Introduction
immune-mediated lesions, death, OLP
DISORDER, DEGENERATION, LYMPHOCYTIC INFILTRATE, ORAL LICHEN PLANUS, ORAL LICHEN PLANUS
Oral lichen planus (OLP) is a chronic inflammatory T-cell-mediated disorder that affects the oral mucosa, with an estimated general population prevalence of 0.89% [Microscopically, OLP is characterized by dense subepithelial lymphocytic infiltrate and degeneration of basal keratinocytes, as well as apoptotic keratinocytes seen by light microscope as shrunken cells with condensed nuclei and eosinophilic cytoplasm (Civatte/Colloid bodies) [Caspases are cysteine-proteases required for programmed cell death and activated by two pathways; the extrinsic pathway, which is triggered by attachment of “death receptors” [TNF] family, TNF-1 and FasL on the cell surface, while the intrinsic pathway is triggered by various forms of stress, including inadequate cytokine support and different types of intracellular damage [Different therapies have been developed to control symptomatic OLP, but a permanent cure is not yet available. Although many reviews on OLP therapy recommend topical steroids as the first-line treatment for symptomatic OLP, many other therapies represented effective alternatives for its management but required further research [Calcineurin inhibitors are immunomodulators that bind to intracytoplasmic proteins in T-lymphocytes (cyclosporine to cyclophilin; tacrolimus and pimecrolimus to FK506-binding protein), which in turn inhibit calcineurin, leading to suppression of transcription and production of variable cytokines and suggesting a possible role of these agents in management of variable immune-mediated lesions [Clinical trials with calcineurin inhibitors in the treatment of symptomatic OLP have yielded promising results [The use of currently available topical formulations has a few limitations like reduced patient compliance and salivary washout. In contrast, muco-adhesive buccal film provides the advantage of advanced retention time, increased patient compliance, prolonged release of the drug and better bioavailability at the site of action [We hypothesized that tacrolimus delivered via a mucoadhesive patch would improve clinical outcomes and patient compliance more than tacrolimus or triamcinolone acetonide topical gel. Thus, this study aimed to evaluate the clinical efficacy of tacrolimus 0.1% in mucoadhesive patches compared to tacrolimus or corticosteroids in gel form for symptomatic oral lichen planus and to investigate the effect of these medications on the expression of caspase 3 in oral lichen planus lesions as an early marker of apoptosis.
