randomized study in management of olp patients was planned and conducted during the period of september 2012 to july 2013 in the department of oral medicine and radiology , rajah muthiah dental college and hospital , annamalai university , to compare the effectiveness with topical triamcinolone acetonide 0.1% , clobetasol propionate 0.05% , and tacrolimus in orabase 0.03% .
a formal ethical clearance to conduct this study was obtained from the ethical clearance committee of the college .
the patients for the study were selected among the outpatients who visited the department of oral medicine and maxillofacial radiology .
a total of 30 subjects were randomized using randomization chart and divided into three groups . 

group i -10 patients with clinically and histologically confirmed olp subjects were recruited to receive topical triamcinolone acetonide 0.1% for 6 weeksgroup ii -10 patients with clinically and histologically confirmed olpsubjects were recruited to receive topical clobetasol propionate 0.05% for 6 weeksgroup iii -10 patients with clinically and histologically confirmed olp subjects were recruited to receive topical tacrolimus 0.03% for 6 weeks . 
 
group i -10 patients with clinically and histologically confirmed olp subjects were recruited to receive topical triamcinolone acetonide 0.1% for 6 weeks group ii -10 patients with clinically and histologically confirmed olpsubjects were recruited to receive topical clobetasol propionate 0.05% for 6 weeks group iii -10 patients with clinically and histologically confirmed olp subjects were recruited to receive topical tacrolimus 0.03% for 6 weeks .
inclusion criteria were clinically symptomatic oral lesions confirmed by histologically to be olp and exclusion criteria were patients who had underwent treatment for olp within 4 weeks before the study , pregnant or nursing women , skin lesions and lesion extending to soft palate , and tonsils are excluded from the study .
a detailed case history was recorded for all patients , its nature , duration , and associated with skin lesions are noted .
all the patients were subjected to a thorough general physical and oral clinical examination and details were recorded on a standard pro forma . in provisionally diagnosed olp patients ,
lesion size was measured based on staging given by farzaneh agha - hosseini et al . [ table 1 ] . after establishing the clinical diagnosis ,
the patients were subjected to routine blood investigations to rule out any systemic ailments . for the histopathological confirmation of the subjects with olp ,
all the three groups were instructed to apply the topical ointments on the lesional site .
topical agent is applied 4 times a day for 6 weeks and subjects were checked at 1 , 3 , and 6 week for the remission lesion .
statistical analysis of the data was carried out with spss for windows 9.0 software ( spss , inc . ,
staging system for lichen planus lesion size after the end of 1 week , group a and c ( triamcinolone 0.1% and tacrolimus 0.03% ) show no changes , whereas in the group b ( clobetasol 0.05% ) , three subjects with white striae with erosion > 1 cm is reduced to white striae with erosion < 1 cm . in all the three group a ,
b , and c , there are 10 subjects . of 10 patients , 7 subjects in each group
are in stage 1 ( white striae only ) and 3 patients are in stage 3 ( white striae with erosion more than 1 cm ) . after the end of 3 weeks in group a ( triamcinolone 0.1% ) , 1 subject shows no lesion . in group b ( clobetasol 0.05% ) ,
7 subjects show no lesion and three subjects show white striae only . in group c ( tacrolimus 0.03% ) ,
1 subject from white striae with erosion > 1 cm is reduced to white striae with erosion < 1 cm . at the end of 6 weeks in group a ( triamcinolone 0.1% ) ,
7 subjects show no lesion and 3 patients show white striae only . in group b ( clobetasol 0.05% )
, all the 10 subjects show no lesion . in group c ( tacrolimus 0.03% ) , 3 subjects show no lesion , 5 subjects show white striae only , and 2 patients show no improvement ( white striae with erosion more than 1 cm ) .
there is a significant difference in all the three groups in the 3 and 6 week .
as there is evident of significant difference in all three groups in the 3 and 6 week , we carried out mann  whitney tests on each pair of groups and used the bonferroni correction ( that is , significance level / number of pairwise tests ) to compare the p value .
we used 5% level of significance for three treatments , hence compared the p value for each mann  whitney test with 0.05/3 = 0.017 .
if the significance value is less than the 0.017 , then we infer the treatments have the difference .
after the end of 1 week , group a and c ( triamcinolone 0.1% and tacrolimus 0.03% ) show no changes , whereas in the group b ( clobetasol 0.05% ) , three subjects with white striae with erosion > 1 cm is reduced to white striae with erosion < 1 cm .
in all the three group a , b , and c , there are 10 subjects . of 10 patients , 7 subjects in each group are in stage 1 ( white striae only ) and 3 patients are in stage 3 ( white striae with erosion more than 1 cm ) .
after the end of 3 weeks in group a ( triamcinolone 0.1% ) , 1 subject shows no lesion . in group b ( clobetasol 0.05% ) ,
7 subjects show no lesion and three subjects show white striae only . in group c ( tacrolimus 0.03% ) , 1 subject from white striae with erosion > 1 cm is reduced to white striae with erosion < 1 cm .
at the end of 6 weeks in group a ( triamcinolone 0.1% ) , 7 subjects show no lesion and 3 patients show white striae only . in group b ( clobetasol 0.05% ) ,
all the 10 subjects show no lesion . in group c ( tacrolimus 0.03% ) , 3 subjects show no lesion , 5 subjects show white striae only , and 2 patients show no improvement ( white striae with erosion more than 1 cm ) .
there is a significant difference in all the three groups in the 3 and 6 week .
as there is evident of significant difference in all three groups in the 3 and 6 week , we carried out mann  whitney tests on each pair of groups and used the bonferroni correction ( that is , significance level / number of pairwise tests ) to compare the p value .
