The Clinical Efficacy Of Electrical Pulse And Triamcinolone Acetonide For Oral Lichen Planus

BackgroudOral lichen planus (OLP) is a common autoimmune disease mediated by T lymphcytes which affects the stratified squamous epithelium. OLP predominantly occurs in the middle-age population, although it may be of any age. Women are more susceptible to OLP. OLP is a chronic inflammatory immunological reaction which exists periods of quiescence and recurrence, but there are few spontaneous remissions. OLP has an unknown precise prevalence, but the incidence is reported to be approximately 0.5% to 2%. Clinically, OLP has many presentations, but the most common, in order of occurrence, is the reticular, erosive, atrophic, and plaque types. The pathology of OLP is parakeratosis of epithelium, acanthosis, degeneration and disorder of basal cell, and T cells intensely infiltrate the lamina propria.As the etiology of OLP is unkown, there are many therapeutic solutions. But there is no complete way of curing this disease, current treatment is targeted to symptomatic relief. The main treatment of OLP remains to be corticosteroids. Triamcinolone acetonide (TA) is an artificial glucocorticoid with demiperiod of 5 hours. After intramuscular injection of TA, the efficacy keeps 2-3 weeks. TA has a powerful non-specific anti-in?ammatory effect and immunosuppressive properties. Topical corticosteroid therapy remains the choice of treatment, while intralesional injection of TA could rapidly improve the symptoms. Frequent and long time injections may result in systemic doses high enough to cause side-effects, such as acne, menstrual disorder, candidiasis, uberculosis osteoporosis and femoral head necrosis. The principle of TA application is by minimum dose based on effective remission.Electric pulse (EP) is a physical method whose temperature between scarching unit and tissue is approximate up to 3000℃. EP can, permanently, make superficial lesion carbonize, gasify and disappear in a wink, and it does the same to bacteria. The damage to the nomal tissue is so tiny that EP is an excellent method of cauterization-carbonization-gasification. The coagulative protein caused by EP therapy can protect wound surface from various stimulant, so the pain is not severe. On the other hand, EP is only a physical and traumatogenic method which can remove the lesion transiently. Because EP dose not regulate metabolism of epithelium of oral mucosa or reinforce the function of T lymphocytes, OLP recur easily. In conclusion, this trial combines EP with TA reasonably to find a new way which can rapidly release symptoms, diminish lesion sizes and degrade recrudescence.In this randomized comparative simpe-blind study, 31 consecutive patients with oral lesions consistent clinically and histologically with OLP were recruited. The patients were diveded into 2 groups to receive TA or EP and TA therapy, who were treated for 12 weeks and were followed up for 8 weeks. At last we compared TA group with EP and TA group to see if there were any differences in the mean lesion sizes, avarage VAS, the marker lesion clinical scoring and clinical response.Results1 There was statistical di?erence in meam lesion size between the two groups (u>1.96) at week 6 and week 12. The rapidest reduction period of mean lesion sizes is from baseline to week 3, and the rate of ruduction was gradually slow from week 3 to week 12;2 There was no statistical di?erence in average VAS between the two groups (u<1.96) from baseline to week 12;3 There was no statistical di?erence in clinical scores between the two groups (u<1.96) from baseline to week 12;4 There was no statistical di?erence in clinical response between the two groups (u<1.96) from baseline to week 12.Conclusions:1 Compared with TA group, EP and TA group can diminish lesion sizes rapidly based on less frequent TA injection;2 EP and TA group was as useful as TA group in relief of pain symptom based on less frequent TA injection;3 EP and TA group was as useful as TA group in relief of clinical symptoms and signs of target lesion based on less frequent TA injection;4 EP and TA group was as useful as TA group in clinical response based on less frequent TA injection;5 Combining TA with EP can reduce the dose of TA.