Hydroxychloroquine safe alternative to topical steroids for management of oral lichen planus: Study

In the study, after four weeks of treatment, the topical use of dexamethasone and the systemic use of hydroxychloroquine were effective in improving the objective and subjective clinical manifestations of atrophic/erosive/ulcerative OLP; however, no significant differences were observed between the groups.

To date, topical corticosteroids are prescribed routinely as the first-line choice for treating atrophic/erosive/ulcerative OLP, yet these forms of OLP are most likely to progress to squamous cell carcinoma, and there is a need for repetitive use of the medication owing to the chronicity of oral lichen planus.

Against the above background, Qianming Chen, Sichuan University, Chengdu, China, and colleagues aimed to evaluate the benefit and safety of short-term application of hydroxychloroquine in the management of atrophic/erosive/ulcerative oral lichen planus in a multicenter, randomized, controlled, evaluator-blinded, prospective clinical trial performed from 2019 to 2022.

The study included 99 patients with atrophic/erosive/ulcerative oral lichen planus. They were randomized to receive systemic use of hydroxychloroquine (n = 50), or topical use of 0.05% dexamethasone (n = 49) for four weeks. The response to both treatment modalities was assessed according to reticulation, hyperemic, and ulceration (RHU) score and visual analogue scale (VAS) score.

The study led to the following findings:

• After 4 weeks of medication, both groups showed a substantial reduction in RHU and VAS scores.
• In the hydroxychloroquine group, the average RHU score was reduced from 10.60 to 7.68 (dropped 27.49%), and the average VAS score was reduced from 3.74 to 2.47 (dropped 34.09%).
• There were no differences between the two groups in the reduction of RHU score and VAS score.
• Single-factor analysis found hyperemic area and erosive/ulcerative area had impacts on the drug efficacy of hydroxychloroquine, and logistic regression revealed that no factors influenced its efficacy.

"The findings revealed that hydroxychloroquine is a safe alternative to topical glucocorticoids for the management of atrophic/erosive/ulcerative OLP," the researchers concluded.

Reference:

Xie, Y., Xu, H., Li, C., Wang, Y., Lu, R., Hua, H., Tang, G., Zhou, G., Jin, X., Shang, Q., Dan, P., Zhang, C., Luo, X., Dan, H., Zeng, X., Zhou, Y., & Chen, Q. Hydroxychloroquine is effective in oral lichen planus: A multicenter, randomized, controlled trial. Oral Diseases. https://doi.org/10.1111/odi.14746