EVALUATION OF GLUTAMINE COMBINED WITH TOPICAL CORTICOSTEROIDS IN THE TREATMENT OF EROSIVE ORAL LICHEN PLANUS

Gebril, Marwa M.; Moussa, Eglal M.; Raslan, Hanaa S.

doi:10.21608/adjalexu.2020.82704

EVALUATION OF GLUTAMINE COMBINED WITH TOPICAL CORTICOSTEROIDS IN THE TREATMENT OF EROSIVE ORAL LICHEN PLANUS

Authors

¹ BDS, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.

² Professor of Oral Medicine, Periodontology, Oral Diagnosis and Radiology Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt

³ Professor of Oral Pathology, Faculty of Dentistry, Alexandria University.

10.21608/adjalexu.2020.82704

Abstract

Introduction: Lichen planus (LP) is an inflammatory skin disease of unknown etiology. Increased oxidative stress has been implicated in the pathogenesis of erosive oral lichen planus (EOLP). Glutamine (Gln) is a source of energy for fibroblasts, immunocompetent cells, and intestinal epithelial cells involved in collagen production. It promotes protein and collagen synthesis, imparts immunity, and maintains the alimentary canal mucosa structure.
Objectives: The aim of this study was to evaluate the effect of Glutamine combined with topical corticosteroid in the treatment of erosive OLP.
Materials and methods: This randomized, parallel, controlled clinical study was conducted on thirty patients with a confirmed clinical and histopathological diagnosis of OLP who were randomly divided into two groups. Group 1 treated with topical steroids plus antifungal; Group 2 treated with Glutamine combined with topical steroids plus antifungal. Subjective symptoms and Visual Analogue Scale (VAS) were recorded at base line, after one month and at three months. The objective sign clinical score was recorded at baseline, one and three months post-treatment.
Results:Both groups showed decrease in lesion size and symptoms of OLP. The glutamine treated group showed a significantly higher decrease in pain score in comparison to the corticosteroid treated group. Regarding the healing score, there was no statistically significant difference between the two groups.
Conclusions: Glutamine as adjunctive to topical corticosteroid is effective in the treatment of EOLP; it resulted in a decrease in symptoms of the disease and more control of pain when compared to the conventional therapy. However, it has no effect on the signs of the disease.

Keywords

Main Subjects

Oral medicine

References

1-Scully C, Beyli M, Ferreiro MC, Ficarra G, Gill Y, Griffiths M, et al. Update on oral lichen planus: etiopathogenesis and management. Crit Rev Oral Biol Med. 1998;9:86-122.

2-Payeras MR, Cherubini K, Figueiredo MA, Salum FG. Oral lichen planus: focus on etiopathogenesis. Arch Oral Biol. 2013;58:1057-69. 3-Eisen D, Carrozzo M, Bagan Sebastian JV, Thongprasom K. Number V Oral lichen planus: clinical features and management. Oral Dis. 2005;11:338-49 4-Sugerman PB, Savage NW, Walsh LJ, Zhao ZZ, Zhou XJ, Khan A, et al. The pathogenesis of oral lichen planus. Crit Rev Oral Biol Med. 2002;13:350-65.

5-Gupta S, Jawanda MK. Oral Lichen planus: An Update on Etiology, Pathogenesis, Clinical Presentation, Diagnosis and Management. Indian J. Dermatol. 2015; 60 : 222-29.

6-Lodi G, Scully C, Carrozzo M, Griffiths M, Sugerman PB, Thongprasom K. Current controversies in oral lichen planus: report of an international consensus meeting. Part 1. Viral infections and etiopathogenesis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100:40-51.

7-Thornhill M. The current understanding of the aetiology of oral lichen planus. Oral Dis. 2010;16:507-8.

8-Anshumalee N, Shashikanth M, Sharma S. Oxidative stress and oral lichen planus: A possible association. Cusp. 2007;4:31-4.

9-Sezer E, Ozugurlu F, Ozyurt H, Sahin S, Etikan I. Lipid peroxidation and antioxidant status in lichen planus. Clin Exp Dermatol. 2007;32:430-4.

10-Karthikeyan P, Aswath N. Stress as an Etiologic Co-Factor in Recurrent Aphthous Ulcers and Oral Lichen planus. J Oral Sci. 2016;58:237-40.

11-Kanwar AJ, De D. Lichen planus in children. Indian J Dermatol Venereol Leprol. 2010;76:366-72.

12-Magin PJ, Pond CD, Smith WT, Watson AB, Goode SM. A cross-sectional study of psychological morbidity in patients with acne, psoriasis and atopic dermatitis in specialist dermatology and general practices. J Eur Acad Dermatol Venereol. 2008;22:1435-44.

13-Rezaei R, Wang WW, Wu ZL, Dai Z, Wang J, Wu G. Biochemical and Physiological Bases for Utilization of Dietary Amino Acids by Young Pigs. J Anim Sci Biotechnol. 2013;4:7.

14-Wischmeyer PE. Glutamine and Heat Shock Protein Expression. Nutrition. 2002;18:225-8.

