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Oral Lichen Planus Alternatives

March 23, 2012 Written by JP       [Font too small?]

Oral lichen planus (OLP) is an inflammatory autoimmune disease that, as it’s name implies, affects tissue in and around the oral cavity – the esophagus, gums, palate and tongue. In most cases, it is a chronic condition that manifests itself in patches, rashes or sores that may or may not be accompanied by burning, pain and/or sensitivity. While uncomfortable, it is not contagious. In terms of long term complications, OLP may increase the risk of a specific form of cancer (squamous cell carcinoma) and, if present in the esophagus, could cause difficulty swallowing. As with many other autoimmune diseases, OLP is often managed with the judicious use of corticosteroids or other immunosuppressive medications. However, a growing body of research also points to several natural and safer alternatives.

The February 2012 edition of the journal Inflammation Research suggests that green tea may provide a dietary approach for taming the inflammatory process associated with OLP. The authors of the paper comment that green tea is known to inhibit T-cell activation, migration, proliferation, and modulates “the imbalance between transforming growth factor-B and interferon-y, all of which are involved in the pathogenesis of OLP”. The concluding remarks of the preliminary examination states, “our hypothesis is that green tea consumption may decrease OLP incidence and provide a neoteric, nontoxic and inexpensive therapeutic strategy for OLP”. What’s more, they go on to explain that green tea may also serve as a possible chemoprotective agent in relation to squamous cell carcinoma.

Four dietary supplements are also worthy of consideration: aloe vera, curcumin, Ignatia and lycopene. At least two studies reveal that orally applied aloe vera reduces pain, promotes remission and improves quality of life in patients living with OLP. Curcumin, the spice-derived antioxidant, has likewise benefited those with oral lichen planus. The studies to date indicate that higher dosages of curcumin (up to 6,000 mg/day) help a significant number of OLP patients control their symptoms with only minimal side effects – occasional gastrointestinal discomfort. It’s important to note that smaller quantities of curcumin (>2,000 mg/day) have failed to provide relief.  Ignatia, the homeopathic remedy, is yet another, all-natural and gentle alternative. An Iranian study from 2009 reports that Ignatia 30C (a measure of homeopathic potency) effectively decreased lesion size and pain measures as compared to a placebo. Finally, a tomato extract rich in lycopene, is the latest nutraceutical to show promise in the battle against OLP. Supplementing with 8 mg/day of lycopene reduced burning sensation by 84% and lowered oxidative stress in an 8 week placebo-controlled trial. Previous research indicates that those with OLP often have lower than normal serum levels of lycopene.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 - Green Tea Consumption: An Alternative Approach to Managing Oral (link)

Study 2 - Efficacy of Topical Aloe Vera in Patients with Oral Lichen Planus (link)

Study 3 - The Efficacy of Aloe Vera Gel in the Treatment of Oral Lichen Planus (link)

Study 4 - Use of Curcuminoids in a Cohort of Patients with Oral Lichen Planus(link)

Study 5 - High-Dose Curcuminoids are Efficacious in the Reduction in Symptoms (link)

Study 6 – Possible Action Mechanism for Curcumin in Pre-Cancerous Lesions (link)

Study 7 - A Randomized, Placebo-Controlled, Double-Blind Clinical Trial of (link)

Study 8 - Ignatia in the Treatment of Oral Lichen Planus (link)

Study 9 - Lycopene in the Management of Oral Lichen Planus: A Placebo (link)

Study 10 - Serum Antioxidant Micronutrient Levels in Oral Lichen Planus (link)

OLP Affects Approximately 2% of Adults – Mostly Middle-Aged Women

Source: BMC Res Notes. 2010 Jun 3;3:157. (link)

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18 Comments & Updates to “Oral Lichen Planus Alternatives”

  1. Sylvia Stewart Says:

    As a newly discovered sufferer of OLP, I find this information very interesting! Thanks so much for delving into alternative treatments to treating this irritating condition!

  2. JP Says:

    Thank you, Sylvia!

    I hope this information helps you improve your OLP symptoms and avoid further irritation!

    Be well!

    JP

  3. Donna Loux Says:

    My oral lichen planus has responded very well to high doses of vitamin D3 and magnesium. So far, it surpasses any of the steroid prescriptions I’ve been given or any other remedies I’ve tried. It took a while to figure out the right dose where I could remain symptom free, but I am taking 12,000IU/day D3 and 1000mg/day magnesium. Since starting this protocol two years ago, I have had only one minor flare up that was easily back under control with a day or two of my Rx steroid rinse. I have tried green tea, and the lycopene, but not the curcumin. But I do have a lot of that in my daily diet.

