Oral Lichen Planus Treated With Plasma Rich in Growth Factors
The use of plasma rich in growth factors (PRGF) is a treatment for erosive oral lichen planus (OLP) resistant to steroid therapy. An anonymous database at a clinical center was reviewed to collect demographic data, lesion type, treatment protocol, number of infiltrations, pain score, and healing time of the lesions. Fifteen patients were included in this study. All patients were diagnosed with erosive OLP. The lesions in all patients were refractory to steroid therapy (topical and systemic). Results showed that the use of plasma rich in growth factors (PRGF) could be a promising alternative for the treatment of erosive OLP refractory to steroid therapy, though new prospective studies are needed to confirm these preliminary observations.
Practice Points
- Treating erosive oral lichen planus lesions refractory to conventional steroid treatments can be challenging for clinicians.
- Complete re-epithelialization and total pain relief could be observed after 1 to 3 weekly perilesional infiltrations with plasma rich in growth factors.
- No relapse of the lesions in the same area or other complications could be observed during the follow-up time.
Therapies Administered and Evaluations—Lesions refractory to conventional corticosteroid protocols had been previously treated for 30 days with 0.5% triamcinolone acetonide mouth rinse followed by a cycle of 1% triamcinolone acetonide mouth rinse. Subsequently, a cycle of oral corticosteroids (prednisone for 30 days: 1 mg/kg/d in a single morning dose with staged reduction after the first week) had been administered. One dayafter the corticosteroid treatment was suspended, the patients were treated by PRGF-Endoret (BTI Biotechnology Institute) infiltration following the protocol described by Anitua et al.15,16
Before starting the infiltrations with PRGF, the patient had been asked to rate the pain level on a visual analog scale (VAS) of 1 to 10, with 10 being the most intense imaginable pain. Pain score was subsequently rated and registered during every visit. An initial photograph of the lesion also was obtained to establish a starting point for further comparisons of clinical evolution of the lesions.
Prior to each infiltration, the plasma was separated into 2 fractions. The second fraction was the one that corresponded to the highest number of platelets and included the 2 mL of plasma just above the white series (or buffy coat). This fraction of plasma was the one used to infiltrate the lesions.
Plasma rich in growth factors was activated just before infiltration. The activation was done by adding 10% calcium chloride. Once activated, it was infiltrated into the active lesion using a 31-G × 1/6-in hypodermic needle and a 2-mL Luer-lock syringe. Infiltrations were performed without anesthesia. Four punctures were made for each ulcerative lesion, dividing the lesion into 4 points: upper, lower, right, and left. Plasma rich in growth factors was infiltrated until a slight blanching was observed in the surrounding tissue. At that moment, the infiltration was stopped and was carried out in the next infiltration site.
One treatment session was performed per week, with follow-up 1 week after treatment. In the control visit, the state of the lesions was re-evaluated, and it was decided whether new infiltrations were needed. The treatment was finished when complete epithelialization of the lesion was visualized or the associated symptoms disappeared. At each visit, photographs were taken, and the patient assessed the severity of pain on the VAS.
