Two Novel Treatments for Oral Lichen Planus Hold Promise

In the May 2012 issue of the Journal of the American Academy of Dermatology, there were two separate articles introducing new treatments for moderate to severe oral erosive lichen planus, the most difficult form of the disease to treat.

Erosive lichen planus of the buccal mucosa

Curcumin Curcumin is the health-promoting compound derived from the Indian spice turmeric.  Curcumin has anti-inflammatory and antioxidant properties.  The same authors from the prestigious dental college at UCSF had investigated curcumin at a dose of 2000 mg daily for oral lichen planus in 2003, but it was ineffective.  In the current report, they treated 10 patients with 6000 mg daily and 10 patients with identical placebo capsules for 12 days.  The curcumin group showed a statistically significantly greater reduction in symptoms and signs such as redness and ulceration.  Curcumin was well tolerated. Comment The problem with curcumin is that it is poorly absorbed and retained in the bloodstream.  The UCSF investigators overcame the problem by giving a very high dose of curcumin.  Our practice offers for sale a patented bioenhanced curcumin that has been shown to have 7 times greater bioavailability over 8 hours compared to conventional curcumin extract.  For that reason, I have been recommending Super Bio-Curcumin 400 mg twice daily for some of my patients with oral lichen planus.  This dose supplies the equivalent of 5000-5600 mg of commercial curcumin.  I anticipate using curcumin along with standard corticosteroid and anti-yeast drugs in order to reduce inflammation and support immune health. Ultraviolet Light B Ultraviolet light B (UVB) is commonly used to treat skin diseases such as psoriasis, eczema, and vitiligo.  In this study from Israel, the investigators adapted a device called TheraLight to deliver UVB energy to the oral mucous membranes.  They treated 14 patients three times weekly with conservative doses for 8 weeks.  Nine of 14 patients improved 80-100%, and 5/14 improved 50-80%.  Most of the patients were able to maintain their success by continuing treatments less frequently over the next 29 weeks.  Only one patient complained of a mild burning sensation. Comment Phototherapy for diseases of the oral cavity has intrigued me for a long time.  It is rational to attempt because UVB, especially the wavelengths around 308-312 nm, has anti-inflammatory effects.  The targeted excimer laser has also been used to treat oral lichen planus successfully in the short term.  We use this device frequently in the Camisa Psoriasis Center to treat resistant smaller areas of psoriasis and vitiligo of the skin but have not attempted to employ it in the mouth.  The technical problem which the Israeli group appears to have solved is to design a system that delivers therapeutic UVB rays to mucous membranes in a reproducible manner without contaminating the handpiece with saliva and bacteria.

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40 Responses to Two Novel Treatments for Oral Lichen Planus Hold Promise

  1. Professor A says:

    Dear Dr. Camisa:

    I was delighted to read your article on Curcumin for the treatment of Oral Lichen Planus. I was recently diagnosed with OLP after an extended course of Uceris (Budesonide) for Collagenous Colitis. (While I don’t think the Budesonide caused the OLP per se, my lowered immunity coupled with vaginal candidiasis may have been the trigger.) From what I gather, both Collagenous Colitis and OLP may be autoimmune related.

    I too have been reading about the wonders of Curcumin in improving the symptoms of OLP. I do, however, worry about the potential effect of oral Curcumin relative to my tenuous remission of Collagenous Colitis. Do you think the suggested dose of Curcumin could exacerbate my Colitis?

    From my research, another interesting potential treatment for OLP may be the common weed Purslane (Portulaca. oleracea). A clinical study from Qazvin University of Medical Sciences revealed most of the OLP study participants (except control) taking daily oral doses of 235mg Purslane experienced significantly improved symptoms or complete remission.

    Worried about the effect on my colon, I ordered a tincture of Purslane to use as a mouthwash mixed with water. Do you think using Curcumin as a mouthwash may be as efficacious as the oral supplement?

    I greatly appreciate your insights and applaud you for taking the time to correspond with so many of us in need of your expertise.

