Photobiomodulation in Oral Lichen Planus

December 21, 2018 updated by: Maria Fernanda Setúbal Destro Rodrigues, University of Nove de Julho

Efficacy of Photobiomodulation for Oral Lichen Planus Treatment

The aim of this study was to compare the efficacy of PBM (660nm) and corticosteroid therapy with clobetasol propionate 0.05% in the treatment of OLP. This is a protocol for a randomized, controlled, double blind clinical trial. Fourty-four patients will be randomized in two experimental groups. Control group will be treated with clobetasol propionate 0.05% for 30 consecutive days and with placebo PBM twice a week. The experimental group will be treated with placebo gel for 30 consecutive days to mask the treatment and patients will receive PBM twice a week during 1 month (laser λ = 660±10 nm; power 100mW; radiant energy 177J/cm2; 5-s exposure time per point and 0.5J of energy per point. The primary variable (pain) and the secondary variables including clinical scores and functional scores as well as patient anxiety and depression (The Hospital Anxiety and Depression Scale-HADS), will be evaluated at the baseline, once a week during treatment and after 30 and 60 days of follow up. Evaluation of clinical resolution will be performed at the end of the treatment (30 days). Evaluation of recurrence will be performed after 30 and 60 days of follow up. Serum and salivary levels of IL-6, IL-10, IL-1β, INF-γ and TNF-α will be evaluated at baseline and at the end of treatment (30 days). Quality of life will be evaluated by OHIP-14 questionnaire at baseline, at the end of treatment and after 30 and 60 days of follow up. The chi-square test, Student's t-test and ANOVA will be used and the level of significance of 5% will be considered (p < 0.05).

Study Overview

Detailed Description

Oral lichen planus is an idiopathic chronic mucocutaneous disease with a ride range of clinical manifestations, including white reticular patches, erosive/ulcerative and atrophic lesions, both associated with intense symptomatology. CD4+ and CD8+ T lymphocytes cells play an important role in the pathogenesis of OLP and are responsible for the production of different cytokines, including IL-6, IL-10, IL-1β, INF-γ and TNF-α. Treatment is symptomatic and topical corticosteroids are commonly used as standard therapy. However, patients frequently present relapses after treatment's discontinuation, develop resistance to corticosteroids therapy as well as secondary candidiasis. Photobiomodulation (PBM) has shown to be a potential therapeutic tool to treat inflammatory disorders, including OLP. Some studies have demonstrated that PBM improves the clinical presentation of OLP (erosive/ulcerative or atrophic lesions to reticular lesions), reduces pain and recurrence. However, it remains controversy if PBM is more effective than corticosteroid in the treatment of OLP. The aim of this study is to evaluate the efficacy of PBM in the treatment of OLP in relation to the standard therapy with corticosteroids. This is a protocol for a randomized, controlled, doubled blind clinical trial, with two months of follow up.

Patients with symptomatic OLP and with histopathological diagnosis of OLP based on WHO criteria will be included in this study. Fourty-four patients will be randomized in two experimental groups. Control group will be treated with clobetasol propionate 0.05% gel for 30 consecutive days and the laser device will be positioned over the lesion but will be switched off to mask the treatment. The experimental group will be treated with placebo gel for 30 consecutive days to mask the treatment and patients will receive laser treatment twice a week during 1 month for PBM (laser λ = 660±10 nm; power 100mW; radiant energy; 177J/cm2; 5-s exposure time per point and 0.5J of energy per point). The primary variable (pain by VAS scale) and the secondary variables (clinical scores, functional scores and Patient anxiety and depression) will be evaluated at the baseline, once a week during treatment and after 30 and 60 days of follow up. Evaluation of clinical resolution will be performed at the end of the treatment (30 days). Evaluation of recurrence will be performed after 30 and 60 days of follow up. Serum and salivary levels of IL-6, IL-10, IL-1β, INF-γ and TNF-α will be evaluated at baseline and at the end of treatment (30 days). Quality of life will be evaluated by OHIP-14 questionnaire at baseline, at the end of treatment and after 30 and 60 days of follow up. The findings will be computed and submitted to statistical analysis. Interval estimates will be used for the variables of interest to determine the prevision of the estimates and perform comparisons. If necessary, transformation methods or non-parametric tests will be applied. The chi-square test, Student's t-test and ANOVA will be used and the level of significance of 5% will be considered (p < 0.05).

