DOI: https://doi.org/10.

53350/pjmhs2115113138
ORIGINAL ARTICLE

Effectiveness of Aloe Vera Mouthwash in Comparison with Triamcinolone

Acetonide 0.1% in Patients with Oral Lichen Planus at A Tertiary Care
Hospital
TAHIR HASSAN1, MUHAMMAD KHURRAM SHAHZAD2, NAZIA HANIF3, MADIHA ANWAR4, AYESHA AMBREEN5, MUHAMMAD UMAR
WAHEED6
Assistant Professor, Dermatology Department, Sheikh Zayed Hospital Rahim Yar Khan
Assistant Professor, Dermatology Department, Sheikh Zayed Hospital Rahim Yar Khan
Senior Registar, Dermatology Department Sheikh Zayed Hospital Rahim Yar Khan
Senior Registar, Dermatology Department Sheikh Zayed Hospital Rahim Yar Khan
Post Graduate Resident, CMH Multan.
Senior Registar, Medicine Department Sheikh Zayed Hospital Rahim Yar Khan
Correspondence to: Muhammad Khurram Shahzad, Email: dr.khuram178@gmail.com, Cell: 03457084081

ABSTRACT
Objective: To compare the efficacy of Aloe Vera Mouthwash versus 0.1% Triamcinolone Acetonide in patients presenting with
oral lichen planus at a tertiary care hospital.
Introduction: Oral lichen planus is a chronic immune mediated dermatosis with periods of remissions and relapses. There are
many treatment options to treat this condition; aloe vera mouth wash is one of the newer and safer options.
Methodology: A total of 100 patients with oral lichen planus (OLP) were randomly divided into two groups (group A and B, each
having 50 patients).The patients in group A were given aloe vera mouth wash and in group B were given triamcinolone
acetonide paste (0.1%). Efficacy was observed after 2 months of treatment completion.
Results: Overall Efficacy was noted in 58(58%) of all study cases. In group A 37 patients (74%) showed efficacy and in group B
21 patients (42%) showed efficacy.More efficacy was noted in female patients (87%) treated with Aloe Vera Mouth wash than
those of treated with triamcinolone acetate paste (45%). Patients belonging to old age group (36-50 year) showed more efficacy
(75%) to aloe vera mouth wash than that of triamcinolone acetonide paste (36%)
Conclusion: In our population Aloe vera mouth wash is more efficacious than triamcinolone acetonide (0.1%) in the treatment
of oral lichen planus
Keywords: Oral lichen planus, Aloe vera, Triamcinolone acetonide

INTRODUCTION a new window of opportunity intreatment of these patients 13.

