The e International LDRG - KKU & Saraburi

Hospital Symposium 2014

P2 : Alternative therapy for oral lichen planus with low intensity laser

therapy and red light laser : A case report

Wilairat Sarideechaigul*1 and Sajee Sattayut2

Abstract

Oral lichen planus is a chronic inflammatory oral mucosal disease, which affects oral mucosa,

skin, or other mucous membrane. Erosive, atrophic, ulcerative lesions require long-term treatment,

because of inflammation and severe pain. This is a case report of a 52-year-old female who presented

to a dentist with chief complaints of chronic ulceration and burning sensation of the lip for 5 years.

The patient had generalized erosion with white streaks and hemorrhagic crusting on the lower lip.

The laboratory investigation includes a biopsy from vermillion of the lower lip which was examined

by an oral pathologist. This case was diagnosed with lichen planus of the lip. The patient was treated

by a topical steroid, which was 0.1% fluocinolone acetonide in orabase, applying locally 4 times/day.

The OLP's patient has not been healed. The low intensity laser therapy and red light laser have been

introduced as an alternative treatment. After 6 months with 10 sessions of the treatment with lasers,

the patient's oral lesion has been improved and decreased burning sensation. As the results, the OLP

in this patient has been improved, but the lesion has not cured.

Keywords: Low intensity laser therapy; Red light laser; Oral lichen planus

Introductions Oral lichen planus (OLP) is a chronic inflammatory oral mucosal disease, which affects oral mucosa, skin, or

other mucous membrane. The pathogenesis of OLP involving T-cells mediated disorder which the trigger factors and the

pathologic mechanism of the immune responses remain unknown (Lodi G, et al., 2005). Atrophic and erosive lesions are

severe and painful form of OLP, which are typically experience significant discomfort. The management of OLP varies

considerably between patients, and for individual patients, due to fluctuations in the disease activity (Setterfield JF, et

al, 2000, Thongprasom K, et al., 2003). Various modalities for treatment have been presented to relieve the symptoms.

These include both topical and systemic steroids, tacrolimus, systemic and topical retinoids, calcineurin inhibitors and

phototherapy (Thongprasom K, et al., 2011). However, OLP patients relapse when treatment is discontinued or resistant

to these treatments. Recently, alternative low intensity laser therapy (LILT) has been used as a treatment of OLP(Passeron

T, et al., 2004, Trehan M and Taylor CR, 2004, Miner K, et al, 2003, Mandavi 0, et al., 2013). Laser biostimulation

can obtain different intracellular biological reactions to stimulate regenerative abilities, without undesired adverse effects,

reducing also the pharmacological support and its possible invasiveness (Cafaro A, et al., 2014). The purpose of this

case report was to evaluate the effect of laser therapy in the treatment of OLP.

'Lecturer, Department of Oral Diagnosis, Faculty of Dentistry, Khon Kaen University, Thailand

2Associated Professor Dr, Lasers in Dentistry Research Group and Department of Oral Surgery, Faculty of Dentistry, Khon Kaen University,

Thailand

Correspondence author

Wilairat Sarideechaigul, D.D.S., MSc.

Department of Oral Diagnosis, Faculty of Dentistry, Khon Kaen University, Khon Kaen, 40002, Thailand.

E-mail: anndent17@hotmailcom

Tel 043-202405

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The e International LDRG - KKU & Saraburi

Hospital Symposium 2014

Case report

Patient history and examination

A 52-year-old female who presented to a dentist with chief complaints of chronic ulceration and burning

sensation of the lip for 5 years. The patient had generalized erosion with white streaks and hemorrhagic crusting on

the lower lip. The laboratory investigation includes a biopsy from vermillion of the lower lip which was examined by

an oral pathologist. This case was diagnosed with OLP. The patient had been previously treated with 0.1% fluocinolone

acetonide in orabase, applying locally 4 times/day. After one month of the treatment, the patient's oral lesion has

improved with no lip erosion and decreased burning sensation. The recurrence has been observed after the 2 years of

follow-up period. Nevertheless, the patient's oral lesion had been previously treated with a similar topical steroid as

before. The result has shown that the oral lesion has not been healed and still found a burning sensation (VAS = 3).

Clinical examination showed an erythematous area and erosion with scaly lip (Fig. la).

Laser therapy

LILT was delivered with a 820-nm. A collimated probe, with a diameter of 0.6 cm and a spot size of 0.28 cm2

was used. The output power was 100 mW. A "spot" technique was used, with a slight overlapping in order to evenly

distribute energy covering all the mucosal lesions. Each session was performed delivering an exposure of 4 J/cm2, and

the probe was held perpendicularly at a distance of about 2 mm. The time of delivery per point of application was

40 seconds for 20 times in each session (Fig. lb, c). Six sessions have attended during three months. The patient's oral

lesion has shown a better result. However, it was not recovered completely.

Red light laser producing 635 nm wavelengths light at approximately 5 mW of power, it has exposed for 30

seconds with continuous wave. The laser spot size was 3 mm in diameter, received a second exposure next to the

first so that all areas of the lesion were equally radiated. This resulted in an exposure of 1.5 J/cm2 for each session

(Fig. 1d).

Figure 1 A patient with OLP on the lower lip before treatment (a), low intensity laser device (b), operation with

LILT (c), and cooperate with red light laser (d).

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The eIntemational LDRG - KKU & Saraburi

Hospital Symposium 2014

Results

Ten sessions were attended during 6 months, LILT with the powers of 2 to 4 J/cm2 and red light laser

with the powers of 1.5 J/cm2. After 6 sessions of LILT, the treated area in patient was reduced in an erosive and

erythematous lesion and the pain score VAS from 3 to 2. The lesion had partial remission. Then, at the seventh

session, the LILT and red light laser have been combined initially. However, the result has not been improved even

tually at the tenth session (Fig. 2).

Figure 2 A patient with OLP on the lower lip before treatment (a), after 5 sessions treatment with LILT (b), and

cooperate with red light (c).

Discussion Many attempts have been developed an alternative treatment method to minimize the symptomatic OLP.

Several studies have shown good results with the use of low power laser, due to the acceleration of wound healing by

biostimulation of tissue and promoting pain relief, in addition to reduce the severity of the lesions (Passeron T, et al.,

2004, Trehan M and Taylor CR, 2004, 'Conner K, et al, 2003, Mandavi 0, et al., 2013, Cafaro A, et al., 2014).

According to this case, we have defined that OLP is a chronic oral mucosal disease. We have found burning

sensation, chronic erosive and erythematous lesion. The disease has been improved by the conventional therapy, which

is a topical steroid, such as 0.1% fluocinolone acetonide in orabase. However, developing techniques, which is red laser

light and low intensity laser, have been introduced for a better therapy. As the results, the OLP in this patient has

improved symptom, but the lesion has not cured.

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