  4. JP Says:

    Hi Donna,

    That’s very interesting information. Thank you for sharing it with us!

    When researching this topic, I did examine the potential of Vitamin D. Unfortunately, I didn’t find anything in the medical literature. But, that just means you’re ahead of the curve. :)

    The magnesium is something that didn’t even occur to me. Very interesting indeed.

    I wish you continued success! Be well!

    JP

  5. Holly W. Says:

    Thank you for a comprehensive and informative article.

    Where can I obtain aloe vera gel for the gums to help treat OLP ?

    I tried Kenolog dental paste for one month which cleared up the blisters but not the gum leisions. Upon discontinuing it I had a rosacea flare.

    Do you know of any nonsteroidal lotions for the itching skin that accompanies OLP? I have used 100% Aloe in the past. My skin is dry and irritated.

  6. JP Says:

    Hi Holly,

    You can find high quality aloe vera gels on the Internet and at many health food stores. I suggest looking for one that is intended for oral use – rather than topical use. If you can acquire one that’s organic and free of preservatives all the better.

    As far as the itching skin is concerned, you might consider (all-natural/gentle) moisturizing creams, intended for the face, which contain Vitamin B12 and/or Vitamin D. Now Foods has a few reasonably-priced products that fit the bill:

    http://www.nowfoods.com/Personal-Care/Products/Body/Lotions-Creams/087737.htm

    http://www.nowfoods.com/Personal-Care/Products/Body/Lotions-Creams/087738.htm

    Be well!

    JP

  7. RAM Says:

    Thank you SO much for putting all this information together in one place. Finding science-based recommendations for addressing OLP is shockingly difficult to find. And most doctors/dentists I\’ve consulted have been pretty useless.

    As someone who has had to deal with oral cancer (likely due to OLP combined with use of high-alcohol Listerine), I recommend doing whatever possible to keep the condition under control. And regular ENT visits are a very good idea as well.

  8. JP Says:

    I’m happy it was of value to you, RAM! Thanks for letting me know. :-)

    Be well!

    JP

    PS – I added a few updates below.

  9. JP Says:

    Update: Turmeric may be of value …

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961895/

    Natl J Maxillofac Surg. 2013 Jul;4(2):198-201.

    Turmeric – A new treatment option for lichen planus: A pilot study.

    Turmeric is dried rhizome of the perennial herbs curcumalonga. It is called Haldi in Hindi, turmeric in English, ukon in Japanese. It has been used in Asian Medicine since the second millennium BC. It’s utility is referred to in the ancient Hindu script the Ayurveda. Pathogenesis of the OLP should be taken in consideration for the treatment point of view. The Cell mediated immunity to secondary antigenic change in oral mucous membrane is thought to play a major role in its pathogenesis modified keratocyte surface antigens are the primary target for cytotoxic cellular response. Curcumin also been shown to have immune modulatory effect involving activation of host macrophages and natural killer cells and modulation of lymphocytes mediated function.

    Be well!

    JP

  10. JP Says:

    Update: Aloe vera gel appears to be another effective and safe option …

    http://qi.quintessenz.de/index.php?doc=abstract&abstractID=28352/

    Quintessence Int. 2012 Oct;43(9):793-800.

    Randomized trial of aloe vera gel vs triamcinolone acetonide ointment in the treatment of oral lichen planus.

    OBJECTIVE: To determine the effectiveness of aloe vera gel in the treatment of oral lichen planus when compared with triamcinolone acetonide.

    METHOD AND MATERIALS: A randomized, double-blind, clinical trial was designed. The study sample constituted 40 patients (23 males and 17 females) who were randomly divided into two equal groups. Group A patients received aloe vera gel, while group B patients received triamcinolone acetonide.

    RESULTS: Forty patients were included in the study. Most of the sample presented with erosive (n = 18) and atrophic (n = 14) variants of oral lichen planus. When clinical signs and symptoms were observed after 8 weeks of therapy, it was determined that aloe vera gel was more effective than triamcinolone acetonide in the treatment of oral lichen planus.

    CONCLUSION: Aloe vera gel can be considered a safe alternative treatment for oral lichen planus.

    Be well!

    JP

  11. JP Says:

    Updated 07/19/15:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417489/

    J Dent Res Dent Clin Dent Prospects. 2015 Winter;9(1):23-8.

    A Randomized Placebo-controlled Double Blind Clinical Trial of Quercetin for Treatment of Oral Lichen Planus.