    ~Prof. A

    • DrCamisa says:

      Although I believe LP and colitis are autoimmune diseases, I am not aware of a statistical association between them.
      The recommended dose of curcumin for OLP is necessarily quite high. Therefore, it is possible for it to have an irritant effect on the GI tract when taken as an oral supplement. Starting with half the dose would be a reasonable approach.
      Curcumin has been used as a 1% topical alcoholic gel to treat psoriasis in studies with modest benefit. It may work as a topical agent in OLP as well due to a direct anti-inflammatory, anti-oxidant effect on the affected mucous membranes. However, I think the problem with a rinse may be that curcumin doesn’t dissolve well in water, and the alcoholic gel may not be palatable. These are good ideas, but to my knowledge, have not been tested.
      Finally, thank you for your kind comment.

  2. Frazer Patton says:

    My son who is 35 and is type 1 diabetic was diagnosed with Lichen Planus about 3 years ago, he attends the Glasgow dental Hospital who have treated him with Azatheoprine 150mg, Betnosol 80mg Mouthwsh x 4 times daily, Fluconazole 20mg on for 7 days at a time and Prednesalone steriods 30mg per day. He is at is wits end he cannot eat because of the pain and this in turn upsets his blood sugar levels, its a vicious circle. Please if you can offer any suggestions we would be most grateful.

    • DrCamisa says:

      The anti-rejection drugs cyclosporine and tacrolimus are very effective at controlling severe oral erosive lichen planus. They do not affect blood sugar control, but could cause problems with blood pressure or kidney function, so they would have to be monitored. These drugs are not approved for LP, but neither is azathioprine. They may have to be prescribed by a physician rather than a dentist. Cyclosporine or tacrolimus may be effective enough to be able to reduce or eventually stop the steroid pills and rinses. Best wishes with this difficult problem.

  3. sandra nolan says:

    my oral lichen planus is spreading with red sores…..I have been on triamcinolone 8 months now , and it seems to help but is spreading……I wear dentures and a bottom bridge and my bridge is broken now so I it makes the top of my mouth hurt terribly……..what can I do? please answer…..thank you

    • DrCamisa says:

      I am sorry for your troubles. You need to be examined by a physician who can give you more intensive therapy for the oral LP, making sure there is not a coexisting yeast infection. Badly fitting dentures can also aggravate LP, therefore you must not wear the broken one. You will also have to ask your dentist to repair or make you a new one.

  4. Chris Stein says:

    What do you suggest for a person that does not have Oral Lichen Planus, but has the purplish/red bumps in the creases of elbows, back of legs, arm pits, wrist, feet and chest areas

    • DrCamisa says:

      By your description, this rash could also represent LP on the skin. However, you would have to be examined by a dermatologist to make a definitive diagnosis. A skin biopsy may even be necessary for confirmation.

  5. gail seale says:

    I have been diagnosed with OLP, been told it is auto immune disease and that i just have to live with it..I also have non-alcohol chrioss of the liver. i am limited with what i can take..Do you have any suggestions.

    • DrCamisa says:

      Lichen plans has been associated with all sorts of liver diseases including Hepatitis C and Primary Biliary Cirrhosis which is a rare autoimmune disease (not caused by alcohol). I would think that the common oral “rinse and spit” medicines I use would be safe in a case like yours. They are dexamethasone and nystatin. Ask your doctor about taking them.

  6. chloe says:

    Dr carmisa.
    I suffer from erosive lichen planus of the vagina.
    I am wondering if you have done any studies or have any opinion regarding wether these high doses or curcumin may also be beneficial or otherwise detrimental to erosive lichen planus of this area. Thankyou

    • DrCamisa says:

      I’m not aware of any studies of curcumin used in vulvar LP. However, because it’s the same disease affecting mucous membranes, it would be very reasonable to give it a trial for at least a month.

  7. chloe says:

    Thanks for your reply.
    I am taking meriva, a patented form of curcumin which is more bioavailable. The tablets are 550mg of meriva, equivalent to 99mg of curcumin. I’m not sure what dosage to try? Any advice? The bottle says 2 tablets per day, but that is for osteoarthritis

    • DrCamisa says:

      I would say the higher the dose the better. Start with 2 per day as long as you tolerate it well. The supplement is very safe, and you want to see if it helps within the first month if possible.

  8. melissa g says:

    I was diagnosed with OLP in March. my doctor put me on prednisone. it helped as long as I was taking it, but as soon as I came off of prednisone, the LP came back. Is there any vitamin that I can take that might help this problem.

