Clinical trial NCT05882864: Efficacy of Ginger Muco-bioadhesive Gel in Management of Oral Lichen Planus With Immunohistochemical Analysis
Official title: Efficacy of Ginger Muco-bioadhesive Gel in Management of Oral Lichen Planus: A Randomized Controlled Clinical Trial With Immunohistochemical Analysis
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: PHASE4
Conditions: Oral Lichen Planus
Lead sponsor: Ain Shams University
Sponsor class: OTHER
First posted: 2023-05-31
Enrollment: 28
Sex: ALL
Minimum age (years): 40
Maximum age (years): 60
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Group I Will include 14 patients receiving topical ginger extract 1% four times per day (after every meal and before going to bed) for eight weeks (Zakaria et al., 2020).

Group II Will include 14 patients receiving topical steroid (triamcinolone acetonide 0.1%) four times per day for eight weeks (Laeijendecker et al., 2006)
Primary purpose: TREATMENT

Brief summary: 1. Compare the clinical efficacy of topical ginger extract versus triamcinolone acetonide 0.1% for symptomatic oral lichen planus (Primary Objective).
2. Investigate using immunohistochemical analysis the effect of the two different treatment modalities on FasL expression in oral lichen planus lesions (Secondary Objective).


Eligibility criteria: Inclusion Criteria:

* Males or females, aged from 40 to 60 years.
* Clinically proven painful Bullous/erosive (score 4) or atrophic (score 3) forms of OLP confirmed by the presence of red or erythromatous changes, or shallow ulcerations with fine lacy lines at the periphery of the lesion accentuated by stretching and not eliminated by rubbing (Wickham's striae) (Lozada-Nur and Miranda, 1997)
* Histopathologically, proven Bullous/erosive (score 4) or atrophic (score 3) forms of OLP confirmed by the presence of accepted histopathological criteria for lichen planus; basal cell liquefaction, band like lymphocytic infiltrate at the epithelial-stromal junction with degeneration of basal cell region (Ellis, 1967; Van der Meij and Van der Waal, 2003).

Exclusion Criteria:

* History of drug induced lichenoid lesions.
* Presence of systemic conditions as; serious active or recurrent infections, malignancy, diabetes mellitus, hypertension, or significant heart, liver, or renal diseases. Assessed using medical questionnaire guided by Cornell Medical Index (Pendleton et al., 2004).
* Smoking.
* Known hypersensitivity or severe adverse effects to the treatment drugs or to any ingredient of their preparation as mentioned in medical history.
* Pregnancy or breast-feeding.
* History of previous treatments potentially effective on OLP such as antimalarial agents, retinoids, corticosteroids or immunosuppressive drugs from less than 2 weeks for topical medications, and 4 weeks for systemic medications prior to starting the study (Swift et al., 2005).
* Patients suffering from lichen planus skin lesions.
* Loss of pliability or flexibility in the tissues involved by the oral lesions of lichen planus.
* Histological signs of epithelial dysplasia or lichenoid lesions within the biopsied.
* Refusing to participate in the study.
* Vulnerable groups (handicapped, orphans and prisoners).

