Clinical Oral Investigations

, Volume 23, Issue 2, pp 947–956 | Cite as

Topical pimecrolimus versus betamethasone for oral lichen planus: a randomized clinical trial

  • Ola M. EzzattEmail author
  • Iman M. Helmy
Original Article



Oral lichen plans (OLP) is a potentially malignant inflammatory mucocutaneous disease. CD133 is an investigated surface marker for cancer stem-like cells (CSCs) that may be involved in tumor initiation in head and neck carcinomas. We compared short-term clinical effectiveness of topical pimecrolimus as selective inflammatory cytokine release inhibitor with betamethasone cream for erosive/atrophic OLP and investigated the influence of this therapy on CD133 expression.

Material and methods

Thirty patients were randomly assigned into two equal groups to receive topical pimecrolimus (group I) or betamethasone (group II) four times daily for 4 weeks. A marker lesion in each patient were assessed at baseline using clinical score (CS) and visual analog scale (VAS) then at 1, 2, and 4 weeks and after 4 weeks of treatment-free period. CD133 expression was detected in pre- and post-treatment immunostained sections.


Both drugs showed a reduction in CS, VAS, and CD133 expressions after treatment termination (p < 0.001). Pimecrolimus-treated lesions showed significant higher 1st week reduction in severity (33.1% (22.2)), pain score (57.53% (14.27)), less recurrence in follow-up period and less CD133 expression by the end of the 1st 4 weeks compared with betamethasone.


Pimecrolimus showed earlier clinical response and less recurrence rate compared with standard topical corticosteroid in symptomatic OLP lesions, and both treatment reduced CD133-positive CSC population.

Clinical relevance

The study proved the benefits of topical pimecrolimus in early management of painful lesions of OLP and its ability to inhibit CSCs, suggesting a possible role in reducing risk of malignant transformation.


Oral lichen planus Pimecrolimus Betamethasone Cancer stem cells CD133 



The authors did not receive any funding for this study. The authors greatly appreciate the technical and scientific assistance of Dr. Heba Gad (Gad HA), Lecturer of pharmaceutics and industrial pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt, for formulating, testing, and preparing the inert oral adhesive paste and dispensing the treatment drugs for patients.


The study was funded by personal resources to be refunded later by the Ministry of Higher Education, Cairo, Egypt on international publishing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

784_2018_2519_MOESM1_ESM.doc (218 kb)
ESM 1 (DOC 218 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Oral Medicine, Periodontology and Oral Diagnosis, Faculty of DentistryAin Shams UniversityCairoEgypt
  2. 2.Department of Oral Pathology, Faculty of DentistryAin-Shams UniversityCairoEgypt
  3. 3.King Abdel Aziz UniversityJeddahSaudi Arabia

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