Efficacy of ozonized water for the treatment of erosive oral lichen planus: a randomized controlled study

F Veneri, E Bardellini, F Amadori, G Conti, A Majorana, F Veneri, E Bardellini, F Amadori, G Conti, A Majorana

Abstract

Background: Management of erosive Oral Lichen Planus (eOLP) is challenging. Currently, topical corticosteroids are widely used as first-line therapy, but they might be associated with side-effects and incomplete clinical response. Among non-pharmacological strategies, ozone at low medical concentration has proven to induce a mild activation of protective anti-oxidant pathways, thus exerting therapeutic effects in many inflammatory diseases. The aim of this randomized controlled study was to investigate the effectiveness of ozonized water in association with conventional topical corticosteroids for the treatment of eOLP.

Material and methods: Fifty-one patients were included in the study and randomized into 2 groups: study group (n=26) included patients receiving ozonized water treatment; control group (n=25) included patients receiving placebo treatment (i.e. double-distilled water). Treatment protocol consisted of 1-minute oral rinses, repeated for 4 times, twice a week for 4 weeks. All patients received conventional corticosteroid topical therapy (betamethasone soluble tablets, 2 rinses/day for 4 weeks). Assessment of size of lesions, sign and pain scores was performed before treatment, after 2 weeks of treatment (T1) and at the end of 4-week treatment (T2). Efficacy Index (EI) of treatment, candidiasis and relapse rates were also recorded.

Results: All patients experienced significant improvement of sign and pain scores with a higher rate of improvement in ozone-treated group (T1 improvement rates: Thongprasom 92.2% vs 28%; VAS pain 76.9% vs 32%; p<0.05). Pain and size reduction were significantly higher in ozone-treated group both at T1 and T2 (p<0.05). Ozone-treated group showed a higher EI at every time point (T0-T2: 72.77% vs 37.66%, p<0.01). Candidiasis (32% vs 11.5%) and relapse (40% vs 34.6%) rates were higher in control group, however the differences were not statistically significant.

Conclusions: Within the limitations of this study, ozonized water seems to be effective as an adjunct therapy, in combination with topical corticosteroids, for the treatment of eOLP.

Conflict of interest statement

Conflicts of interest The Authors disclose any financial and personal relationships with other people or organisations that could inappropriately influence their work.

Figures

Figure 1
Figure 1
VAS pain median values over time.
Figure 2
Figure 2
Size of lesions (median, mm) over time.
Figure 3
Figure 3
Clinical presentation of emblematic cases from study group (a; b) and from control group (c; d), before (a; c) and after treatment (b; d) respectively. (Study group: betamethasone rinses associated with ozonized water rinses. Control group: betamethasone rinses and placebo (double-distilled water) rinses).