    • DrCamisa says:

      Yes, the anti-inflammatory anti-oxidant vitamins and supplements are helpful for lichen planus. The supplements I recommend are vitamin B complex, curcumin, green tea extract, berry extract, and resveratrol.

  9. Sheena says:

    I have OLP, and I took 6000mgs of Curcumin . I experienced bloating and urinary tract pain as well as lower back pain.
    I took another dose the next day just to see and the same symptoms occurred.
    I have bought some Life Extension Super Bio -Curcumin.
    Am I likely to have the same reaction?

    • DrCamisa says:

      I don’t know, but if you try it, please let us know. If you can take it for about a month, tell us if you think it helped the OLP.

  10. Lisa says:

    My 14 year old daughter has had lichen planus since mid-May — over 3.5 months. At first, we thought she had poison ivy or bumps due to allergies. It has spread all over her body and is the worst case that our dermatologist has ever seen. She is receiving cortisone shots but I am ready to try anything that you recommend. She is a beautiful girl and she has about thousand sores and bumps all over her body. It is at the top of her neck and starting to move to her face. It continues to get worse. We live in Dayton, Ohio, so I thought about the Cleveland Clinic. My father was in his residency at Mayo Clinic many years ago so he may also have some luck there. However, there doesn’t seem to be many doctors that specialize in this area. I can send photos if needed. At the present time, we don’t think that she has the oral part of this disease but I am concerned that this is next. Thanks for any help that you can provide. I plan on calling your office tomorrow.

    • DrCamisa says:

      I don’t do personal medical consultations over the internet due to confidentiality and legal issues, especially for a minor. LP is very uncommon in children. It does occur, but I would prefer to have a biopsy confirmation. It is true in my experience that patients who have the more severe skin eruptions tend to lack the oral manifestations and vice versa. The Mayo and Cleveland Clinic Derm Depts should be able to help your daughter.

  11. Lisa says:

    My daughter just corrected me and said that they are steroid shots and she is also using Alevicyn cream. She has also been tested for liver disease and celiac disease and both were negative.

    • DrCamisa says:

      Cortisone and steroid shots usually mean the same thing. I am unfamiliar with the name of the cream you write. Please give the generic or chemical name and the % concentration.

  12. Heather Landon says:

    I have recently been diagnosed with OLP. I also suffer with chronic sinus and ear pain (left ear, same side as the more severe OLP) which generally leads to headaches (migraines). I also found out I have low white blood cell counts. My question is, is there a chance that the headaches and sinus/ear pain is connected to OLP? Is the low white cell count related also? Thank you.

    • DrCamisa says:

      The chronic sinusitis, earache, and headaches could be reactive to the lichen planus inflammation in the oral cavity, but they could also be coincidental. In is unlikely that the low white blood cell count is related to OLP, but it should be investigated by your physician because it could be caused by some medications, lupus, and other conditions. Depending on the actual level, it could even be normal for you.

  13. Leslie says:

    Hi Dr. Camisa – My husband has been diagnosed with lichen planus on his lower leg and mouth. It seems to be worsening and his current dermatologit is not familiar with treatment protocol. Are you able to refer a specialist in the northern New Jersey area? Is the super bio-curcumin you refer to available for purchase by mail?

    • DrCamisa says:

      I would tend to look for medical dermatologists that are affiliated with university hospitals and medical schools. I would also inquire whether they have doctors on staff who are interested in treating LP before making the appointment. The bio-curcumin is available on-line from Life Extension http://www.lef.org. I have no financial interest in them, but I like their products.

  14. Kris says:

    Hello,
    Can the disease of lichen planus alone drive a very high ANA result? My ANA is 1:1280 and I have the symtoms of lichen planus but very little else. My physician has tested my ANA profile and complements among other things and they all come back normal. I’m concerned about such a high ANA titer but the physicians cannon seem to find a reason behind it. I’m wondering if it’s simply due to the lichen planus.

    • DrCamisa says:

      Probably not. Low titers of ANA may be found in patients with LP or who are normal. A high titer such as this is more likely associated with a connective tissue disease such as lupus. Some patients have lupus/lichen planus overlap syndromes. It would be interesting to know the “pattern” of the ANA. If you know it, please let us know it.

