Manju Trehan1, Charles R Taylor. 1. Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Abstract
BACKGROUND: Lichen planus is a difficult-to-treat chronic inflammatory disorder that affects mucous membranes, causing inanition, halitosis, and dyspareunia. OBJECTIVE: To evaluate the novel use of low-dose 308-nm excimer laser radiation for the treatment of symptomatic oral lichen planus (OLP). DESIGN: A single-center, before-after trial. SETTING: Academic clinical research center. PATIENTS: Nine patients with symptomatic, biopsy-proven OLP, unresponsive to conventional therapies, were recruited from the dermatology clinics of the Massachusetts General Hospital in Boston. Eight participants completed the entire study, and 1, despite early improvement, did not complete the study because of hospitalization for an unrelated reason. Intervention With a narrow, fiberoptic handpiece to target precisely only diseased sites, 308-nm excimer laser radiation was delivered at an initial dose of 100 mJ/cm(2) once a week. MAIN OUTCOME MEASURE: A visual analog scale was used to grade subjective disease severity. Clinical improvement was graded in quartiles as follows: poor (<25%), fair (25%-50%), good (51%-75%), and excellent (>75%). Follow-up visits occurred for up to 18 months. A paired t test was performed to evaluate efficacy of treatment. RESULTS: Treatments were painless and well tolerated. Five patients demonstrated overall excellent clinical and subjective improvement after 7 treatments. Two participants with nonerosive OLP were deemed fair responders. The only poor responder in the study also had chronic active hepatitis C infection. Overall improvement was statistically significant (P<.05), and for the responders, remission times ranged from 2 to 17 months. Conclusion Low-dose treatment with the excimer 308-nm laser can be very effective in treating symptomatic and especially erosive OLP, an otherwise notoriously difficult-to-control disease.
BACKGROUND:Lichen planus is a difficult-to-treat chronic inflammatory disorder that affects mucous membranes, causing inanition, halitosis, and dyspareunia. OBJECTIVE: To evaluate the novel use of low-dose 308-nm excimer laser radiation for the treatment of symptomatic oral lichen planus (OLP). DESIGN: A single-center, before-after trial. SETTING: Academic clinical research center. PATIENTS: Nine patients with symptomatic, biopsy-proven OLP, unresponsive to conventional therapies, were recruited from the dermatology clinics of the Massachusetts General Hospital in Boston. Eight participants completed the entire study, and 1, despite early improvement, did not complete the study because of hospitalization for an unrelated reason. Intervention With a narrow, fiberoptic handpiece to target precisely only diseased sites, 308-nm excimer laser radiation was delivered at an initial dose of 100 mJ/cm(2) once a week. MAIN OUTCOME MEASURE: A visual analog scale was used to grade subjective disease severity. Clinical improvement was graded in quartiles as follows: poor (<25%), fair (25%-50%), good (51%-75%), and excellent (>75%). Follow-up visits occurred for up to 18 months. A paired t test was performed to evaluate efficacy of treatment. RESULTS: Treatments were painless and well tolerated. Five patients demonstrated overall excellent clinical and subjective improvement after 7 treatments. Two participants with nonerosive OLP were deemed fair responders. The only poor responder in the study also had chronic active hepatitis C infection. Overall improvement was statistically significant (P<.05), and for the responders, remission times ranged from 2 to 17 months. Conclusion Low-dose treatment with the excimer 308-nm laser can be very effective in treating symptomatic and especially erosive OLP, an otherwise notoriously difficult-to-control disease.