Lichen planus is an immune mediated chronic illness that involves In our population triamcinolone acetonide (0.1%) paste is
both skin and mucosae 1. Various disturbances in immune system most commonly used therapy for the treatment of oral lichen
play a key role in its pathogenesis; however its exact etiology still planus10. Triamcinolone acetonide (TAC) is a moderately potent
remains unclear2.It may affect various mucosal (e.g. Mouth, corticosteroid and it has dampening effect on cell-mediated
pharynx, esophagus, stomach, anus, larynx, genitals, ear, nose, immunity, thereby modulating the immune function. This therapy
bladder and peritoneum) or cutaneous surfaces (i.e. nails, skin and has various side effects and limitations 14. So we compared the
scalp) 3, 4.Oral lichen planus (also called as mucosal lichen planus) efficacy of aloe vera mouth wash vs triamcinolone acetonide paste
may involve buccal mucosae, inner aspects of lips, tongue, palate (0.1%) in the treatment of oral lichen planus.Aim of this study was
and pharynx and it may co-exist with other clinical variants of to find a more efficacious treatment modality in terms of patient
lichen planus 5. Various clinical forms of oral lichen planus include visits, cost and side effects.
Reticular, Erosive, Papular, Plaque like, Atrophic and Bullous 6.
Many times these different clinical forms may coexist in the same MATERIAL AND METHODS
patient. Clinically oral lichen planus may present as white lesions Inclusion criteria: Age:18-50 year
(wickham’s striae) bilaterally on inner cheeks. Patients usually Gender: Both male and female
complain of pain and/or discomfort, burning sensation and Site: Oral lichen planus (accessed clinically)
soreness in the mouth7.Oral lichen planus has been reported to Duration of disease: Any
occur in association with many systemic comorbidities such as Exclusion criteria: Patient with previous history of any systemic
metabolic syndrome, hypertension, diabetes mellitus, thyroid disease including heart disease, renal disease, and pre-existing
diseases, psychosomatic diseases, chronic liver disease, cases of hypertension, Diabetes mellitus and neurological
gastrointestinal illness, and genetic susceptibility to cancer8. disorders.
Common therapeutic remedies for oral lichen planus include Patient using any treatment for oral lichen planus or any
systemic corticosteroids, immune-suppressives, retinoids, oral immunosuppressive drug during the 4 weeks preceding the study.
antibiotics phototherapy, topical steroids and topical tacrolimus9. Patients with lichenoid lesions (due to contact with amalgam
Corticosteroid treatment (systemic and topical) is regarded restorations, with previous history of allergy to other dental
as one of the first-line therapy for oral lichen planus10. However its materials and having dysplastic lesions).
use is associated with various side effects such as tingling The approval of this randomized comparative study was
sensations, local irritation, taste alteration, nausea, iatrogenic taken from ethical review committee. A total of 100patients with
Cushing and hypothalamic pituitary axis deviation11. oral lichen planus assessed clinically visiting outpatient department
Aloe Vera plant contains various active ingredients like (OPD) of Dermatology, Sheikh Zayed Hospital Rahim Yar Khan
polysaccharides, anthraquinone, lectin, superoxide dismutase (an were included in this study. These 100 symptomatic patients were
antioxidantenzyme), glycoprotein, amino acids, vitamin C, vitamin randomly divided in 2 groups by draws method (group A and group
E and minerals 12. Because of its antioxidant and anticancer B). The patients in group A were asked to rinse the mouth with 2
properties, it can be used in various diseases. Aloe Vera does not tablespoons of Aloe Vera mouthwash for 2 minutes, 4 times a day
have immunosuppressive and other adverse effects as that of and expectorate. The patients in the group B were instructed to
other treatment modalities available for oral lichen planus. As apply a thin layer of triamcinolone acetonide 0.1% paste on the
oxidative stress is thought be a newly explored etiology of oral oral lesions, 4 times daily and patients were advised not to eat,
lichen planus, anti-oxidative effects of Aloe Vera mouth wash open drink or smoke for 20 minutes after each application. The study

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 T. Hassan, M. K. Shahzad, N. Hanif et al