15-Belal MH. Management of Symptomatic ErosiveUlcerative Lesions of Oral Lichen planus in an Adult Egyptian Population Using Selenium-ACE Combined with Topical Corticosteroids plus Antifungal Agent. Contemp Clin Dent. 2015;6:454-60.

16-Glick M. Burket's Oral Medicine. 12th ed. Shelton, Connecticut: People's Medical Publishing House USA; 2015.

17-Lodi G, Tarozzi M, Sardella A, Demarosi F, Canegallo L, Di Benedetto D, et al. Miconazole as adjuvant therapy for oral lichen planus: a double-blind randomized controlled trial. Br J Dermatol. 2007;156:1336-41.

18-Inaba M, Terai H, Nakajima Y, Fukui N, Suwa Y, Yamamoto K, et al. Usefulness of oral administration of the specialized amino acid supplement consisting of βhydroxy-β-methylbutyrate, L-arginine and L-glutamine (Abound™) for chronic soft tissue diseases in the mouth. SDRP J Food Sci Technol. 2016;123-7.

19-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.

20-Scott J, Huskisson EC. Graphic representation of pain. Pain. 1976;2:175-84.

21-ISMA–UK International Stress Management Association. 2013. Available at: http://isma.org.uk/wpcontent/uploads/2013/08/Stress-Questionnaire.pdf.

22-Saghaei M. Random Allocation Software [Internet]. 2004 [cited 2019 Apr 25]. Avaliable form: http://mahmoodsaghaei.tripod.com/Softwares/randalloc.ht ml

23-Saghaei M. Random Allocation Software for Parallel Group Randomized Trials. 2004;6;1-6

24-Kaplan I, Ventura-Sharabi Y, Gal G, Calderon S, Anavi Y. The dynamics of oral lichen planus: A retrospective clinicopathological study. Head Neck Pathol 2012; 6: 178-83.

25-Hertzog MA. Considerations in determining sample size for pilot studies. Research in nursing and health. 2008; 31:180-91.

26-Thongprasom K, Luengvisut P, Wongwatanakij A, Boonjatturus C. Clinical Evaluation in Treatment of Oral Lichen planus with Topical Fluocinolone Acetonide: A 2 Year Follow-Up. J Oral PatholMed. 2003;32:315-22.

27-Kyriakis KP, Terzoudi S, Palamaras I, Michailides C, Emmanuelidis S, Pagana G. Sex and Age Distribution of Patients with Lichen planus. J Eur Aca. Dermatol Venereol. 2006;20:625-6.

28-Abdullah SA, Maaita TJ. Epidemiological and Clinical Features of Lichen planus Injordanian Patients. Pak J Med Sci. 2007;23:92-4.

29-Bilgili SG, Karadag AS, Ozkol HU, Calka O, Akdeniz N. The prevalence of skin diseases among the geriatric patients in Eastern Turkey. J Pak Med Assoc. 2012;62:535-9.

30-Al-Hashimi I, Schifter M, Lockhart PB, Wray D, Brennan M, Migliorati, CA, et al. Oral Lichen planus and Oral Lichenoid Lesions: Diagnostic and Therapeutic Considerations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:e21-12.

31-Pandhi D, Singal A, Bhattacharya SN. Lichen planus in Childhood: A Series of 316 Patients. Pediatr Dermatol. 2014;31:59-67.

32-Kanwar AJ, De D. Lichen planus in Childhood: Report of 100 Cases. Clin Exp Dermatol. 2010;35:257-62.

33-Tawil M, Sediki, N, Hassan H. Psychobiological Aspects of Patients with Lichen Planus. Curr Psychiatry. 2009;16:370-80.

34-Chiappelli F, Cajulis OS. Psychobiologic Views on StressRelated Oral Ulcers. Quintessence Int. 2004;35:223-7.

35-Newsholme P. Why Is L-Glutamine Metabolism Important to Cells of the Immune System in Health, Postinjury, Surgery or Infection? J Nutr. 2001;131:2515S-222S; discussion 23S-4S.

36-Heyland D, Muscedere J, Wischmeyer PE, Cook D, Jones G, Albert M, et al. Canadian Critical Care Trials Group A Randomized Trial of Glutamine and Antioxidants in Critically Ill Patients. N Engl J Med. 2013;368:1489-97.

37-Holecek M. Side Effects of Long-Term Glutamine Supplementation. J Parenter EnterNutr. 2013;37:607-16.

38-Candow DG, Chilibeck PD, Burke DG, Davison KS, SmithPalmer T. Effect of Glutamine Supplementation Combined with Resistance Training in Young Adults. Eur J Appl Physiol. 2001;86:142-9.

39-Garrett-Cox RG, Stefanutti G, Booth C, Klein NJ, Pierro A, Eaton S. Glutamine Decreases Inflammation in Infant Rat Endotoxemia. J Pediatr Surg. 2009;44:523-9.

40-Son H, Baek JH, Go BS, Jung DH, Sontakke SB, Chung HJ, et al. Glutamine Has Antidepressive Effects Through Increments of Glutamate and Glutamine Levels and Glutamatergic Activity in the Medial Prefrontal Cortex. Neuropharmacology. 2018;143:143-52.