PHOTODYNAMIC THERAPY AS SUPPORT OF PHARMACOLOGICAL THERAPY IN A CASE OF PARTICULAR REFRACTORY ORAL LICHEN PLANUS: A CASE REPORT.

Aim: Lichen planus (LP) is a chronic autoimmune mucocutaneous condition, primarily affecting the oral and genital mucous membrane, skin, nails, and scalp. The oral lichen planus (OLP) affects approximately 2% of the population. OLP, in general, may arise in > 70% of persons with skin lesions. The frequency of malignant change ranges from 0.4% to 3.3%. OLP is seen worldwide, mostly in the fifth to sixth decades of life, and is twice as prevalent in women as in men. OLP has demonstrated numerous systemic connotations such as diabetes mellitus (DM), hypertension, metabolic syndrome (MS), thyroid diseases, psychosomatic ailments, chronic liver disease, gastrointestinal diseases, and genetic susceptibility to cancer. The treatment options for OLP are numerous and include topical and systemic agents. Topical corticosteroids remain the mainstay of therapy. Case report: A 62-year-old woman came to our observation for a lesion present for about 1 year extended to the hard palate and the upper vestibular gingival mucosa. In the anamnesis she reported osteoporosis and gastro-esophageal reflux. On objective examination there were erosion areas of different width and depth interspersed with erythematous and rare areas white patterns. The patient also reported the formation of bubbles that in a very short time exploded. The negative Nickolsky sign on physical examination did not testify for a diagnosis of vesicular-bullous disease. An incisional biopsy was performed in the palatine area. The subsequent histological evaluation and immunofluorescence were significant for the diagnosis of lichen planus bullous. Topical therapy prescribed with Clobetasol 0.05% 2 times a day and topical Nystatin (100.000 ul/ ml) 3-4 times a day for 3 weeks brought an evident improvement; however an erosive lesion persisted in the area 22-23. It was decided to proceed with a photodynamic support therapy with 460 nm diode light, 4 watts (FlashMax P4 CSM Dental, Copenhagen, Denmark) and 3% hydrogen peroxide. Mucous surface was wetted with hydrogen peroxide then illuminated with diode light 20 times for 3 seconds, subsequently the hydrogen peroxide was removed with a sterile gauze. This treatment was repeated 3 times every 7 days. Results: One week later there was an important clinical improvement, the subsequent therapeutic sessions allowed an almost complete remission of the lesion unresponsive to corticosteroid treatment. Numerous invasive and non- invasive therapeutic methods including local and systemic corticosteroids, laser therapy, and surgical intervention for the treatment of OLP are suggested. Extended use of corticosteroids for chronic OLP may have certain local and systemic complications, which includes opportunistic candidiasis, mucosal atrophy, adrenal insufficiency, gastrointestinal disorders, hypertension, and diabetes. To surmount the side effects of steroid therapy, photodynamic therapy (PDT) has been proposed as an alternative treatment strategy for OLP. PDT uses a photosensitizing agent which, when activated by the energy of light, creates a photodynamic reaction that is cytotoxic. A systematic review of the literature assessed the effectiveness of PDT in the management of OLP. PDT also showed an increase in the bactericidal activity of hydrogen peroxide in a case of refractory hairy tongue. Conclusions: Photodynamic therapy appears to have some effect in the symptomatic treatment of OLP in adult patients. However, further randomized controlled trials with standardized PDT parameters are needed

Polarized Light as an Adjuvant to Drug Therapy for the Treatment of Refrectory Oral Erosive Lichen Planus: A Case Report

Oral lichen planus is a chronic inflammatory disease of unknown etiology, associated with a malignant transformation in 1.2% of cases. It can be predominantly white and therefore almost always asymptomatic, or with the presence of large erosions in different areas of the oral cavity. In this case the pathology can be disabling, causing severe chewing difficulties and compromising the patient's quality of life. The gold standard for the treatment of this pathology is the use of topical cortisones combined with nystatin. The use of photodynamic therapy for the treatment of these lesions is also documented in the scientific literature. Polarized light is a light with a very wide wavelength variability, created for the treatment of erosive and ulcerative skin lesions and then also introduced in other fields, such as in oral medicine. It has an excellent analgesic and bio stimulating effect. We propose a case of erosive lichen planus refractory to systemic cortisone therapy, present for 4 years without remission, successfully treated with 6 15-minute sessions of phototherapy with polarized light, using a Bioptron device at 25 watts of power. After an important improvement, the therapy was concluded with gel based on ozonated olive oil (Ialozon, Gemavip, Cagliari, Italy) and topical cortisone, due to the impossibility of continuing the therapies in the study (lockdown). Polarized light is very easy to use, has no side effects, does not require special eye protection and has proven to be very effective in the clinical resolution of refractory lesions to drug therapy

Photodynamic Therapy with 460 nm Diode Lamp for Oral Mucosa Lesions: A Case Series

Photodynamic therapy is a process that involves the presence of a photosensitizer that selectively attaches itself to the surface of bacterial, fungal, viral or fungal cells, a laser or non-laser light that activates the photosensitizer with a specific wavelength, in the presence of oxygen. ROS are generated, which however are not harmful to the host's cells, which is why it is considered very safe. Photodynamic therapy has been successfully proposed in the treatment of malignant and potentially malignant lesions and autoimmune diseases, including in the oral cavity. The most commonly used dyes for oral diseases are methylene blue, toluidine blue and indocyanine green. The wavelengths of the light used are 660, 630,810 nm respectively. We propose cases of infectious and autoimmune pathologies (Hairy tongue, HPV lesion and oral lichen planus) of the oral cavity treated with diode light at 460 nm and such photosensitizers curcumin and hydrogen peroxide. This type of light is known in dentistry especially in the restorative field for the polymerization of the composite. This type of photosensitizer is extremely recent and still little studied, but we believe that it can be very useful to evaluate it in subsequent studies also for its ease of use and low toxicity

Polarized Light as an Adjuvant to Drug Therapy for the Treatment of Refractory Oral Erosive Lichen Planus: A Case Report

Oral lichen planus is a chronic inflammatory disease of unknown etiology, associated with a malignant transformation in 1.2% of cases. It can be predominantly white and therefore almost always asymptomatic, or with the presence of large erosions in different areas of the oral cavity. In this case the pathology can be disabling, causing severe chewing difficulties and compromising the patient's quality of life. The gold standard for the treatment of this pathology is the use of topical cortisones combined with nystatin. The use of photodynamic therapy for the treatment of these lesions is also documented in the scientific literature. Polarized light is a light with a very wide wavelength variability, created for the treatment of erosive and ulcerative skin lesions and then also introduced in other fields, such as in oral medicine. It has an excellent analgesic and bio stimulating effect. We propose a case of erosive lichen planus refractory to systemic cortisone therapy, present for 4 years without remission, successfully treated with 6 15-minute sessions of phototherapy with polarized light, using a Bioptron device at 25 watts of power. After an important improvement, the therapy was concluded with gel based on ozonated olive oil (Ialozon, Gemavip, Cagliari, Italy) and topical cortisone, due to the impossibility of continuing the therapies in the study (lockdown). Polarized light is very easy to use, has no side effects, does not require special eye protection and has proven to be very effective in the clinical resolution of refractory lesions to drug therapy