we used 5% level of significance for three treatments , hence compared the p value for each mann  whitney test with 0.05/3 = 0.017 .
if the significance value is less than the 0.017 , then we infer the treatments have the difference .
olp is a t - cell - mediated chronic inflammatory oral mucosal disease of unknown etiology , but it is believed to result from an abnormal t - cell - mediated immune response in which basal epithelial cells are recognized as foreign because of changes in the antigenicity of their cell surface . it is a relatively common disorder that is estimated to affect 0.52.0% of the general population .
olp affects primarily middle - aged adults , and the prevalence is greater among women . in this study , we included patients in the age range of 1865 years .
age distribution table [ table 2 ] shows that the maximum percentage of patients included in the study falls in the range of 3050 years and the mean age of patients in the group is 39.77 years .
our results are consistent with the another study who reported the typical age of presentation is between 30 and 60 years , but its occurrence in younger people and children is not uncommon .
this study shows that the incidence was higher in females ( 60% ) when compared to males ( 40% ) .
similar observations were found in some of the previous studies found that in a study of 30 olp patients , 56.7% were females and 43.3% were males [ table 3 ] .
probable reason for the increased incidence of olp in females may be due to greater psychological stress as a consequence of activities of hormones . frequency distribution table for gender olp exists in many clinical forms .
however , in the present study , only two clinical forms could be recorded : reticular and erosive . in the current study ,
the incidence of reticular form of olp is more frequent ( 21 out of 30 patients ) , followed by erosive olp ( 9 out of 30 patients ) .
the lesion size was also reduced in the clobetasol propionate ( mean rank of 9.0 ) when compared with triamcinolone acetonide 0.1% ( mean rank of 12.0 ) .
this was proved another study that clobetasol propionate compared with triamcinolone acetonide provides a more immediate clinical response [ table 4 ] .
the lesion size was also reduced in the triamcinolone acetonide 0.1% ( mean rank of 8.20 ) when compared with tacrolimus 0.03% at the end of 6 weeks ( mean rank of 12.80 ) [ tables 57 ] .
this is in contrast to the study who found tacrolimus 0.1% ointment induced a better initial therapeutic response than the triamcinolone acetonide 0.1% .
this can be because the concentration of tacrolimus ( 0.1% ) they used is more than that of our study which is 0.03% .
the lesion size was also reduced in the clobetasol propionate ( mean rank of 7.0 ) when compared with tacrolimus 0.03% ( mean rank of 14.0 ) at the end of 6 week [ table 8 ] .
this was supported by another study done who reported that clobetasol propionate 0.05% ointment was found to be more useful than tacrolimus 0.1% in the treatment of olp .
this is in contrast to the study done by who found tacrolimus to be as useful as clobetasol in the treatment of olp .
treatment progression ( lesional ) after the end of 1 week treatment progression ( lesional ) after the end of 3 week treatment progression after the end of 6 week comparing all three groups a , b , and c test statistics for groups b and c the other study evaluated the effect of different formulation of clobetasol with other corticosteroids in the treatment of olp and emphasized that clobetasol had better effects .
as there were few studies done to compare the effectiveness of corticosteroids with tacrolimus in the treatment of olp , this study was undertaken . in this study
, we infer that clobetasol propionate 0.05% is useful in effectively reducing the lesion size at the end of 6 weeks in olp subjects , and also that clobetasol propionate 0.05% has got the better therapeutic effect when compared with triamcinolone acetonide 0.1% and tacrolimus ointment 0.03% [ tables 9 and 10 ] .
however , for increasing the strength of the study , a detailed blinded , randomized trial with a large sample size could be pursued .
it is concluded that clobetasol propionate 0.05% ointment has higher efficacy when compared to triamcinolone acetonide 0.1% ointment and tacrolimus ointment 0.03% in the management of olp .
 background : oral lichen planus ( olp ) is believed to result from an abnormal t - cell mediated immune response . 
 the most useful agent in the treatment is corticosteroids . 
 the present study will be aimed at evaluation of therapeutic efficiency of two corticosteroids triamcinolone acetonate ( 0.1% ) and clobetasol propionate with tacrolimus orabase ( 0.03% ) , an immunomodulator in the management of olp.aim:to compare the effectiveness of topical triamcinolone acetonate ( 0.1% ) , clobetasol propionate ( 0.05% ) , and tacrolimus orabase ( 0.03% ) in the management of olp and also to compare which has less recurrence.study design : the study comprises 30 patients , all were diagnosed with olp clinically and histopathologically . 
 they are randomly divided into three groups : group a - triamcinolone acetonate ( 0.1% ) , group b - clobetasol propionate ( 0.05% ) , and group c - tacrolimus ( 0.03% ) . 
 a formal informed consent was obtained from all of them who participated in the study.results and conclusion : subjects in the group a ( triamcinolone 0.1% ) and group b ( clobetasol 0.05% ) show a significant reduction in lesion size than that of group c ( tacrolimus 0.03% ) . 
 group b ( clobetasol 0.05% ) shows a better significant reduction in lesion size than that of group a ( triamcinolone 0.1% ) . 
 the overall treatment response was significant better in the group b ( clobetasol 0.05% ) . 
 no recurrence was observed in any of the three groups at the end of 3 months . 
 it is concluded that clobetasol propionate 0.05% ointment has higher efficacy when compared to triamcinolone acetonide 0.1% ointment and tacrolimus ointment 0.03% in the management of olp . 
 it was also inferred that triamcinolone 0.1% has better effects than tacrolimus 0.03% . 
Materials and Methods
Inference
Lesion size
Inference 1
Inference 2
Inference 3
Discussion
Conclusion
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Conflicts of interest