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.
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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