Primary outcomes:
measure: Efficacy of Ginger Muco-bioadhesive Gel in Management of Oral Lichen Planus
timeFrame: Baseline
Secondary outcomes:
Other outcomes:
Locations:
Study officials:
References:
citation: Ahn SI, Lee JK, Youn HS. Inhibition of homodimerization of toll-like receptor 4 by 6-shogaol. Mol Cells. 2009 Feb 28;27(2):211-5. doi: 10.1007/s10059-009-0026-y. Epub 2009 Feb 20.
citation: Ali BH, Blunden G, Tanira MO, Nemmar A. Some phytochemical, pharmacological and toxicological properties of ginger (Zingiber officinale Roscoe): a review of recent research. Food Chem Toxicol. 2008 Feb;46(2):409-20. doi: 10.1016/j.fct.2007.09.085. Epub 2007 Sep 18.
citation: Anitua E, Pinas L, Alkhraisat MH. Histopathological features of oral lichen planus and its response to corticosteroid therapy: A retrospective study. Medicine (Baltimore). 2019 Dec;98(51):e18321. doi: 10.1097/MD.0000000000018321.
citation: Canto AM, Muller H, Freitas RR, Santos PS. Oral lichen planus (OLP): clinical and complementary diagnosis. An Bras Dermatol. 2010 Sep-Oct;85(5):669-75. doi: 10.1590/s0365-05962010000500010.
citation: Chainani-Wu N, Silverman S Jr, Lozada-Nur F, Mayer P, Watson JJ. Oral lichen planus: patient profile, disease progression and treatment responses. J Am Dent Assoc. 2001 Jul;132(7):901-9. doi: 10.14219/jada.archive.2001.0302.
citation: Cheng A, Mann C. Oral erosive lichen planus treated with efalizumab. Arch Dermatol. 2006 Jun;142(6):680-2. doi: 10.1001/archderm.142.6.680. No abstract available.
citation: Choonhakarn C, Busaracome P, Sripanidkulchai B, Sarakarn P. The efficacy of aloe vera gel in the treatment of oral lichen planus: a randomized controlled trial. Br J Dermatol. 2008 Mar;158(3):573-7. doi: 10.1111/j.1365-2133.2007.08370.x. Epub 2007 Dec 17.
citation: Dragovich T, Rudin CM, Thompson CB. Signal transduction pathways that regulate cell survival and cell death. Oncogene. 1998 Dec 24;17(25):3207-13. doi: 10.1038/sj.onc.1202587.
citation: Eisenberg E. Oral lichen planus: a benign lesion. J Oral Maxillofac Surg. 2000 Nov;58(11):1278-85. doi: 10.1053/joms.2000.16629. No abstract available.
citation: Ellis FA. Histopathology of lichen planus based on analysis of one hundred biopsy specimens. J Invest Dermatol. 1967 Feb;48(2):143-8. doi: 10.1038/jid.1967.23. No abstract available.
citation: Eversole LR. Immunopathogenesis of oral lichen planus and recurrent aphthous stomatitis. Semin Cutan Med Surg. 1997 Dec;16(4):284-94. doi: 10.1016/s1085-5629(97)80018-1.
citation: Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies. Clin Dermatol. 2010 Jan-Feb;28(1):100-8. doi: 10.1016/j.clindermatol.2009.03.004.
citation: Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007 May;39(2):175-91. doi: 10.3758/bf03193146.
citation: Gonzalez-Moles MA, Warnakulasuriya S, Gonzalez-Ruiz I, Gonzalez-Ruiz L, Ayen A, Lenouvel D, Ruiz-Avila I, Ramos-Garcia P. Worldwide prevalence of oral lichen planus: A systematic review and meta-analysis. Oral Dis. 2021 May;27(4):813-828. doi: 10.1111/odi.13323. Epub 2020 Apr 2.
citation: Gorouhi F, Davari P, Fazel N. Cutaneous and mucosal lichen planus: a comprehensive review of clinical subtypes, risk factors, diagnosis, and prognosis. ScientificWorldJournal. 2014 Jan 30;2014:742826. doi: 10.1155/2014/742826. eCollection 2014.
citation: Grzanna R, Lindmark L, Frondoza CG. Ginger--an herbal medicinal product with broad anti-inflammatory actions. J Med Food. 2005 Summer;8(2):125-32. doi: 10.1089/jmf.2005.8.125.