  15. Jane says:

    I read about the studies done in India and it seems the turmeric was delivered topically in a gel form. Is there a way to make it yourself since it doesn’t seem to exist? Was it effective in that study because it was topical or is it just as effective if taken orally?

    • DrCamisa says:

      It might be effective topically, but the powder would have to be dissolved and compounded by a pharmacist into a gel or ointment. If you share your references here, I will review them and comment on them here. I have only been using the capsule form of curcumin for OLP, but I would be willing to try it topically if available.

  16. Pam says:

    I have OLP that seems to come back when I drink wine. Would wine cause a flare up?

  17. Shelley says:

    I suspect I may have OLP. I have 2 oral ulcers (one side) on my buccal mucosa and the Wickham striae on both sides of my mouth, as well as a tiny patch of the plaque type. It does not affect my tongue or gums. I arrive at this suspicion based on extensive reading and research, comparing what I’m dealing with to images of OLP via reputable sources. My symptoms: I experience SEVERE reactive pain due to hot/cold or spicy liquids and foods. It’s gotten to the point that I sometimes don’t bother eating to avoid the pain. I asked my dentist what this was at my last routine cleaning, (Sept. ’16). He told me he didn’t know and to gargle with salt water for 2weeks. If it didn’t clear up by then, I should see a regular physician. My question is this… what type of doctor would have the most experience with OLP and is more likely to give me a definitive diagnosis? Thank you!

    • Dr. Camisa says:

      Most dermatologists should be able to recognize a typical case of OLP. You could ask the appointment maker if the doctor sees OLP cases first. Oral surgeons are also pretty good at diagnosing and doing oral biopsies if necessary. An ENT doctor may be able to help, but there might be more variability there.

  18. Claire says:

    Hi Dr. Camisa,
    Have any of your OLP patients gotten good results with the Life Extension Bio Curcumin alone? I’m trying to avoid steroids. I also wonder if there could be a connection between OLP and thyroid dysfunction, as I seemed to develop both problems almost at once and am otherwise healthy. I’m also trying purslane extract and aloe, as I read studies about both helping OLP, but no luck yet. My main concern is the increased oral cancer risk.
    Thank You,
    Claire

    • Dr. Camisa says:

      I have patients who want to avoid the steroids like you. They usually take the Curcumin with other antioxidant supplements such as green tea extract, resveratrol, and Berry Complete.

  19. Brittiany T says:

    I have a severe case of Lichen planus on my genitals. I have been seeing a dermatologist for a year now and i have tried every drug from immune suppression and my body does not react well. I just want some relief my vagina has shorted and has fuse to the inner lips to the outer lips. I have a bad case of oral lichen planus too. I am currently trying anything and my ob-gyn said there is not to much she can do for me. This problem has be going on for five years now with no relief.

    • Dr. Camisa says:

      Potent immunosuppressive oral drugs such as cyclosporine and tacrolimus may prevent some of the changes you describe, but once established, surgical revision may be required. The overall disease activity may be reduced, but it is considered incurable.

  20. Fran Dundon says:

    Dr. Camisa:
    I have had oral LP for over 10 years and seen numerous doctors. Long story short – before we left Kentucky, I was able to see a Dr. Alan Gould. After a thorough examination, he prescribed a mouthwash (Tacro in distilled water – swish 4 times per day – but, normally I do not need that much). What a relief! And, since this is not ingested – NO side effects. It has dramatically helped with my oral LP for two years; however, I have developed a couple of sores in my mouth. We are waiting for the biopsies to come back. We now live in Nokomis, Florida and because of insurance, I went to an oral surgeon – Dr. Boland in St. Petersburg. Wonderful man.
    Here is my question: Is there some type of topical steroid that can be used in the mouth to help with healing the sores? Thank you…your work with LP is needed for those of us who suffer from this disease. And, if you accept my insurance, I’d be more than happy to make a trip to your office for consultation.

    • Dr. Camisa says:

      I wouldn’t be able to answer your question without knowing the results of the oral biopsy. A steroid may not be appropriate if the biopsy does not show LP. Keep me posted. As for insurance, you would have to call our office to confirm. Thank you.

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