Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
권호 표지
DOI QR코드

DOI QR Code

Effectiveness of hyaluronic acid in the management of oral lichen planus: a systematic review and meta-analysis

  • Received : 2022.08.31
  • Accepted : 2022.11.14
  • Published : 2022.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

Oral lichen planus (OLP) is a chronic inflammatory immune-mediated condition that has been identified as a potentially malignant oral disorder. Various therapies have been proposed for its management as alternative to corticosteroids. However, no definitive treatment has been identified that can result in complete remission or minimal recurrence. Hyaluronic acid has recently been used as an alternative therapy for the management of OLP. This study aimed to systematically review the effectiveness of Hyaluronic acid in the management of symptomatic OLP. Online electronic databases and manual searches were performed for randomized controlled trials (RCTs) published in English between January 2010 and April 2022. RCTs were identified that compared the efficacy of hyaluronic acid and other interventional therapies at baseline and during follow-up. The Cochrane Risk of Bias tool was used to assess the quality of the included studies. Visual analog scale (VAS) scores, Thongprasom sign scores, lesion size, degree of erythema, clinical severity, and disease severity were assessed both quantitatively and qualitatively. Seven studies were analyzed. Five studies reported a high risk of bias while the remaining two studies reported an unclear risk of bias. The overall quantitative assessment of size, symptoms, degree of erythema, and sign score in OLP lesions treated with HA was not statistically significant compared to that in the control group (P > 0.05). In addition, subgroup analysis comparing HA with placebo or corticosteroids did not yield statistically significant (P > 0.05) results. Qualitatively, both HA and tacrolimus resulted in an effective reduction in signs and symptoms. Clinical/disease severity index/scores were inconsistent. A high degree of heterogeneity was observed among the included studies. None of the included studies reported the side effects of HA. These findings suggest that corticosteroids, tacrolimus, placebo, and HA could be equally effective in OLP management. The clinical/disease severity index or score reduction cannot be determined with certainty. Thus, OLP can be treated with HA as an alternative therapy. Owing to limited clinical trials on HA, high heterogeneity, and high risk of bias in the included studies, definitive conclusions cannot be derived.

