only 2 – White striae & erosions < 1 sqcm 3 – White striae & erosions > 1 sqcm 4 – White striae & ulceration < 1sqcm 5 – White striae & ulceration > 1sqcm www.indiandentalacademy.com
  15. 15.  All the patients underwent baseline investigations which included complete blood count, RBS, and Liver biochemistry. www.indiandentalacademy.com
  16. 16.  The drug was given to the patient and patient recalled for clinical assessment.  Patients were told to apply the thrice daily after meals and not to eat and rinse for 45 minutes after applying the medication. www.indiandentalacademy.com
  17. 17. SOME CLINICAL CASES TREATED www.indiandentalacademy.com
  18. 18. 18yr old Female with papular OLP www.indiandentalacademy.com
  19. 19. 45yrold female with desquamative gingivitis pre treatment post treatment www.indiandentalacademy.com
  20. 20. PRE TREATMENT POST TREATMENT www.indiandentalacademy.com
  21. 21. 32 year male patient with erosive lichen planus invloving buccal mucosa www.indiandentalacademy.com
  22. 22. PRE TREATMENT POST TREATMENT www.indiandentalacademy.com
  23. 23. 44 year male patient having symptomatic reticular lesions of buccal mucosa www.indiandentalacademy.com
  24. 24. PRE TREATMENT POST TREATMENT www.indiandentalacademy.com
  25. 25. 24 years old male patient with erosive OLP of buccal mucosa www.indiandentalacademy.com
  26. 26. PRE TREATMENT POST TREATMENT www.indiandentalacademy.com
  27. 27. RESULTS www.indiandentalacademy.com
  28. 28.  20 Patients participated in the study. (13 females 7 males)  Average age of FEMALES: 37.92 years. MALES: 38.86 years.  Average duration of treatment for MALES: 77 days FEMALES: 88.6 days www.indiandentalacademy.com
  29. 29. 0 1 2 3 4 5 6 Male Female Male Female pre treatment Post teatment bar chart showing the average pre treatment and post treatment VAS Series1 www.indiandentalacademy.com
  30. 30. S.No. Difference in VAS scale (Mean±SD) Paired t- test t (19,.05) p-value at α=.05 Z at α=.01 p-value at α=.01 Visual anlouge scale 4.45 ± 2.1145 9.412 2.093 p<.05* p<.01** Right buccal mucosa 11 3.78 1.96 p<.05* 2.58 p<.01** Left buccal mucosa 12 4.01 1.96 p<.05* 2.58 p<.01** Desquamative gigivitis 5 2.99 1.96 p<.05* 2.58 p<.01** www.indiandentalacademy.com
  31. 31. DISCUSSION  The treatment of oral lichen planus is challenging. A number of therapies are reported, none of which are highly effective and all of which are aimed at controlling the disease rather than inducing remission. Topical corticosteroids, topical tretinoin, and topical cyclosporin have all been used without dramatic success. Systemic therapies including oral psoralens UvA, etretinate, dapsone, & thalidomide have been reported in the treatment of OLP. www.indiandentalacademy.com
  32. 32.  Majority of these drugs have toxicities that limit long term use and have not been evaluated in rigorous controlled studies.  Our result in all the 20 patients showed a positive response to treatment with topical tacrolimus and reported a partial to complete resolution of symptoms.  13 of the 20 patients have complete healing of the lesions. Out of these 13 cases 10 have resolution of even the reticular component also.  In rest seven cases partial response to treatment was present and the patients came under the category of 1-2 clinical scoring. 5 patients reported increased burning sensation after first 3-4 application which was not so severe as to discontinue the drug. www.indiandentalacademy.com
  33. 33. CONCLUSION  Topical tacrolimus showed promising results in the treatment of oral lichen planus lesions and is an effective and safe therapy for lesions recalcitrant to other modes of treatments.  Our study also proved tacrolimus to effective in patients who are seeking treatment for the first time for this condition.  Further double blinded studies are required with the same drug to further establish the efficacy of topical tacrolimus as modality of treatment in oral lichen planus. www.indiandentalacademy.com
  34. 34. Picture slide  Bullet 1  Bullet 1 www.indiandentalacademy.com

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