    Background and aims. Standard treatment of oral lichen planus (OLP) includes topical or systemic corticosteroids that have many adverse effects. A trend toward alternative natural or herbal drugs has attended recently. This study was conducted to evaluate the effect of quercetin in treatment of erosive-atrophic OLP. Materials and methods. Thirty patients participated in this randomized clinical trial from April 2010 to June 2010 (TRIAL REGISTRATION NUMBER: NCT01375101). Patients were randomly allocated in two groups. Both groups received the standard treatment (dexamethasone mouthwash and nystatin suspension). Experimental group received oral 250 mg quercetin hydrate capsules (bid) and the control group received placebo capsules. The pain and severity of the lesions were recorded at the initial visit and the follow-ups. All recorded data were analyzed with chi-square, Mann-Whitney, t-test, Wilcoxon and Friedman tests using SPSS 11.5. Results. There were no significant differences between the two groups in severity of the lesions and pain in the follow-ups.According to the Friedman test, there was a significant reduction in pain (P = 0.01) and severity indices (P = 0.00) in the case group. These differences were not observed in the control group(P = 0.26,SI; and P = 0.86, PI). No adverse effect of quercetin was reported. Conclusion. According to the results, no significant therapeutic effect can be considered for quercetin in treatment of OLP.

    Be well!

    JP

  12. JP Says:

    Updated 07/19/15:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316324/

    J Clin Diagn Res. 2014 Dec;8(12):ZC01-3.

    Association of salivary cortisol and anxiety levels in lichen planus patients.

    BACKGROUND: Oral lichen planus (OLP) is a frequently encountered chronic inflammatory disease of oral mucosa and skin, where the patients often relate the onset and aggravation of oral symptoms to increased levels of stress. Cortisol, also called as “stress hormone” has been used as an indicator in various stress evaluation studies.

    AIM: The aim of this cross-sectional study was to determine any association between anxiety and salivary cortisol levels in OLP patients.

    MATERIALS AND METHODS: A total of 20 OLP patients along with same number of age and sex matched healthy controls were included in the study. Saliva was collected from all the subjects between 9.00 to 9.15 am to avoid diurnal variations of cortisol levels. The saliva samples were analysed for cortisol levels by competitive enzyme-linked immunosorbent assay (ELISA) method. Anxiety levels of 40 patients were measured by using Hamilton’s anxiety scale. Student’s t-test was used to compare the anxiety and salivary cortisol levels between both groups.

    RESULTS: The mean salivary cortisol level of the OLP group showed highly significant difference (p<0.001) from the controls. The mean anxiety scores of the OLP group showed highly significant difference (p<0.001) from the controls. A positive correlation was found between anxiety and salivary cortisol levels in the OLP patients.

    CONCLUSION: These findings suggest that anxiety play a vital role in the pathogenesis of OLP, thus besides traditional treatment, psychological support is also needed.

    Be well!

    JP

  13. JP Says:

    Updated 07/19/15:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290339/

    J Clin Diagn Res. 2014 Nov;8(11):ZC92-5.

    Lipid profile and metabolic syndrome status in patients with oral lichen planus, oral lichenoid reaction and healthy individuals attending a dental college in northern India – a descriptive study.

    BACKGROUND: Chronic inflammation causes disturbances in the lipid metabolism. When this dyslipidemia becomes prolonged it increases the risk of cardiovascular disease. Recent literature reveals similar dyslipidemia in patients with lichen planus. However, the results were not compared with lichenoid reactions.

    OBJECTIVE: The aim of this study was to profile the lipid levels and metabolic syndrome status in patients with oral lichen planus (OLP), oral lichenoid reactions (OLR) and healthy individuals in order to evaluate their respective cardiovascular risk.

    MATERIALS AND METHODS: This case-control descriptive study included 32 adults from the OPD visiting the Department of Oral Medicine, 18 with either oral lichen planus or oral lichenoid reactions and 14 age and sex matched healthy controls. Ethical clearance and informed consent were obtained. Their lipid levels, body mass index and metabolic syndrome status were evaluated. Statistical analyses were performed with the SPSS version 16.0 software.P≥0.05 was considered significant.

    RESULTS: The key findings of this study were a) increased levels of S.cholesterol and LDL-C in OLP and OLR patients when compared to normal healthy individuals b) significantly higher S.triglyceride and VLDL in OLP when compared to OLR and c) lower HDL-C levels in OLP when compared to OLR. 2(18%) patients with OLP and 3(50%) with OLR were found to have high BMI suggestive of obesity whereas none of the normal individuals were obese.