Keywords

References

  1. Elenbaas A, Enciso R, Al-Eryani K. Oral lichen planus: a review of clinical features, etiologies, and treatments. Dent Rev 2022; 2: 100007. https://doi.org/10.1016/j.dentre.2021.100007
  2. Azab NA, Gamal-Abdel Naser A. Natural remedies versus topical steroids for the treatment of oral lichen planus: a systematic review. J Herb Med 2020; 24: 100394. https://doi.org/10.1016/j.hermed.2020.100394
  3. Gupta S, Ghosh S, Gupta S. Interventions for the management of oral lichen planus: a review of the conventional and novel therapies. Oral Dis 2017; 23: 1029-42. https://doi.org/10.1111/odi.12634
  4. Oberti L, Alberta L, Massimo P, Francesco C, Dorina L. Clinical management of oral lichen planus: a systematic review. Mini Rev Med Chem 2019; 19: 1049-59. https://doi.org/10.2174/1389557519666190301144157
  5. Singh A, Rai A, Aftab M, Jain S, Singh M. Efficacy of steroidal vs non-steroidal agents in oral lichen planus: a randomised, open-label study. J Laryngol Otol 2017; 131: 69-76. https://doi.org/10.1017/S0022215116009658
  6. Shetty RR, Burde KN, Guttal KS. The efficacy of topical hyaluronic acid 0.2% in the management of symptomatic oral lichen planus. J Clin Diagn Res 2016; 10: ZC46-50.
  7. 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: 198.
  8. Agha-Hosseini F, Atyabi F, Akbari K, Moosavi MS. Decreased recurrence of symptoms in oral lichen planus with intralesional injection of hyaluronic acid and triamcinolone. Int J Oral Maxillofac Surg 2021; 50: 1643-8. https://doi.org/10.1016/j.ijom.2021.02.028
  9. Suresh SS, Chokshi K, Desai S, Malu R, Chokshi A. Medical management of oral lichen planus: a systematic review. J Clin Diagn Res 2016; 10: ZE10-5.
  10. Kapoor P, Sachdeva S, Sachdeva S. Topical hyaluronic acid in the management of oral ulcers. Indian J Dermatol 2011; 56: 300-2.
  11. Yang Z, Li M, Xiao L, Yi Z, Zhao M, Ma S. Hyaluronic acid versus dexamethasone for the treatment of recurrent aphthous stomatitis in children: efficacy and safety analysis. Braz J Med Biol Res 2020; 26; 53: e9886.
  12. Kuduva Ramesh SS, Sadaksharam J. Assessment of clinical efficacy of microbiome and topical hyaluronic acid gel combination therapy in minor aphthous ulcer management - A comparative study. J Indian Acad Oral Med Radiol 2021; 33: 135-40. https://doi.org/10.4103/jiaomr.jiaomr_236_20
  13. Youssef Mi, EI Sayed NM, Darwis ZE, Fahmy RA. The effect of topically applied hyaluronic acid gel versus topical corticosteroid in the treatment of erosive oral lichen planus. Alex Dent J 2019; 44: 57-63. https://doi.org/10.21608/adjalexu.2019.57577
  14. Nolan A, Baillie C, Badminton J, Rudralingham M, Seymour RA. The efficacy of topical hyaluronic acid in the management of recurrent aphthous ulceration. J Oral Pathol Med 2006; 35: 461-5.
  15. Bruckmann C, Seemann R, Rappersberger K, Rausch-Fan X, Haririan H, Dvorak G. Is topical application of hyaluronic acid in oral lichen planus effective? a randomized controlled crossover study. Appl Sci 2020; 10: 7988.
  16. Al-Khateeb R, Olszewska-Czyz I. Biological molecules in dental applications: hyaluronic acid as a companion biomaterial for diverse dental applications. Heliyon 2020 6; 6: e03722.
  17. Casale M, Moffa A, Vella P, Sabatino L, Capuano F, Salvinelli B, et al. Hyaluronic acid: perspectives in dentistry. a systematic review. Int J Immunopathol Pharmacol 2016; 29: 572-82. https://doi.org/10.1177/0394632016652906
  18. Hashem AS, Issrani R, Elsayed TEE, Prabhu N. Topical hyaluronic acid in the management of oral lichen planus: a comparative study. J Investig Clin Dent 2019; 10: e12385.
  19. Polizzi A, Santonocito S, Lo Giudice A, Alibrandi A, De Pasquale R, Isola G. Analysis of the response to two pharmacological protocols in patients with oral lichen planus: a randomized clinical trial. Oral Dis 2021; 00: 1-9.
  20. Santonocito S, Polizzi A, De Pasquale R, Ronsivalle V, Lo Giudice A, Isola G. Analysis of the efficacy of two treatment protocols for patients with symptomatic oral lichen planus: a randomized clinical trial. Int J Environ Res Public Health 2020; 23; 18: 56.
  21. Al-Maweri SA, Alanazi R, Alhajj MN, Daer A, Hunaish AA, Nabhan AB, et al. Efficacy of topical hyaluronic acid for symptomatic oral lichen planus: A systematic Review. J Oral Res 2021; 10: 1-7.
  22. Sterne JAC, Savovic J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898. https://doi.org/10.1136/bmj.l5779
  23. Gobbo M, Rupel K, Zoi V, Perinetti G, Ottaviani G, Di Lenarda R, Bevilacqua L, Woo SB, Biasotto M. Scoring systems for oral lichen planus used by differently experienced raters. Med Oral Patol Oral Cir Bucal 2017; 22: e562-71.
  24. Chainani-Wu N, Silverman S Jr, Reingold A, Bostrom A, Lozada-Nur F, Weintraub J. Validation of visual analogue scale, numeric rating scale, change in symptoms scale, and modified oral mucositis index for measurement of symptoms and signs of oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: P328.
  25. Raj A, Kt S, Anita B. Dapsone in the treatment of resistant oral erosive lichen planus: A clinical study. J Indian Acad Oral Med Radiol 2012; 24: 20-3. https://doi.org/10.5005/jp-journals-10011-1253
  26. 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
  27. Krogh HB, Storebo OJ, Faltinsen E, Todorovac A, Ydedahl-Jensen E, Magnusson FL, et al. Methodological advantages and disadvantages of parallel and crossover randomised clinical trials on methylphenidate for attention deficit hyperactivity disorder: a systematic review and meta-analyses. BMJ Open 2019; 9: e026478.