and follow up period for both groups was 3 months (one month for Efficacy was noted in 58 (58%) of all study cases. In group A
treatment and 2 months for follow up). The patients in both groups 37 patients (74%) showed efficacy and in group B 21 patients
were asked to take treatment for one month and to report (42%) showed efficacy. (Table 1)
immediately if there was any side effect during or after the study (in 7 male (38%) and 28 female (87%) patients from group A
follow up period i.e. 2 months). Patients were evaluated on day 8, showed efficacy to treatment. 5 male (26%) and 14 female (45%)
16 and after completing the course of treatment (visit 1–3). Efficacy patients from group B showed efficacy to treatment. Female
was observed after 2 months of treatment completion. Patients patients in group A showed superior efficacy (87%) as compared
were assessed for any possible side effects at each appointment. to female patients in Group B (45.16%). So more efficacy was
All of the patients were truly monitored and checked for their noted in female patients treated with Aloe Vera Mouth wash than
compliance to drugs. those of treated with triamcinolone acetate paste (Table no 2)
The data was entered and analyzed using computer 4 out of 10 patients (40%) from younger age group(18-35
program SPSS-22. Frequencies and percentages were calculated year)in group A and 9 out of 12 in group B showed efficacy to
for the qualitative variables.Effect modifiers like age, gender, site of treatment.30 out of 40 patients (75%) from older group (36-50) in
Oral Lichen Planus and type of Oral Lichen Planus were controlled group A and 14 out of 38 patients (36%) from group B showed
by stratification. Post stratification chi-square test was applied to efficacy to treatment. So, older patients(36-50 year) showed more
see the effect of these on outcome (50% reduction in size of lesion efficacy to aloe vera mouth wash than that of triamcinolone
with complete resolution of pain). P value equal or less than 0.05 acetonide paste and younger patients showed more efficacy
was considered as significant. totriamcinolone acetonide paste than that of aloe vera mouth wash
(Table no 3).
RESULTS
Total 100 cases were enrolled in this study which was divided in DISCUSSION
group A and B, each having 50 patients. Out of total 100 cases, 37 Lichen planus is a mucocutaneous disease characterized by
were male and 63 were female. There were 18 male (36%) and 32 nonspecific inflammation 1. It leads to the severe destruction of the
female (62%) in group A; and 19 male (38%) and 31 female (62%) epithelial basal layer 2. Oral lichen planus usually presents
in group B.Total 100 cases were divided into two age groups i.e. bilaterally on mucosae of inner cheeks and has various clinical
younger group (age 18-35 year) having 23 cases and older group patterns; with reticular, erythematous (erosive), plaque and
(age 36-50 year) having 77% patients. ulcerative being the most common 5, 6. These patterns may coexist
in the same region or may alternate in time 6. The most commonly
Table 1: Distribution of study cases by efficacy (n-100) affected sites are the buccal mucosa, the tongue and the gingiva 4,
Efficacy Group A Group B 5
. Involvement of the palate and lips is rare, and even rarer is the
(n=100) Frequency Percentage Frequency Percentage involvement of the oral floor 5. Burning symptoms, itching and pain
Yes 37 74 21 42
are particularly seen in the ulcerative and erythematous variants 7.
n=58
(58%) The diagnosis is based on clinical and histopathological
No 13 26 29 58 examination. In classical lesions, only clinical diagnosis is possible
7
n=42 . In the absence of typical manifestations of the reticular pattern,
(42%) other patterns may be difficult to diagnose. In these cases, a
biopsy is indicated.
Total 50 100 50 100 It is clear that oral lichen planus is an incurable disease 9.
P=0.0012 However, the disease has periods of exacerbation and remission 9.
During exacerbation, both the erythematous/ulcerated areas and
Table No. 2: Stratification of efficacy with regards to gender in both groups
the pain increase. These periods may be related to stress, anxiety
(n=100)
Efficacy
or mechanical trauma 9, 10. Several protocols for monitoring the
Gender Groups Yes No P - value disease have been described. They are usually based on the
(n=54) (n=46) clinical aspect, the number of areas involved and the severity of
07 11 0.412 symptoms. Several studies report the malignant potential of oral
Male Group A (n=18) lichen planus8. However, this topic is still quite controversial. The
(n=37) 05 14 frequency of malignant transformation varies between 0 and 3.5%,
Group B and erythematous and erosive lesions show the highest index 16, 17.
(n=19) Common therapeutic options for oral lichen planus include
28 04 0.0003
systemic corticosteroids, immune-suppressives, retinoids, oral
Female Group A
(n=63) (n=32)
antibiotics, phototherapy, topical steroids and topical tacrolimus 9.
14 17 In our population triamcinolone acetonide 0.1% paste is most
Group B commonly used therapy for the treatment of oral lichen planus 10.
(n=31) Triamcinolone acetonide (TAC) is a moderately potent
corticosteroid and it has dampening effect on cell-mediated
Table No. 3: Stratification of efficacy with regards to age in both groups
immunity, thereby modulating the immune function 10. This therapy
(n=100)
Efficacy
has various side effects and limitations 11.
Age Groups Yes No P - value Aloe Vera plant contains various active ingredients which
groups (n=49) (n=37) have antioxidant and anticancer properties; so, it can be used in
various diseases 12. Aloe Vera does not have immunosuppressive
18 – 35 Group A 04 06 and other adverse effects as that of other treatment modalities
Years (n=10)
0.096
available for oral lichen planus 13. Because of its anti-oxidative
(n=23) properties aloe vera mouth wash can be used in the treatment of
Group B 09 03 oral lichen planus 12, 13.
(n=12)
According to Li C et al estimated overall pooled prevalence
36 – 50 Group A 30 10
of oral lichen planus was 0.89% among the general population and
years (n=40) 0.98% among clinical patients15. A higher prevalence of oral lichen
0.0006 planus was found in non-Asian countries, among women, and
(n=77)
Group B 14 24 among people 40 years and older 15. Werneck et al reported 66 %
(n=38) female patients having oral lichen planus 17 and Chainani-Wu et al

P J M H S Vol. 15, No.11, NOV 2021 3139

Effectivenss of Aloe Vera Mouthwash in Comparison with Triamcinolone Acetonide 0.1% in Patients with Oral Lichen Planus

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