    CONCLUSION: There may be an association between chronic inflammation and dyslipidemia that increases the risk for cardiovascular disease. OLP and OLR patients have increased serum cholesterol and LDL-C when compared to normal adults. Further research on lipid levels in OLR are required to establish the findings of this study.

    Be well!

    JP

  14. Lynda Says:

    This is all relatively new to me and very uncomfortable and something new seems to pop up every week; i.e. one part of my gums is now bleeding a lot when I brush and don’t know if that’s normal with this. Wanted to add that when this first broke out I switched toothpaste to organic Tom’s of Maine. Worked great and cleared it up in a few days!

  15. JP Says:

    Thank you for sharing that, Lynda! Much appreciated!

    Be well!

    JP

  16. JP Says:

    Updated 08/16/15:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439686/

    J Pharm Bioallied Sci. 2015 Apr;7(Suppl 1):S255-9.

    Benefits of Aloe vera in dentistry.

    Aloe vera (Aloe barbadensis) is a plant that belongs to Liliaceae family. The name Aloe derives from the Arabic word “Alloeh” meaning shining bitter substance while “vera” in Latin means true. It contains various minerals and vitamins. It has got various properties such as immunomodulatory, antiviral and antiinflammatory in nature. A. vera can play a significant role in dentistry in treatment of lichen planus, oral submucous fibrosis, recurrent aphthous stomatitis, alveolar osteitis, periodontitis, etc.

    Be well!

    JP

  17. JP Says:

    Updated 08/16/15:

    http://www.bjoms.com/article/S0266-4356%2815%2900143-6/abstract

    Br J Oral Maxillofac Surg. 2015 Sep;53(7):621-6.

    Relevance of psychosocial factors to quality of life in oral cancer and oral lichen planus: a prospective comparative study.

    We can improve our understanding of how patients cope with oral squamous cell carcinoma (SCC) by making a comparison with their processes of coping and those used in other conditions. We have therefore compared quality of life (QoL), severity of symptoms, coping strategies, and factors that influence coping between patients with oral SCC and those with oral lichen planus. We asked 104 patients with oral SCC and 51 with oral lichen planus to complete questionnaires about their coping strategies, social support, locus of control, spirituality, QoL, and severity of symptoms. The outcome was that patients with oral SCC were far more likely to resort to coping strategies such as depressive coping, distraction, and self-motivation. The groups also differed regarding QoL and severity of symptoms. Patients with oral SCC had a poorer QoL and higher depression scores, whereas patients with oral lichen planus had better scores in the social support and spirituality categories. Patients with oral SCC generally had more distress than those with oral lichen planus. Not only did the former resort to depressive coping strategies, but they also had poorer QoL and higher values for depression. For the patients with oral lichen planus, social support and spirituality were protective, whereas they were associated with distress by patients with oral SCC.

    Be well!

    JP

  18. JP Says:

    Updated 08/16/15:

    Note: Not every natural remedy is effective. But, this is still valuable information:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417489/

    J Dent Res Dent Clin Dent Prospects. 2015 Winter;9(1):23-8.

    A Randomized Placebo-controlled Double Blind Clinical Trial of Quercetin for Treatment of Oral Lichen Planus.

    Background and aims. Standard treatment of oral lichen planus (OLP) includes topical or systemic corticosteroids that have many adverse effects. A trend toward alternative natural or herbal drugs has attended recently. This study was conducted to evaluate the effect of quercetin in treatment of erosive-atrophic OLP. Materials and methods. Thirty patients participated in this randomized clinical trial from April 2010 to June 2010 (TRIAL REGISTRATION NUMBER: NCT01375101). Patients were randomly allocated in two groups. Both groups received the standard treatment (dexamethasone mouthwash and nystatin suspension). Experimental group received oral 250 mg quercetin hydrate capsules (bid) and the control group received placebo capsules. The pain and severity of the lesions were recorded at the initial visit and the follow-ups. All recorded data were analyzed with chi-square, Mann-Whitney, t-test, Wilcoxon and Friedman tests using SPSS 11.5. Results. There were no significant differences between the two groups in severity of the lesions and pain in the follow-ups.According to the Friedman test, there was a significant reduction in pain (P = 0.01) and severity indices (P = 0.00) in the case group. These differences were not observed in the control group(P = 0.26,SI; and P = 0.86, PI). No adverse effect of quercetin was reported. Conclusion. According to the results, no significant therapeutic effect can be considered for quercetin in treatment of OLP.

    Be well!

    JP

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