The management of oral lichen planus

OBJECTIVE: To review the current literature regarding the medical treatment of oral lichen planus (OLP). DATA SOURCES: PubMed on-line Medline data searches were carried out for the years 1966-1998 to identify reports on therapy of OLP. METHODS OF STUDY SELECTION: Single case reports or open trials were include d if they covered new therapeutic approaches or suggested significant modif ications of known treatment modalities. Review papers were limited to those dealing with the topic. DATA EXTRACTION AND SYNTHESIS: Every paper was critically examined. Because of the great heterogeneity of the response criteria, many data could not b e directly compared. Stronger weight was given to therapies that have prove n to be effective under placebo-controlled research protocols. Attention wa s also drawn to potential and effective adverse effects of every drug used. CONCLUSIONS: Among the various medications advocated for the treatment of O LP, several lack conclusive findings from adequately controlled trials. Mai nly high-potency topical corticosteroids in an adhesive medium appear at pr esent the safest and most efficacious. Adjuvant agents as antimycotics may be useful in topical steroid treatment. Systemic corticosteroids may be occ asionally indicated for severe recalcitrant erosive OLP or for diffuse muco cutaneous involvement. Topical cyclosporine should be considered in steroid -unresponsive cases considering that its efficacy in OLP could be related t o a systemic effect and its high cost. Classical PUVA therapy seems to have too many side effects; topical application of psoralen is promising but st ill experimental. Topically and systemically delivered retinoids combined w ith topical corticosteroids could improve the efficacy of these agents wher eas complete remission is difficult to achieve with retinoids alone and the y frequently cause adverse effects. Finally, there are only few data concer ning the long-term effect of the medical treatments upon the course of OLP and we do not know if therapy influences the malignant evolution of OLP.