In a significant advancement for oral medicine, a recent randomized clinical trial has provided valuable insights into the efficacy of combining oral acitretin with topical triamcinolone compared to the use of topical triamcinolone alone in treating patients with symptomatic oral lichen planus (OLP). OLP, a persistent inflammatory condition impacting the oral mucosa, has been conventionally managed with symptomatic relief using topical corticosteroids like triamcinolone. The study was published in the Journal of JAMA Dermatology, and it evaluated the efficacy of oral acitretin plus topical triamcinolone acetonide (TAC), 0.1%, with TAC monotherapy in patients with symptomatic OLP.
Dr. Vinay and colleagues conducted a monocentric, investigator-initiated, placebo-controlled, investigator- and patient-blinded randomized clinical trial at the Postgraduate Institute of Medical Education and Research in Chandigarh, India. The study spanned from December 2018 to June 2020 involved 64 patients aged 18 years or older with symptomatic OLP recruited through consecutive sampling. Data analysis was performed from July to December 2020.
Participants were randomly assigned to two groups: the treatment group, receiving a combination of oral acitretin (25-35 mg/d) and TAC, and the placebo group, receiving TAC in combination with a placebo. The treatment period lasted for 28 weeks, followed by an additional 8 weeks of treatment-free follow-up, resulting in a total study duration of 36 weeks. Out of the 64 patients, 31 in the treatment group and 30 in the placebo group completed the study. Both groups had similar ages (around 50 years) and gender ratios. The baseline scores for the oral disease severity score (ODSS), visual analog scale, and oral health impact profile 14 were alike. In comparison to the placebo group, more patients in the treatment group (88%) achieved a significant reduction in ODSS compared to the placebo group (47%) at 28 weeks. This trend continued at 36 weeks, with 84% in the treatment group versus 41% in the placebo group. After treatment, both groups experienced low relapse rates during the 8-week follow-up (3% in the treatment group vs 6% in the placebo group). The study shows promising outcomes for the treatment group in managing symptoms of OLP.
Combining acitretin with topical TAC is more effective in treating OLP than using topical TAC alone. Therefore, this combination should be considered as a treatment option for symptomatic disease or in cases where patients do not adequately respond to topical treatments alone.
Reference
Vinay K, Kumar S, Dev A, Cazzaniga S, Borradori L, Thakur V, et al. Oral Acitretin Plus Topical Triamcinolone vs Topical Triamcinolone Monotherapy in Patients With Symptomatic Oral Lichen Planus: A Randomized Clinical Trial. JAMA Dermatology [Internet]; 2023 Dec 6.