Study Type

Interventional

Enrollment (Anticipated)

44

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

  • Name: Ana Paula C Silva, Bachelor
  • Phone Number: + 55 11 3385-9197
  • Email: aninha@uninove.br

Study Contact Backup

  • Name: Anna Carolina RT Horliana, PhD
  • Phone Number: +55 13 981999848
  • Email: annacrth@gmail.com

Study Locations

    • SP
      • São Paulo, SP, Brazil, 05508000
        • Recruiting
        • Scholl of Dentistry, University of São Paulo
        • Contact:
        • Principal Investigator:
          • Maria F Rodrigues, PhD
        • Sub-Investigator:
          • Camila B Gallo, PhD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

16 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • The participants in this study will be male and female (aged over 18 years) diagnosed with symptomatic oral lichen planus, based on the clinical and histopathological criteria of the World Health Organization (WHO).

Exclusion Criteria:

  • Patients with ongoing cancer; pregnant or breastfeeding women; patients with history of corticosteroids and nonsteroidal anti-inflammatory treatment in the last one months, patients with uncontrolled systemic disease; consumption of illicit drugs; use of medication associated with oral lichenoid reactions; amalgam restoration near to OLP lesions; epithelial dysplasia in the histopathological examination.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Photobiomodulation
Patients will be treated with localized PBM with a diode laser with continuous wave (laser λ =660 nm; power 100mW;radiant energy: 177J/cm2; 5-s exposure time per point and 0.5J of energy per point) applied directly to the surrounding oral mucosa and to the center of OLP, always by the same operator, twice a week for 4 weeks, totaling 8 session. The number of points will be variable according to the lesion size. The output power of the laser equipment will be evaluated using a power meter (Laser Check; MMOptics LTDA, São Paulo, Brazil) before treatment to confirm the effective mean power as well as the doses applied during the procedure.
Patients will be treated with localized PBM with a diode laser with continuous wave (laser λ = 660 nm; power 100mW;radiant energy: 177J/cm2; 5-s exposure time per point and 0.5J of energy per point) applied directly to the surrounding oral mucosa and to the center of OLP, always by the same operator, twice a week for 4 weeks, totaling 8 session. The number of points will be variable according to the lesion size. The output power of the laser equipment will be evaluated using a power meter (Laser Check; MMOptics LTDA, São Paulo, Brazil) before treatment to confirm the effective mean power as well as the doses applied during the procedure.
Other Names:
  • Low level laser therapy
Placebo gel for 30 consecutive days to mask the treatment
Other Names:
  • inative gel
Active Comparator: Propionate clobetasol gel 0.05%
Patients will be treated with Propionate clobetasol gel 0.05% for 30 consecutive days. Laser device will be positioned over the lesion but will be switched off to mask the treatment. Patients will be instructed to apply the propionate clobetasol gel 0.05% in the entire lesion three times/days. To prevent oral candidiasis, patients will use micostatin solution (Nystatin oral suspension 100,000 USP/ml) once a day during 4 weeks.
Patients will be treated with Propionate clobetasol gel 0.05% for 30 consecutive days and with placebo laser twice a week. Patients will be instructed to apply the propionate clobetasol gel 0.05% in the entire lesion three times/days. To prevent oral candidiasis, patients will use micostatin solution (Nystatin oral suspension 100,000 USP/ml) once a day during 4 weeks.
Other Names:
  • Clobetasol
Laser device will be positioned over the lesion but will be switched off to mask the treatment.
Other Names:
  • Laser off

