Topical medications previously prescribed for the treatment of lichen planus were stopped two weeks before the start of the study, and systemic medications four weeks before. In addition to reticulated lesions (including lace-like networks of lines, papules, and plaques as described by Andreasen 6), all the patients had various degrees of erythema or erosion. All the patients were symptomatic and had no evidence of cutaneous lichen planus. Sixteen patients with oral lichen planus proved on biopsy were enrolled in our study. In this article we report that cyclosporine administered as a swish-and-spit medication produced marked improvement in this oral condition, with minimal systemic absorption. 3 4 5 To make an objective assessment, we conducted a double-blind study of topical cyclosporine as compared with its vehicle in oral lichen planus. Three letters published recently in medical journals have suggested, on the basis of nonblinded evaluations, that topical cyclosporine might improve oral lichen planus. The primary goal of therapy for all forms of lichen planus is palliative. In comparison with the cutaneous form of lichen planus, oral lesions are more resistant to therapy and less likely to undergo spontaneous remission. 2 However, the erythematous and erosive forms of the disease can be a source of morbidity. Although reticular and papular lesions occur most frequently, they are usually asymptomatic and require no treatment. 1 Any oral mucosal site may be involved, and there are usually multiple areas of involvement. Oral lichen planus is a relatively common disorder affecting up to 2 percent of the general population. Conclusions.Īs a topical preparation, cyclosporine may be useful in the treatment of oral lichen planus and possibly other cutaneous disorders. Cyclosporine levels present in specimens of oral mucosa at the end of therapy four hours after the patients swished were similar to the levels previously reported in psoriatic lesions after treatment with systemic cyclosporine (14 mg per kilogram of body weight per day). In most cases blood cyclosporine levels were low or undetectable. After a switch to cyclosporine for eight weeks, the vehicle-treated patients had improvement similar to that seen in the patients who initially received cyclosporine. Results.Īfter eight weeks, the eight recipients of cyclosporine had marked improvement in erythema (P = 0.003), erosion (P = 0.02), reticulation (presence of white lace-like lesions P = 0.007), and pain (P = 0.002), whereas the eight recipients of vehicle had no change or minimal improvement. The patients swished and expectorated 5 ml of medication (containing 100 mg of cyclosporine per milliliter) three times daily. In a double-blind trial, 16 patients with symptomatic oral lichen planus were randomly assigned to receive either topical cyclosporine or its vehicle. These treatments require prolonged use, however, and are not always effective. It is frequently palliated with topical or systemic corticosteroids and retinoids. Oral lichen planus is a relatively common disorder of the mouth that can be debilitating.
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