A Comparative Evaluation of Clinical Efficacy of Topical Amlexanox and Triamcinolone Acetonide in Oral Lichen Planus

Background: Oral lichen planus (OLP) is a chronic mucocutaneous disease affecting the general population, with its exact etiology remaining unknown. This condition is characterized by T -cell mediated autoimmunity wherein auto-cytotoxic CD8+ T cells precipitate basal cell apoptosis in the oral epithelium. Conventionally, corticosteroids have been the mainstay of treatment for OLP, necessitating the exploration of alternatives to mitigate long-term corticosteroid-related adverse effects. Amlexanox, a topical anti-inflammatory agent, impedes the synthesis and release of histamine, TNF-alpha, and leukotrienes from mast cells, neutrophils, and mononuclear cells, conceivably implicated in OLP pathogenesis. Aims: The study aims to evaluate and compare the clinical efficacy of topical amlexanox and triamcinolone acetonide in the treatment of OLP. Objectives: The objectives of this study are (i) to evaluate the lesion size following the topical application of 5% amlexanox paste in the treatment of OLP, (ii) to evaluate the burning sensation of the patient based on the VAS score, and (iii) to compare and evaluate the clinical efficacy of 5% amlexanox with 0.1% triamcinolone acetonide in the treatment of OLP. Methodology: Forty patients clinically and histopathologically diagnosed with symptomatic OLP were randomly assigned into two groups, each comprising 20 patients. Group A was prescribed topical 5% amlexanox, while Group B received topical 0.1% triamcinolone acetonide with instructions to apply the drug at the site of the lesion intraorally thrice a day after food. The clinical improvement was evaluated using the Thongprasom scale, and the burning sensation was assessed using the visual analog scale (VAS) score weekly over four weeks. Results: The study showed that there was a statistically significant reduction in the VAS score and size of lesion with each drug individually (p=0.000). There was a statistically significant difference in the mean values of VAS scores and size of the lesion between the first visit and fourth week, indicating a gradual reduction of the burning sensation and size of the lesion in both Group A and Group B, respectively. When both the groups were compared, there was no significant difference (p>0.05) in the reduction of burning sensation between Group A and Group B, indicating that amlexanox was as effective as triamcinolone in reducing the VAS score. However in terms of reduction of lesion size during the second week (p=0.022) and the third week (p=0.013), a statistically significant value was seen with a greater reduction in the size of the lesion in Group B compared to Group A. Conclusion: Given its anti-inflammatory properties and lower incidence of adverse effects relative to corticosteroids, amlexanox acts as a promising first -line therapeutic option for OLP. In cases of inadequate response, adjunctive therapies can be considered.