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Assessment of Pain of OLP
Time Frame: Participants will be evaluated at baseline (Day 0)
The pain will be assessed by applying a Visual Analog Scale, consisting of a 100-mm line numbered in centimeters, with two closed ends. One end is labeled "0" and the other "100", meaning no pain and terrible pain, respectively. Each patient will be instructed to mark a vertical line according to the best value that matches the intensity of pain during the evaluation.
Participants will be evaluated at baseline (Day 0)
Assessment of Pain of OLP
Time Frame: Participants will be evaluated after 1 week of treatment (Day 7)
The pain will be assessed by applying a Visual Analog Scale, consisting of a 100-mm line numbered in centimeters, with two closed ends. One end is labeled "0" and the other "100", meaning no pain and terrible pain, respectively. Each patient will be instructed to mark a vertical line according to the best value that matches the intensity of pain during the evaluation.
Participants will be evaluated after 1 week of treatment (Day 7)
Assessment of Pain of OLP
Time Frame: Participants will be evaluated after 2 weeks of treatment (Day 14)
The pain will be assessed by applying a Visual Analog Scale, consisting of a 100-mm line numbered in centimeters, with two closed ends. One end is labeled "0" and the other "100", meaning no pain and terrible pain, respectively. Each patient will be instructed to mark a vertical line according to the best value that matches the intensity of pain during the evaluation.
Participants will be evaluated after 2 weeks of treatment (Day 14)
Assessment of Pain of OLP
Time Frame: Participants will be evaluated after 3 weeks of treatment (Day 21)
The pain will be assessed by applying a Visual Analog Scale, consisting of a 100-mm line numbered in centimeters, with two closed ends. One end is labeled "0" and the other "100", meaning no pain and terrible pain, respectively. Each patient will be instructed to mark a vertical line according to the best value that matches the intensity of pain during the evaluation.
Participants will be evaluated after 3 weeks of treatment (Day 21)
Assessment of Pain of OLP
Time Frame: Participants will be evaluated after 4 weeks of treatment (Day 30)
The pain will be assessed by applying a Visual Analog Scale, consisting of a 100-mm line numbered in centimeters, with two closed ends. One end is labeled "0" and the other "100", meaning no pain and terrible pain, respectively. Each patient will be instructed to mark a vertical line according to the best value that matches the intensity of pain during the evaluation.
Participants will be evaluated after 4 weeks of treatment (Day 30)
Assessment of Pain of OLP
Time Frame: 30 days after the discontinuation of treatment (follow-up period)
The pain will be assessed by applying a Visual Analog Scale, consisting of a 100-mm line numbered in centimeters, with two closed ends. One end is labeled "0" and the other "100", meaning no pain and terrible pain, respectively. Each patient will be instructed to mark a vertical line according to the best value that matches the intensity of pain during the evaluation.
30 days after the discontinuation of treatment (follow-up period)
Assessment of Pain of OLP
Time Frame: 60 days after the discontinuation of treatment (follow-up period)
The pain will be assessed by applying a Visual Analog Scale, consisting of a 100-mm line numbered in centimeters, with two closed ends. One end is labeled "0" and the other "100", meaning no pain and terrible pain, respectively. Each patient will be instructed to mark a vertical line according to the best value that matches the intensity of pain during the evaluation.
60 days after the discontinuation of treatment (follow-up period)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Assessment of clinical presentation of OLP
Time Frame: Participants will be evaluated at baseline (Day 0)
Clinical data will be evaluated by scores according to Thongprasom et al
Participants will be evaluated at baseline (Day 0)
Assessment of clinical presentation of OLP
Time Frame: Participants will be evaluated after 1 week of treatment (Day 7)
Clinical data will be evaluated by scores according to Thongprasom et al
Participants will be evaluated after 1 week of treatment (Day 7)
Assessment of clinical presentation of OLP
Time Frame: Participants will be evaluated after 2 weeks of treatment (Day 14)
Clinical data will be evaluated by scores according to Thongprasom et al
Participants will be evaluated after 2 weeks of treatment (Day 14)
Assessment of clinical presentation of OLP
Time Frame: Participants will be evaluated after 3 weeks of treatment (Day 21)
Clinical data will be evaluated scores according to Thongprasom et al
Participants will be evaluated after 3 weeks of treatment (Day 21)
Assessment of clinical presentation of OLP
Time Frame: Participants will be evaluated after 4 weeks of treatment (Day 30)
Clinical data will be evaluated by scores according to Thongprasom et al
Participants will be evaluated after 4 weeks of treatment (Day 30)
Assessment of clinical presentation of OLP
Time Frame: 30 days after the discontinuation of treatment (follow-up period)