citation: Haghpanah P, Moghadamnia AA, Zarghami A, Motallebnejad M. Muco-bioadhesive containing ginger officinal e extract in the management of recurrent aphthous stomatitis: A randomized clinical study. Caspian J Intern Med. 2015 Winter;6(1):3-8.
citation: Ismail SB, Kumar SK, Zain RB. Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation. J Oral Sci. 2007 Jun;49(2):89-106. doi: 10.2334/josnusd.49.89.
citation: Jolad SD, Lantz RC, Solyom AM, Chen GJ, Bates RB, Timmermann BN. Fresh organically grown ginger (Zingiber officinale): composition and effects on LPS-induced PGE2 production. Phytochemistry. 2004 Jul;65(13):1937-54. doi: 10.1016/j.phytochem.2004.06.008.
citation: Laeijendecker R, Tank B, Dekker SK, Neumann HA. A comparison of treatment of oral lichen planus with topical tacrolimus and triamcinolone acetonide ointment. Acta Derm Venereol. 2006;86(3):227-9. doi: 10.2340/00015555-0070.
citation: Li C, Tang X, Zheng X, Ge S, Wen H, Lin X, Chen Z, Lu L. Global Prevalence and Incidence Estimates of Oral Lichen Planus: A Systematic Review and Meta-analysis. JAMA Dermatol. 2020 Feb 1;156(2):172-181. doi: 10.1001/jamadermatol.2019.3797.
citation: Lopez-Jornet P, Camacho-Alonso F, Salazar-Sanchez N. Topical tacrolimus and pimecrolimus in the treatment of oral lichen planus: an update. J Oral Pathol Med. 2010 Mar;39(3):201-5. doi: 10.1111/j.1600-0714.2009.00830.x. Epub 2009 Nov 20.
citation: Lozada-Nur F, Miranda C. Oral lichen planus: epidemiology, clinical characteristics, and associated diseases. Semin Cutan Med Surg. 1997 Dec;16(4):273-7. doi: 10.1016/s1085-5629(97)80016-8.
citation: Mashhadi NS, Ghiasvand R, Askari G, Feizi A, Hariri M, Darvishi L, Barani A, Taghiyar M, Shiranian A, Hajishafiee M. Influence of ginger and cinnamon intake on inflammation and muscle soreness endued by exercise in Iranian female athletes. Int J Prev Med. 2013 Apr;4(Suppl 1):S11-5.
citation: Mozaffari HR, Sharifi R, Sadeghi M. Prevalence of Oral Lichen Planus in Diabetes Mellitus: a Meta-Analysis Study. Acta Inform Med. 2016 Dec;24(6):390-393. doi: 10.5455/aim.2016.24.390-393.
citation: Nagata S. Apoptosis regulated by a death factor and its receptor: Fas ligand and Fas. Philos Trans R Soc Lond B Biol Sci. 1994 Aug 30;345(1313):281-7. doi: 10.1098/rstb.1994.0107.
citation: Nagata S. Fas ligand-induced apoptosis. Annu Rev Genet. 1999;33:29-55. doi: 10.1146/annurev.genet.33.1.29.
citation: Pedersen A. Abnormal EBV immune status in oral lichen planus. Oral Dis. 1996 Jun;2(2):125-8. doi: 10.1111/j.1601-0825.1996.tb00212.x.
citation: Pendleton N, Clague JE, Horan MA, Rabbitt PM, Jones M, Coward R, Lowe C, McInnes L. Concordance of Cornell medical index self-reports to structured clinical assessment for the identification of physical health status. Arch Gerontol Geriatr. 2004 May-Jun;38(3):261-9. doi: 10.1016/j.archger.2003.10.005.
citation: Peter ME, Krammer PH. Mechanisms of CD95 (APO-1/Fas)-mediated apoptosis. Curr Opin Immunol. 1998 Oct;10(5):545-51. doi: 10.1016/s0952-7915(98)80222-7.
citation: Prasad S, Tyagi AK. Ginger and its constituents: role in prevention and treatment of gastrointestinal cancer. Gastroenterol Res Pract. 2015;2015:142979. doi: 10.1155/2015/142979. Epub 2015 Mar 8.
citation: Radwan-Oczko M, Zwyrtek E, Owczarek JE, Szczesniak D. Psychopathological profile and quality of life of patients with oral lichen planus. J Appl Oral Sci. 2018 Jan 18;26:e20170146. doi: 10.1590/1678-7757-2017-0146.
citation: Ramalingam S, Malathi N, Thamizhchelvan H, Sangeetha N, Rajan ST. Role of Mast Cells in Oral Lichen Planus and Oral Lichenoid Reactions. Autoimmune Dis. 2018 Jan 17;2018:7936564. doi: 10.1155/2018/7936564. eCollection 2018.
