Evaluation of chitosan as a treatment modality for erosive oral lichen planus via detection of salivary TNF-α

Objective: Oral lichen planus (OLP) is a common chronic inflammatory mucosal disease in which T-cell mediated immune responses are implicated in the pathogenesis. TNF has been found to be involved in the pathogenesis of many inflammatory or autoimmune diseases such as lichen planus. Various treatments have been employed to treat symptomatic OLP, but a complete cure is very difficult to achieve because of its recalcitrant nature. Topical corticosteroids therapy of OLP has shown conflicting results in many reports. Natural products have served as a major source of drugs for centuries, this study aimed to evaluate the effectiveness of topical intra-lesional chitosan in the treatment of oral erosive lichen planus. This was achieved via detection of salivary TNF-α level. Subjects and methods: The study was carried out using thirty-four patients of both sexes ranging in age between 30-50 years old with symptomatic erosive OLP and treated with intra-lesional 1% low molecular weight chitosan (50,000-190,000 Da) obtained from (Sigma-Aldrich, St. Louis, MO) and five healthy volunteers for estimation of the mean of normal salivary TNF-α. The appearance score, pain score, and salivary TNF-α of the target lesions were evaluated at weeks 0, 2, 4, and 16. Results: The study showed that there was a significant reduction of the mean of salivary TNF-α, VAS, score and criteria of clinical data which continued up to the end of the 4 months evaluation period as compared to the mean baseline value. Conclusion: Topical intra-lesional chitosan injection is effective for erosive OLP, which suggests that topical intra-lesional chitosan injection can be a promising therapeutic alternative for erosive OLP.