Clinical data will be evaluated by scores according to Thongprasom et al
30 days after the discontinuation of treatment (follow-up period)
Assessment of clinical presentation of OLP
Time Frame: 60 days after the discontinuation of treatment (follow-up period)
Clinical data will be evaluated by scores according to Thongprasom et al
60 days after the discontinuation of treatment (follow-up period)
Function
Time Frame: Participants will be evaluated at baseline (Day 0)
The functional scores will be applied to evaluate chewing function, swallowing, fluid intake and altered sense of taste, according to Libelly et al (2006). Each function evaluated will receive the follow scores: 0 ( no difficulty) , 1 ( mild difficulty) , 2, ( moderate difficulty), 3, (severe difficulty), and 4 ( impossibility to perform certain function).
Participants will be evaluated at baseline (Day 0)
Function
Time Frame: Participants will be evaluated after 1 week of treatment (Day 7)
The functional scores will be applied to evaluate chewing function, swallowing, fluid intake and altered sense of taste, according to Libelly et al (2006). Each function evaluated will receive the follow scores: 0 ( no difficulty) , 1 ( mild difficulty) , 2, ( moderate difficulty), 3, (severe difficulty), and 4 ( impossibility to perform certain function).
Participants will be evaluated after 1 week of treatment (Day 7)
Function
Time Frame: Participants will be evaluated after 2 weeks of treatment (Day 14)
The functional scores will be applied to evaluate chewing function, swallowing, fluid intake and altered sense of taste, according to Libelly et al (2006). Each function evaluated will receive the follow scores: 0 ( no difficulty) , 1 ( mild difficulty) , 2, ( moderate difficulty), 3, (severe difficulty), and 4 ( impossibility to perform certain function).
Participants will be evaluated after 2 weeks of treatment (Day 14)
Function
Time Frame: Participants will be evaluated after 3 weeks of treatment (Day 21)
The functional scores will be applied to evaluate chewing function, swallowing, fluid intake and altered sense of taste, according to Libelly et al (2006). Each function evaluated will receive the follow scores: 0 ( no difficulty) , 1 ( mild difficulty) , 2, ( moderate difficulty), 3, (severe difficulty), and 4 ( impossibility to perform certain function).
Participants will be evaluated after 3 weeks of treatment (Day 21)
Function
Time Frame: Participants will be evaluated after 4 weeks of treatment (Day 30)
The functional scores will be applied to evaluate chewing function, swallowing, fluid intake and altered sense of taste, according to Libelly et al (2006). Each function evaluated will receive the follow scores: 0 ( no difficulty) , 1 ( mild difficulty) , 2, ( moderate difficulty), 3, (severe difficulty), and 4 ( impossibility to perform certain function).
Participants will be evaluated after 4 weeks of treatment (Day 30)
Function
Time Frame: 30 days after the discontinuation of treatment (follow-up period)
The functional scores will be applied to evaluate chewing function, swallowing, fluid intake and altered sense of taste, according to Libelly et al (2006). Each function evaluated will receive the follow scores: 0 ( no difficulty) , 1 ( mild difficulty) , 2, ( moderate difficulty), 3, (severe difficulty), and 4 ( impossibility to perform certain function).
30 days after the discontinuation of treatment (follow-up period)
Function
Time Frame: 60 days after the discontinuation of treatment (follow-up period)
The functional scores will be applied to evaluate chewing function, swallowing, fluid intake and altered sense of taste, according to Libelly et al (2006). Each function evaluated will receive the follow scores: 0 ( no difficulty) , 1 ( mild difficulty) , 2, ( moderate difficulty), 3, (severe difficulty), and 4 ( impossibility to perform certain function).
60 days after the discontinuation of treatment (follow-up period)
Clinical Resolution
Time Frame: Participants will be evaluated after 4 weeks of treatment (Day 30)
The clinical resolution will be evaluated at the end of treatment (day 30) according to Corozzo et al. (1999). Complete resolution will be considered when patients present absence of symptoms and remission of atrophic/erosive lesions regardless the presence of any persisting hyperkeratotic lesions. Partial resolution will be considered when a decrease but not the complete remission of atrophic/erosive areas and symptoms were observed. No response to treatment will be considered when OLP lesions present the same clinical or worse presentation in relation to the baseline condition.
Participants will be evaluated after 4 weeks of treatment (Day 30)
Recurrence rate
Time Frame: The recurrence rate will be evaluated 30 days after the discontinuation of treatment (follow-up period)
No recurrence will be considered when the patient presents the same clinical aspect of lesion at the end of treatment and recurrence, when the patient present new atrophic/erosive lesion at the same site during the follow-up period.
The recurrence rate will be evaluated 30 days after the discontinuation of treatment (follow-up period)
Recurrence rate
Time Frame: The recurrence rate will be evaluated 60 days after the discontinuation of treatment (follow-up period)
