Clinical Evaluation of Efficacy of Triamcinolone Acetonide with Tacrolimus in the Management of Oral Lichen Planus: A Pilot Prospective Observational Study

INTRODUCTION: Lichen planus (LP) is a relatively common chronic, mucocutaneous disease of autoimmune origin, involves oral mucosa, skin, scalp, nails, and genital mucosa. The prevalence of oral LP (OLP) varies worldwide, commonly seen in middle-aged and elderly people. It usually presents as symmetrical and bilateral or multiple lesions with burning sensation (BS) sometimes accompanied by pain. Corticosteroids and calcineurin inhibitors have shown promising results in the treatment of OLP, but its chronic course and unpredictable exacerbations/remission continues to result in a high degree of morbidity. The study aimed to evaluate the efficacy of intralesional triamcinolone acetonide (injection TA) combined with topical application of TA orabase and Tacrolimus (TAC) ointment for symptomatic cases of OLP. MATERIALS AND METHODS: The prospective study included 52 symptomatic OLP patients to receive (0.5 ml) intralesional injection of TA once a week for the first 4 weeks followed by one injection in the 6(th) week along with TA mucosal paste (0.1%.) and TAC ointment (0.03%) in tapering dose till 8(th) week. The subjective symptoms including BS and pain were assessed on a 10 cm visual analog scale (VAS) and objective signs like size and site of the lesion were scored according to criterion scale modified by Thongprasom et al. Differences were compared after 8 weeks treatment course and follow-up observations were performed at 20(th) week to record any recurrent lesion. RESULTS: 41 patients (78.8%) had complete remission of disease and 11 (21%) had shown partial improvement. The VAS scores for BS and pain improved significantly. Improvement was also noted with decrease in the average size of active lesions and the number of sites with treatment. The relapse was seen in 17 patients (41%) in the 20(th) week. CONCLUSION: TA combined with TAC is a valuable therapeutic option for the treatment of symptomatic OLP. Our findings suggest that patients have shown statistically significant improvement.