Factors Affecting the Result of Intralesional Corticosteroid Injection in Patients With Oral Lichen Planus

Clinical and Experimental Otorhinolaryngology Vol. 11, No. 3: 205-209, September 2018 https://doi.org/10.21053/ceo.2017.01319 pISSN 1976-8710 eISSN 2005-0720 Original Article Factors Affecting the Result of Intralesional Corticosteroid Injection in Patients With Oral Lichen Planus Young Chan Lee1,2·Jun Seok Lee1·Ah Ra Jung2·Jung Min Park1·Young-Gyu Eun1,2 Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul; 1 Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University Graduate School, Seoul, Korea 2 Objectives. To examine the factors which affect the improvement or the recurrence of disease after intralesional steroid injection in patients with oral lichen planus (OLP). Methods. Sixty-two patients diagnosed as OLP were treated with intralesion corticosteroid injection. To evaluate the objective severity of OLP, total severity score of OLP was assessed. To examine the factors affecting the therapeutic effect of intralesional steroid injection, factors were compared between the symptom-improved group and symptom-notimproved group. To assess the symptom of patients, patients filled in 10-cm visual analogue scale, along with an Oral Health Impact Profile-14. Results. Symptoms improved in 50 patients (80.6%, symptom-improved group), but not in 12 patients (symptom-not-improved group). In a comparison between both group, OLP with lip involvement was the only variable which showed significant difference (P =0.008). Twenty-nine of 50 patients had recurrence of OLP (58%, recurrence group) and 21 of 50 patients did not have recurrence (42%, no-recurrence group). Statistically significant differences were not found between both groups. Conclusion. This study suggested that patients suffering from OLP with lesion on the lip might not be effective in treating with intralesional corticosteroid injection. Keywords. Oral Lichen Planus; Corticosteroid; Treatment INTRODUCTION ing reported that OLP is occurring at a higher rate in postmenopausal women and post-middle-aged men [4]. Also, it is well known that OLP is associated with other medical conditions such as chronic liver disease and oral cavity cancer [4]. Current data suggest that OLP is a T cell-mediated autoimmune disease in which auto-cytotoxic CD8+ T cells trigger apoptosis of oral epithelial cells [8,9]. Therefore, the most common treatment option of OLP is management of the condition with topical or systemic corticosteroids in OLP patients [10,11] although chemotherapy with retinoic acid, cyclosporine, and photochemotherapy [12] is used today. Topical corticosteroids have been considered to be the first-choice agent for the treatment of OLP [7]. In a comparison study between intralesional injection of triamcinolone acetonide (TA) versus a TA mouth rinse, the efficacies of both treatment were found to be similar, but intralesional injection of TA had a lower adverse effect [13]. Oral lichen planus (OLP) is a common chronic inflammatory mucocutaneous disease that typically affects the oral mucosa and causes noninfectious ulceration though the precise etiology of OLP is unknown [1-6]. The tendency towards an increased incidence of OLP has recently been shown to increase for reasons such as psychological stress [4,7]. Additionally, it is also be••Received September 28, 2017 Revised December 6, 2017 Accepted December 30, 2017 ••Corresponding author: Young-Gyu Eun Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea Tel: +82-2-958-8474, Fax: +82-2-958-8470 E-mail: Copyright © 2018 by Korean Society of Otorhinolaryngology-Head and Neck Surgery. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 205 206 Clinical and Experimental Otorhinolaryngology Vol. 11, No. 3: 205-209, September 2018 It is still not known which patient respond well to local corticosteroid treatment. Also, it is not known which patients will relapse after topical corticosteroid treatment. The aims of this study were to examine the factors affecting the therapeutic effect of intralesional corticosteroid injection and to determine the factors affecting recurrence after treatment in patients with OLP. MATERIALS AND METHODS Patients This study was a prospective cohort study involving patients with OLP. The study was performed at two university hospitals. Patients who had been diagnosed with OLP by means of clinical and histopathologic examination were enrolled. The exclusion criteria were as follows: potential candidates for the study were excluded if they were under 18 years old; had a history of topical or systemic corticosteroid usage for treating OLP in the past 4 weeks; had a history of using medications capable of inducing lichenoid reactions; had a history of taking the immunosuppressive medication; had a history of corticosteroid allergy; had oral cavity malignancy; were experiencing pregnancy and lactation; or were unwilling to attend the study. All of the enrolled patients in this study had an intralesional injection of TA (40 mg/mL; Hanall Biopharma, Seoul, Korea). Intralesional TA injection was carried out once a week for 4–6 weeks. The injection was placed directly into the subepithelial tissue just underlying the lesion adjacent to the normal mucosa. Intralesional injections of TA were conducted by two otolaryngologists. Written informed consents were obtained. This study was approved by Institutional Review Boards (IRB No. KHNMC 2015-08-020-005 & KMC IRB 1303-05). Measurement To assess the pain of the OLP patients, patients filled out a 10cm visual analogue scale (VAS) at each time they visited the hospital. In particular, the category of VAS was divided into oral pain and burning mouth sensation; then the sum of VAS subcategories was measured (range, 0 to 20 points). Also, quality of life of patients with OLP was evaluated with Oral Health Impact H I G H L I G H T S This study was to investigate the factors which affect the improvement or the recurrence of disease after intralesional steroid injection for oral lichen planus (OLP). Symptoms improved in 50 patients after treatment, but not in 12 patients. Patients with lip lesion of OLP might not be effective in treating with intralesional corticosteroid injection. Profile-14 (OHIP-14) [14] in every hospital visit. The OHIP-14 is a self-administered questionnaire that evaluates quality of life using 14 items to measure seven dimensions: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. Each dimension is measured by two questions. Subjects were asked how often they had had negative impacts in t (...truncated)