No recurrence will be considered when the patient presents the same clinical aspect of lesion at the end of treatment and recurrence, when the patient present new atrophic/erosive lesion at the same site during the follow-up period.
The recurrence rate will be evaluated 60 days after the discontinuation of treatment (follow-up period)
Salivary levels of IL-1β, IL-6, IL-8, IL-10 and TNFα
Time Frame: Baseline (day 0)
The samples will be centrifuged and stored at -80°C. Salivary levels of IL-6, IL-10, IL-1β, INF-γ and TNF-α will be evaluated by Enzyme Linked Immune Sorbent Assay (ELISA), according to manufacturer's instructions.
Baseline (day 0)
Salivary levels of IL-1β, IL-6, IL-8, IL-10 and TNFα
Time Frame: After 4 weeks of treatment (Day 30)
The samples will be centrifuged and stored at -80°C. Salivary levels of IL-6, IL-10, IL-1β, INF-γ and TNF-α will be evaluated by Enzyme Linked Immune Sorbent Assay (ELISA), according to manufacturer's instructions.
After 4 weeks of treatment (Day 30)
Serum levels of IL-1β, IL-6, IL-8, IL-10 and TNFα
Time Frame: Baseline (Day 0)
Peripheral blood will be centrifuged at 400xg for 10 min at 4°C. Serum will be collected and stored at -80°C. Serum levels of IL-6, IL-10, IL-1β, INF-γ and TNF-α will be evaluated by Enzyme Linked Immune Sorbent Assay (ELISA), according to manufacturer's instructions.
Baseline (Day 0)
Serum levels of IL-1β, IL-6, IL-8, IL-10 and TNFα
Time Frame: After 4 weeks of treatment (Day 30)
Peripheral blood will be centrifuged at 400xg for 10 min at 4°C. Serum will be collected and stored at -80°C. Serum levels of IL-6, IL-10, IL-1β, INF-γ and TNF-α will be evaluated by Enzyme Linked Immune Sorbent Assay (ELISA), according to manufacturer's instructions.
After 4 weeks of treatment (Day 30)
Assessment of Quality of life in OLP patients
Time Frame: Baseline (Day 0)
Patient quality of life will be measured by means of the Oral Health Impact Profile (OHIP 14)
Baseline (Day 0)
Assessment of Quality of life in OLP patients
Time Frame: After 4 weeks of treatment (Day 30)
Patient quality of life will be measured by means of the Oral Health Impact Profile (OHIP 14)
After 4 weeks of treatment (Day 30)
Assessment of Quality of life in OLP patients
Time Frame: 30 days after the discontinuation of treatment (follow-up period)
Patient quality of life will be measured by means of the Oral Health Impact Profile (OHIP 14)
30 days after the discontinuation of treatment (follow-up period)
Assessment of Quality of lifein OLP patients
Time Frame: 60 days after the discontinuation of treatment (follow-up period)
Patient quality of life will be measured by means of the Oral Health Impact Profile (OHIP 14)
60 days after the discontinuation of treatment (follow-up period)
Anxiety and Depression
Time Frame: Baseline (Day 0)
Patient anxiety and depression will be measured by means of The Hospital Anxiety and Depression Scale (HADS)
Baseline (Day 0)
Anxiety and Depression
Time Frame: Participants will be evaluated after 1 week of treatment (Day 7)
Patient anxiety and depression will be measured by means of The Hospital Anxiety and Depression Scale (HADS)
Participants will be evaluated after 1 week of treatment (Day 7)
Anxiety and Depression
Time Frame: Participants will be evaluated after 2 weeks of treatment (Day 14)
Patient anxiety and depression will be measured by means of The Hospital Anxiety and Depression Scale (HADS)
Participants will be evaluated after 2 weeks of treatment (Day 14)
Anxiety and Depression
Time Frame: Participants will be evaluated after 3 weeks of treatment (Day 21)
Patient anxiety and depression will be measured by means of The Hospital Anxiety and Depression Scale (HADS)
Participants will be evaluated after 3 weeks of treatment (Day 21)
Anxiety and Depression
Time Frame: Participants will be evaluated after 4 weeks of treatment (Day 30)
Patient anxiety and depression will be measured by means of The Hospital Anxiety and Depression Scale (HADS)
Participants will be evaluated after 4 weeks of treatment (Day 30)
Anxiety and Depression
Time Frame: 30 days after the discontinuation of treatment (follow-up period)
Patient anxiety and depression will be measured by means of The Hospital Anxiety and Depression Scale (HADS)
30 days after the discontinuation of treatment (follow-up period)
Anxiety and Depression
Time Frame: 60 days after the discontinuation of treatment (follow-up period)
Patient anxiety and depression will be measured by means of The Hospital Anxiety and Depression Scale (HADS)
60 days after the discontinuation of treatment (follow-up period)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Maria Fernanda SD Rodrigues, PhD, University of Nove de Julho

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

November 1, 2018

Primary Completion (Anticipated)

November 1, 2020

Study Completion (Anticipated)

December 1, 2020

Study Registration Dates

First Submitted

October 17, 2017

First Submitted That Met QC Criteria

October 20, 2017

First Posted (Actual)

October 25, 2017

Study Record Updates

Last Update Posted (Actual)

December 26, 2018

Last Update Submitted That Met QC Criteria

December 21, 2018

Last Verified

December 1, 2018

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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