Efficacy Evaluation of Photodynamic Therapy for Oral Lichen Planus

A Systematic Review and Meta-analysis

Yuqing He; Jiaxin Deng; Yi Zhao; Huiqian Tao; Hongxia Dan; Hao Xu; Qianming Chen

Disclosures

BMC Oral Health. 2020;20(302) 

In This Article

Background

Oral lichen planus (OLP), a chronic immune-mediated, inflammatory, and psychosomatic condition that frequently affects the oral mucosa in a typical bilateral pattern, often presents as pain and a burning sensation.[1] OLP has an overall prevalence of about 2.2%.[2] The most common is the reticular type, which has a white lacy appearance. Other forms include erosive, atrophic, bullous, papular, and plaque-like. OLP is an oral potentially malignant disorder (OPMD) and has been linked to oral squamous cell carcinoma with a malignant transformation rate of 1.4%.[3]

The aim of OLP management is to reduce the occurrence of symptoms and manifestation of lesions. Currently, the most common treatment for OLP is pharmacological therapy. Others include surgery, photodynamic therapy, and laser therapy. There is a large difference in the curative effect of the current treatments. In pharmacologic therapy, topical corticosteroids are usually prescribed, such as triamcinolone acetonide and dexamethasone.[4] However, long-term treatment with topical corticosteroids may cause obvious side effects, such as local pigmentation, oral candidiasis, and dry mouth.[5] Additionally, some studies have claimed that patients do not respond to drug treatment and the erosion does not heal, which increases the risk of canceration.[6]

Photodynamic therapy (PDT) is a therapeutic method based on the photochemical and photobiological effects that are mediated by a photosensitiser (PS), which leads to cell damage at the lesioned tissue.[7] It is a minimally invasive treatment because it has the advantage of high selectivity. Thus, PDT causes only mild trauma and adverse reactions and is a new option for the treatment of OLP.

Currently, there are different opinions on the efficacy of PDT for OLP. One study has revealed that PDT has some effect in the symptomatic treatment of OLP in adult patients.[8] However, the authors used a small number of articles and did not perform subgroup analyses. On the contrary, according to a systematic review,[9] PDT fails to exert any significant effect on the symptoms of OLP. A meta-analysis that reviewed 22 publications has shown that the partial response (PR) rate of OLP lesions to PDT is approximately 70%; however, this study analysed the effect of PDT on OPMD. Only six articles focused on OLP and the authors did not investigate the effect of different factors on the efficacy of PDT in OLP versus that in all OPMDs in the subgroup analysis.[10]

These three reviews used a small number of articles focused on OLP and did not analyse the influence of factors, including the site of OLP lesion in mouth, type of PS, and administration method, that may be related to the final therapeutic response. Therefore, the aim of this systematic review and meta-analysis was to assess the efficacy of PDT in the treatment of OLP and compare the efficacy of PDT with steroid therapy. The results of this study will provide clinicians with a comprehensive understanding of the efficacy of PDT in OLP.

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