Topical steroid therapy in oral lichen planus: review of a novel delivery method in 24 patients.

Lichen planus is a chronic mucocutaneous disorder of unknown etiology. The natural progression of oral lichen planus (OLP) is long and can extend over a number of years. Although many patients with OLP remain asymptomatic, some experience periods of marked inflammation with breakdown of the lesions, and require treatment. Corticosteroids are the mainstay of treatment for oral lesions, but delivery to affected mucosal sites can be problematic. The purpose of this study was to retrospectively review the results of topical steroid therapy in a group of patients with OLP, using a novel delivery method. The records of 33 patients with biopsy-proven OLP were reviewed and the relevant clinical features were noted at minimum review intervals of one, six and 12 months. Of this group, 24 patients had been treated using a standardized treatment protocol consisting of a corticosteroid ointment applied topically to mucosal lesions using cloth strips. Gingival lesions were treated using a steroid preparation in an adhesive paste. Nine patients remained asymptomatic and were not treated. In the treated group, 14/24 (58 per cent) of patients showed an improvement in symptoms by one month. The remainder showed no change or a worsening of their symptoms. Repetition of the treatment protocol resulted in improvement in all the non-responders, and by one year 23 of 24 (96 per cent) of the patients had experienced improvement or control of their symptoms. Long-term failure to control the symptoms in the single non-responding case was related to poor patient compliance. Results from this study show that a novel delivery method and treatment protocol for the application of topical steroids onto lesional mucosa is useful for the symptomatic control of oral lichen planus.