Efficacy of low‐level laser therapy compared to steroid therapy in the treatment of oral lichen planus: A systematic review

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Lichen planus is a common chronic mucocutaneous inflammatory disorder, which generally affects middle‐aged adults. On the basis of different clinical patterns, oral lichen planus (OLP) is mainly classified into three main forms: reticular, erosive, and atrophic.1 Reticular lesions are asymptomatic and require no treatment; however, patients with erosive‐atrophic forms of OLP often seek treatment as these lesions are associated with pain and discomfort.2 Erosive‐atrophic patterns manifests as diffuse, erythematous patches surrounded by fine white lines (Wickham striae) where some lesions may undergo malignant transformation.4
Therapeutic methods including topical and systemic corticosteroids for the treatment of OLP are suggested. Unlike cutaneous lesions, which generally improve spontaneously, OLP requires long‐term treatment and follow‐up.5 However, long‐term use of corticosteroids for chronic OLP has certain local and systemic complications, which includes opportunistic candidiasis, mucosal atrophy, adrenal insufficiency, gastrointestinal disorders, hypertension, and diabetes.6 However, long‐term use of corticosteroids may be associated with local and systemic complications, and moreover, some patients may not be responsive. To surmount these problems, low‐level laser therapy (LLLT) has been proposed as a potential alternative treatment strategy for the treatment of OLP.7 The principle of LLLT application is based on its biostimulatory, anti‐infective, and anti‐ablation effects.8 LLLT includes wavelengths between 500 and 1100 nm and typically involves the intensification of electromagnetic fields excited by external source of energy such as light that emits coherent, well‐collimated, and monochromatic laser beam. This mechanism implies redox regulation that explains the clinical effects in chronic inflammatory response (OLP) characterized by acidosis and tissue hypoxia that has the potential of tissue healing and tissue regeneration without systemic disturbances and undesirable effects on the healthy tissue.9
A number of studies have compared the outcomes of LLLT with corticosteroid therapy in the management of OLP and showed conflicting results.11 In a clinical trial by El Shenawy et al,11 OLP patients treated with local corticosteroid showed significant improvement in signs and symptoms as compared to those patients treated with LLLT. Similar results were reported by Othman et al12 However, Jajarm et al13 concluded that patients with OLP treated with LLLT showed comparable improvement in clinical outcomes over the use of corticosteroids at follow‐up. Moreover, in a recent study by Dillenburg et al,14 LLLT showed statistically significant improvement than topical steroid therapy in the treatment for OLP.
There appears to be a controversy with regard to the role of LLLT in the management of OLP, and considering the diversity of these results, a systematic review seems desirable. Therefore, the aim of this study was to systematically review the efficacy of LLLT in comparison with corticosteroid therapy in the treatment of OLP.

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