Efficacy of 0.1% Chitosan-Curcuminoids Mouthwash in Treatment of Oral Lichen Planus and Prevention of Disease Relapse -

Abstract

Introduction and Objective: The aim of this study was to determine the therapeutic efficacy of 0.1%
alcohol-free chitosan-curcuminoids mouthwash (CHI-CUR) which exerts anti-inflammatory and antifungal activity
in management of oral lichen planus (OLP) in comparison to a standard 0.1% triamcinolone acetonide mouthwash
(TA) to provide its clinical application as an alternative therapeutic agent for OLP.
Methods: A pilot single-blinded randomized controlled trial was conducted at the Faculty of Dentistry,
Prince of Songkla University, Thailand between February 2019 - April 2021. Participants were aged 18 years or
older with a confirmed diagnosis of OLP by an oral medicine practioner. Patients were randomly assigned to CHICUR or TA mouthwash at a dose of five milliliters for two min, four times a day for four weeks. Primary outcome
measures include a complete relief of erythematous lesions, a reduction in the number of C. albicans colonies
present in the oral cavity and the disease relapse.
Results: The result showed within the 4-week treatment course, that from the patients in the mild/
marked erythema group, three of six patients (50%) using TA mouthwash and two of eight patients (20%) using
CHI-CUR mouthwash had a complete relief of erythematous lesions, whereas patients in the ulceration group (where 3 patients used TA mouthwash and one patient used CHI-CUR mouthwash) had a decrease in site activity score level from 16 and 11 to 5 and 6 (mild/marked erythema), respectively. Both treatment groups provided
comparable efficacy in relief of pain or dryness of the oral cavity within the 2-week treatment course. For inhibitory
efficacy against candida colonization in the oral cavity, it was found at the fourth week after the treatment that all seven of the nine patients (77.8%) with candida infection in the CHI-CUR mouthwash treatment group had a
complete anti-candida response and eight of the ten patients (80%) with candida infection in the TA mouthwash
treatment group were found candidiasis in six of the ten patients (60%) with two of the ten (20%) having candida
superinfection at 4-weeks during the treatment course. Disease relapse was not observed after 6-months follow-up time in either intervention group.
Discussion: TA mouthwash exerted a high anti-inflammatory efficacy, but it has no antifungal activity. In
the present study, an alcohol free 0.1% CHI-CUR mouthwash was found to be as effective as 0.1% TA mouthwash in managing the signs and symptoms of OLP with a comparable time to remission state and a comparable efficacy in relief of pain or dryness of the oral cavity. On the contrary, a complete anticandidal response was found only in patients using CHI-CUR mouthwash. In addition, CHI-CUR mouthwash could be effective in decreasing the rate of symptom recurrence.
Conclusion and Recommendation: 0.1% alcohol-free CHI-CUR mouthwash may serve as a therapeutic
alternative in treating candida-associated OLP or OLP patients who have candida superinfection undergoing topical corticosteroids therapy.