citation: Regezi JA, Dekker NP, MacPhail LA, Lozada-Nur F, McCalmont TH. Vascular adhesion molecules in oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996 Jun;81(6):682-90. doi: 10.1016/s1079-2104(96)80074-6.
citation: Scott J, Huskisson EC. Graphic representation of pain. Pain. 1976 Jun;2(2):175-84. No abstract available.
citation: Kongiel-Chablo I. [Behavior of complex cyanides in natural water with high rate of contamination]. Rocz Panstw Zakl Hig. 1966;17(1):95-102. No abstract available. Polish.
citation: Swift JC, Rees TD, Plemons JM, Hallmon WW, Wright JC. The effectiveness of 1% pimecrolimus cream in the treatment of oral erosive lichen planus. J Periodontol. 2005 Apr;76(4):627-35. doi: 10.1902/jop.2005.76.4.627.
citation: Thongprasom K, Luangjarmekorn L, Sererat T, Taweesap W. Relative efficacy of fluocinolone acetonide compared with triamcinolone acetonide in treatment of oral lichen planus. J Oral Pathol Med. 1992 Nov;21(10):456-8. doi: 10.1111/j.1600-0714.1992.tb00974.x.
citation: Tripathi S, Bruch D, Kittur DS. Ginger extract inhibits LPS induced macrophage activation and function. BMC Complement Altern Med. 2008 Jan 3;8:1. doi: 10.1186/1472-6882-8-1.
citation: Tripathi P, Tripathi P, Kashyap L, Singh V. The role of nitric oxide in inflammatory reactions. FEMS Immunol Med Microbiol. 2007 Dec;51(3):443-52. doi: 10.1111/j.1574-695X.2007.00329.x. Epub 2007 Sep 27.
citation: van der Meij EH, van der Waal I. Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications. J Oral Pathol Med. 2003 Oct;32(9):507-12. doi: 10.1034/j.1600-0714.2003.00125.x.
citation: Xue JL, Fan MW, Wang SZ, Chen XM, Li Y, Wang L. A clinical study of 674 patients with oral lichen planus in China. J Oral Pathol Med. 2005 Sep;34(8):467-72. doi: 10.1111/j.1600-0714.2005.00341.x.
citation: Yildirim B, Senguven B, Demir C. Prevalence of herpes simplex, Epstein Barr and human papilloma viruses in oral lichen planus. Med Oral Patol Oral Cir Bucal. 2011 Mar 1;16(2):e170-4. doi: 10.4317/medoral.16.e170.
citation: Zakrzewska JM, Chan ES, Thornhill MH. A systematic review of placebo-controlled randomized clinical trials of treatments used in oral lichen planus. Br J Dermatol. 2005 Aug;153(2):336-41. doi: 10.1111/j.1365-2133.2005.06493.x.
citation: de Wied D. [Neuropeptides and behavior. The neuropeptide concept]. Ned Tijdschr Geneeskd. 1979 Sep 15;123(37):1589-90. No abstract available. Dutch.
citation: Van Zee KJ, Coyle SM, Calvano SE, Oldenburg HS, Stiles DM, Pribble J, Catalano M, Moldawer LL, Lowry SF. Influence of IL-1 receptor blockade on the human response to endotoxemia. J Immunol. 1995 Feb 1;154(3):1499-507.
citation: Scully C, el-Kom M. Lichen planus: review and update on pathogenesis. J Oral Pathol. 1985 Jul;14(6):431-58. doi: 10.1111/j.1600-0714.1985.tb00516.x.
citation: Sugerman PB, Savage NW, Walsh LJ, Zhao ZZ, Zhou XJ, Khan A, Seymour GJ, Bigby M. The pathogenesis of oral lichen planus. Crit Rev Oral Biol Med. 2002;13(4):350-65. doi: 10.1177/154411130201300405.
citation: Thongprasom K, Dhanuthai K. Steriods in the treatment of lichen planus: a review. J Oral Sci. 2008 Dec;50(4):377-85. doi: 10.2334/josnusd.50.377.
citation: Kramer IR, Lucas RB, Pindborg JJ, Sobin LH. Definition of leukoplakia and related lesions: an aid to studies on oral precancer. Oral Surg Oral Med Oral Pathol. 1978 Oct;46(4):518-39. No abstract available.
citation: Atterhog JH, Duner H, Pernow B. Experience with pindolol, a betareceptor blocker, in the treatment of hypertension. Am J Med. 1976 May 31;60(6):872-6. doi: 10.1016/0002-9343(76)90907-4.