Corticosteroids for treating oral lichen planus

Giovanni Lodi, Maddalena Manfredi, Valeria Mercadante, Ruth Murphy, Marco Carrozzo 

    Review question 

    Are corticosteroids effective and safe for the treatment of oral lichen planus that is causing pain?

    Background 

    Oral lichen planus is a common condition that can cause long‐term, painful areas on the lining of the mouth. Usual treatment is with drugs known as corticosteroids applied directly to the painful areas (topically), or taken internally (systemically). Treatment aims to reduce pain and improve healing of the mouth, but there is no cure for the disease.

    Study characteristics

    The evidence in this review is up‐to‐date as of 25 February 2019. We included 35 randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) with 1474 participants, which tested several different corticosteroids, mostly delivered topically (on the skin). Corticosteroids were compared with one of the following: a placebo (a treatment that resembled the corticosteroid but had no active ingredient); a medicine from a category called calcineurin inhibitors; another medicine type; another corticosteroid or mode of delivery; the same corticosteroid plus an extra treatment; or an alternative treatment. Treatments were given for between one week and six months, with side effects measured throughout the treatment, and pain and healing measured at the end of treatment.

    Key results

    Results from two studies showed that topical corticosteroids (e.g. clobetasol propionate, flucinonide, betamethasone and triamcinolone acetonide), when applied to the mouth in a sticky cream, may be effective in reducing and stopping pain. We do not have the evidence that topical corticosteroids can eliminate the oral lichen planus lesions, and we are uncertain about side effects.

    We found no consistent evidence that any particular corticosteroid was better than any other.

    Three studies using another topical medicine called tacrolimus (a calcineurin inhibitor) found that this medicine may be more effective than corticosteroids, but may be more likely to cause mild side effects.

    Available evidence comparing corticosteroids with other treatments is very limited.

    Reliability of the evidence

    The reliability of most of the evidence is very low, so we cannot be sure about the findings and future research may lead us to different conclusions.

    Conclusion

    The available evidence suggests that topical corticosteroids may be effective for treating painful oral lichen planus, but our confidence in these findings is limited as there were only a small number of studies and participants. There is some evidence that tacrolimus may be more effective than a corticosteroid, but evidence on negative side effects is inconclusive.

    Read the full review.

    Lodi  G, Manfredi  M, Mercadante  V, Murphy  R, Carrozzo  M. Interventions for treating oral lichen planus: corticosteroid therapies. Cochrane Database of Systematic Reviews 2020, Issue 2. Art. No.: CD001168. DOI: 10.1002/14651858.CD001168.pub3.