References

    1. Cheng YS, Gould A, Kurago Z, Fantasia J, Muller S. Diagnosis of oral lichen planus: a position paper of the American Academy of Oral and Maxillofacial Pathology. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122:332–54.
    1. Bardellini E, Amadori F, Flocchini P, Bonadeo S, Majorana A. Clinicopathological features and malignant transformation of oral lichen planus: a 12-years retrospective study. Acta Odontol Scand. 2013;71:834–40.
    1. Andreasen JO. Oral lichen planus. 1. A clinical evaluation of 115 cases. Oral Surg Oral Med Oral Pathol. 1968;25:31–42.
    1. Pinna R, Cocco F, Campus G, Conti G, Milia E, Sardella A. Genetic and developmental disorders of the oral mucosa: Epidemiology; molecular mechanisms; diagnostic criteria; management. Periodontol 2000. 2019 ;80:12–27.
    1. Mutafchieva MZ, Draganova-Filipova MN, Zagorchev PI, Tomov GT. Effects of Low Level Laser Therapy on Erosive-atrophic Oral Lichen Planus. Folia Med (Plovdiv) 2018;60:417–24.
    1. Cheng S, Kirtschig G, Cooper S, Thornhill M, Leonardi-Bee J, Murphy R. Interventions for erosive lichen planus affecting mucosal sites. Cochrane Database Syst Rev. 2012;2:CD008092.
    1. Bagan JV, Eisen D, Scully C. The diagnosis and management of oral lichen planus: a consensus approach. Oral Biosci Med. 2004;1:21–7.
    1. Lodi G, Carrozzo M, Furness S, Thongprasom K. Interventions for treating oral lichen planus: a systematic review. Br J Dermatol. 2012;166:938–47.
    1. Al-Maweri SA, Kalakonda B, Al-Soneidar WA, Al-Shamiri HM, Alakhali MS, Alaizari N. Efficacy of low-level laser therapy in management of symptomatic oral lichen planus: a systematic review. Lasers Med Sci. 2017;32:1429–37.
    1. Amadori F, Bardellini E, Conti G, Pedrini N, Schumacher RF, Majorana A. Low-level laser therapy for treatment of chemotherapy-induced oral mucositis in childhood: a randomized double-blind controlled study. Lasers Med Sci. 2016;31:1231–6.
    1. Yang H, Wu Y, Ma H, Jiang L, Zeng X, Dan H. Possible alternative therapies for oral lichen planus cases refractory to steroid therapies. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;121:496–509.
    1. Travagli V, Zanardi I, Valacchi G, Bocci V. Ozone and ozonated oils in skin diseases: a review. Mediators Inflamm. 2010;2010:610418.
    1. Elvis AM, Ekta JS. Ozone therapy: A clinical review. J Nat Sci Biol Med. 2011;2:66–70.
    1. Yarosz EL, Chang CH. The Role of Reactive Oxygen Species in Regulating T Cell-mediated Immunity and Disease. Immune Netw. 2018;18:e14.
    1. Galiè M, Covi V, Tabaracci G, Malatesta M. The Role of Nrf2 in the Antioxidant Cellular Response to Medical Ozone Exposure. Int J Mol Sci. 2019;20:4009.
    1. Santoro A, Majorana A, Bardellini E, Festa S, Sapelli P, Facchetti F. NF-kB expression in oral and cutaneous lichen planus. J Pathol. 2003;201:466–72.
    1. Sklavos MM, Tse HM, Piganelli JD. Redox modulation inhibits CD8 T cell effector function. Free Radic Biol Med. 2008;45:1477–86.
    1. Costanzo M, Cisterna B, Vella A, Cestari T, Covi V, Tabaracci G. Low ozone concentrations stimulate cytoskeletal organization, mitochondrial activity and nuclear transcription. Eur J Histochem. 2015;59:2515.
    1. Scassellati C, Costanzo M, Cisterna B, Nodari A, Galiè M, Cattaneo A. Effects of mild ozonisation on gene expression and nuclear domains organization in vitro. Toxicol In Vitro. 2017;44:100–10.
    1. van der Meij EH, van der Waal I. Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications. J Oral Pathol Med. 2003;32:507–12.
    1. Gorsky M, Raviv M. Efficacy of etretinate (Tigason) in symptomatic oral lichen planus. Oral Surg Oral Med Oral Pathol. 1992;73:52–5.
    1. Thongprasom K, Luangjarmekorn L, Sererat T, Taweesap W. Relative efficacy of fluocinolone acetonide compared with triamcinolone acetonide in treatment of oral lichen planus. J Oral Pathol Med. 1992;21:456–8.
    1. Bayer S, Kazancioglu HO, Acar AH, Demirtas N, Kandas NO. Comparison of laser and ozone treatments on oral mucositis in an experimental model. Lasers Med Sci. 2017;32:673–7.
    1. Kazancioglu HO, Ezirganli S, Aydin MS. Effects of laser and ozone therapies on bone healing in the calvarial defects. J Craniofac Surg. 2013;24:2141–6.
    1. Erdemci F, Gunaydin Y, Sencimen M, Bassorgun I, Ozler M, Oter S. Histomorphometric evaluation of the effect of systemic and topical ozone on alveolar bone healing following tooth extraction in rats. Int J Oral Maxillofac Surg. 2014;43:777–83.
    1. Mostafa B, Zakaria M. Evaluation of Combined Topical Ozone and Steroid Therapy in Management of Oral Lichen Planus. Open Access Maced J Med Sci. 2018;6:879–84.
    1. Noel S, Martina MN, Bandapalle S, Racusen LC, Potteti HR, Hamad AR. T Lymphocyte-Specific Activation of Nrf2 Protects from AKI. J Am Soc Nephrol. 2015;26:2989–3000.
    1. Sun SL, Liu JJ, Zhong B, Wang JK, Jin X, Xu H. Topical calcineurin inhibitors in the treatment of oral lichen planus: a systematic review and meta-analysis. Br J Dermatol. 2019;181:1166–76.
    1. Scully C, Carrozzo M. Oral mucosal disease: lichen planus. Br J Oral Maxillofac Surg. 2008;46:15–21.
    1. Arita M, Nagayoshi M, Fukuizumi T, Okinaga T, Masumi S, Morikawa M. Microbicidal efficacy of ozonated water against Candida albicans adhering to acrylic denture plates. Oral Microbiol Immunol. 2005;20:206–10.

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