Comparative Efficacy of Topical Curcumin and Triamcinolone for Oral Lichen Planus: A Randomized, Controlled Clinical Trial

Original Article Comparative Efficacy of Topical Curcumin and Triamcinolone for Oral Lichen Planus: A Randomized, Controlled Clinical Trial Seid Javad Kia1, Shiva Shirazian2, Arash Mansourian3, Leila Khodadadi Fard4, Sajjad Ashnagar5 1Assistant Professor, Department of Oral Medicine, Faculty of Dentistry, Guilan University of Medical Sciences, Guilan, Iran 2Assistant Professor, Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Iran 3Associate Professor, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran 4Dentist, Faculty of Dentistry, Guilan University of Medical Sciences, Guilan, Iran 5Student, Scientific Research Center, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Abstract \\  Corresponding author: A. Mansourian, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Received: 3 May 2015 Accepted: 16 October 2015 Objectives: Lichen planus (LP) is a chronic inflammatory mucocutaneous disease. Its treatment is often symptomatic and includes topical and systemic corticosteroids. Although corticosteroid therapy is usually successful, it has side effects and thus, an alternative treatment is favorable. The aim of this study was to compare the efficacy of topical curcumin and triamcinolone for treatment of oral lichen planus (OLP). Materials and Methods: In this study, 50 patients (36 women and 14 men) in the age range of 38 to 73 years with OLP were randomly divided into two groups. Each group received 0.1% triamcinolone or 5% curcumin oral paste three times a day for four weeks. Assessment of the appearance score and severity of pain was done at baseline and at the end of two and four weeks and recorded in the patients’ questionnaires. The data were analyzed by SPSS 17 software, using the Mann-Whitney and Spearman’s tests. Results: With respect to pain reduction, nine patients (36%) in the curcumin group and eight patients (32%) in the triamcinolone group showed complete remission. With respect to the appearance score, one patient (4%) in each group showed complete remission. No statistically significant difference was noted between the two groups. Conclusion: Application of curcumin is suggested for treatment of OLP because of its desirable anti-inflammatory effects and insignificant side effects. Keywords: Curcumin; Lichen Planus; Triamcinolone Journal of Dentistry, Tehran University of Medical Sciences, Tehran, Iran (2015;Vol. 12, No. 11) INTRODUCTION Oral lichen planus is an immune-mediated disease of unknown etiology with the mediation of T cells [1], in which the symptoms of patients decrease with an increase in CD4⁺ counts [2]. Oral lichen planus lesions can be of reticular, papular, plaque-like, bullous, erythematous (atrophic) and ulcerative forms. www.jdt.tums.ac.ir November 2015; Vol. 12, No. 11 Ulcerative lesions are the most debilitating form of OLP [3], which develop painful symptoms and interfere with eating, speaking, swallowing and tooth brushing [4]. Corticosteroids are usually successful for controlling the symptoms of the disease [5]; but because of the side effects of long-term corticosteroid therapy such as secondary candidiasis, telangiectasia, 789 Journal of Dentistry, Tehran University of Medical Sciences hypothalamic–pituitary–adrenal suppression [6,7], muco-cutaneous atrophy and increased potential of systemic absorption, it may be better to avoid their long-term use [8]. Curcuma longa is a perennial plant belonging to Zingiberaceae family [9]. It has been used for centuries in the Indian traditional medicine for its anti-inflammatory effects [10]. Its main constituents include three curcuminoids including curcumin (the primary ingredient and the one responsible for its yellow color and antiinflammatory effect), demethoxycurcumin and bisdemethoxycurcumin. Chainani-Wu in a systematic review [11], and others [9, 12-16] confirmed the antiinflammatory, antioxidant, wound healing and anticarcinogenic effects as well as safety of curcumin. Clinical studies assessing curcuminoids have evaluated its utilization in inflammatory conditions such as rheumatoid arthritis, postsurgical inflammation and chronic uveitis [11]. The curcuminoids are safe even in high doses and only a few side effects have been reported [11]. Since oxidative stress may play a role in pathophysiology of OLP [17], and by noting that OLP is a chronic inflammatory disease [18], the herbs which have both anti-inflammatory and antioxidant properties may efficiently control OLP. Chainani-Wu et al, in 2007 and 2012 assessed the efficacy of systemic administration of curcuminoids for treatment of OLP [10, 19]. Efficacious results were obtained in controlling the signs and symptoms of OLP using high doses of this herb. Concerning noticeable side effects reported by patients who used corticosteroids [20], chronic nature of OLP, risk of oral candidiasis upon usage of topical corticosteroids, and fewer side effects, safety and anti-inflammatory properties of curcuminoids, we aimed to clinically evaluate the efficacy of curcuminoids for treatment of OLP, compared with conventional corticosteroid therapy. 790 Kia et al. MATERIALS AND METHODS This clinical trial was conducted on 50 patients (36 women and 14 men) in the age range of 38 to 73 and a mean age of 50.66 years. The patients had clinical signs of OLP (atrophic and ulcerative forms), and the disease was confirmed by clinical and histopathological examination. The exclusion criteria were pregnancy and lactation, current use of anticoagulants or antiplatelet agents (curcumin has inhibitory effects on platelet aggregation) [21], current orthodontic treatment, history of gastric ulcers, duodenal ulcers, gallstones (curcumin may induce gastric irritation and stimulate gall bladder constrictions) [22], hepatic diseases (curcumin may cause hepatotoxicity in some mammals including mice and rats) [11], any existing malignancy or viral infections in the mouth, history of topical treatment for OLP in the past two weeks or any systemic treatment for OLP in the past four weeks, taking azathioprine, cyclosporine or receiving Psoralen plus ultraviolet A (PUVA), ultraviolet A (UVA) or ultraviolet B (UVB) radiation in the past month and history of allergy to corticosteroids or curcumin [6]. The crushed roots of C. longa L. were purchased from a drugstore in Rasht city in Iran and identified by a research fellow. The ground herbal root (1g) was extracted using 10 mL of 96% ethanol boiling in a water bath for three minutes and the least volume of solvent was added to the given aliquot. Each sample was centrifuged at 8000g for 10 minutes; then the supe (...truncated)