American Journal of Clinical Dermatology

, Volume 18, Issue 3, pp 429–433 | Cite as

Biological Therapy of Refractory Ulcerative Oral Lichen Planus with Plasma Rich in Growth Factors

  • Laura Piñas
  • Mohammad Hamdan Alkhraisat
  • Ricardo Suarez Fernández
  • Eduardo AnituaEmail author
Research letter


Oral lichen planus (OLP) is a chronic inflammatory disorder affecting stratified squamous epithelia and oral mucosa [1, 2]. The atrophic-erosive form has symptoms that range from a mild burning sensation to severe pain, affecting the patient’s quality of life [3].

The treatment of choice for OLP is topical corticosteroids [4, 5]. In the event of acute exacerbation and refractory lesions, systemic corticosteroids are often prescribed. However, corticosteroid treatment is not always effective and several treatment modalities have been suggested.

In this study, we present an alternative treatment for patients with OLP who are refractory to corticosteroid therapy. This treatment is based on the infiltration of autologous plasma rich in growth factors (PRGF) into ulcerative and erosive lesions of OLP.

Materials and Methods

Patients with ulcerative-erosive OLP, diagnosed by clinical histopathological examination, and refractory to corticosteroids therapy were included in the...


Hepatocyte Growth Factor Mycophenolate Mofetil Pemphigus Lichen Planus Triamcinolone Acetonide 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with Ethical Standards


No funding was received for the conduct of this study.

Conflict of interest

Eduardo Anitua is the Scientific Director of BTI Biotechnology Institute (Vitoria, Spain) and the head of the Foundation Eduardo Anitua, Vitoria, Spain. Laura Piñas and Ricardo Suarez Fernández have no conflicts of interest directly relevant to the content of this article. Mohammad Hamdan Alkhraisat is a scientist at BTI Biotechnology Institute (Vitoria, Spain).


  1. 1.
    Al-Hashimi I, Schifter M, Lockhart P, et al. Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(103 Suppl.):S25.e1–12.Google Scholar
  2. 2.
    Scully C, El-Kom M. Lichen planus: review and update on pathogenesis. J Oral Pathol. 1985;14:431–58.CrossRefPubMedGoogle Scholar
  3. 3.
    Yang H, Wu Y, Ma H, et al. Possible alternative therapies for oral lichen planus cases refractory to steroid therapies. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;121:496–509.CrossRefPubMedGoogle Scholar
  4. 4.
    Suresh SS, Chokshi K, Desai S, et al. Medical management of oral lichen planus: a systematic review. J Clin Diagn Res. 2016;10:ZE10–5.PubMedGoogle Scholar
  5. 5.
    Thongprasom K, Carrozzo M, Furness S, Lodi G. Interventions for treating oral lichen planus. Cochrane Database Syst Rev. 2011;7:CD001168Google Scholar
  6. 6.
    Eisen D, Ellis CN, Duell EA, et al. Effect of topical cyclosporine rinse on oral lichen planus: a double-blind analysis. N Engl J Med. 1990;23:290–4.CrossRefGoogle Scholar
  7. 7.
    Passeron T, Lacour JP, Fontas E, Ortonne JP. Treatment of oral erosive lichen planus with 1% pimecrolimus cream a double-blind, randomized, prospective trial with measurement of pimecrolimus levels in the blood. Arch Dermatol. 2007;143:472–6.PubMedGoogle Scholar
  8. 8.
    Becker JC, Houben R, Vetter CS, Bröker E. The carcinogenic potential of tacrolimus oinment beyond immune suppression: a hypothesis creating case report. BMC Cancer. 2006;6:7–13.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Sloberg K, Hersie K, Mobacken H, Thilander H. Severe oral lichen planus remissions and maintenance with vitamin A analogues. J Oral Pathol. 1983;12:473–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Camisa C, Popovsky JL. Effective treatment of oral erosive lichen planus with thalidomide. Arch Dermatol. 2000;136:1442–3.CrossRefPubMedGoogle Scholar
  11. 11.
    Kollner K, Wimmershoff H, Landthaler M, Hohenleutner U. Treatment of oral lichen planus with the 308-nm UVB excimer laser: early preliminary results in eight patients. Lasers Surg Med. 2003;33:158–60.CrossRefPubMedGoogle Scholar
  12. 12.
    Cheng A, Nabb C. Oral erosive lichen planus treated with efalizumab. Arch Dermatol. 2006;142:680–2.CrossRefPubMedGoogle Scholar
  13. 13.
    Lear JT, English JS. Erosive and generalizad lichen planus responsive to azathioprine. Clin Exp Dermatol. 1996;21:56–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Guyot AD, Farhi D, Ingeen-Huesz-Oro S, Bussel A, et al. Treatment of refractory erosive lichen planus with extracorporeal chemotherapy: 12 cases. Br J Dermatol. 2007;156:553–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Nousari HC, Goyal S, Anhalt GJ. Successful treatment of resistant hypertrophic and bullous lichen planus with mycophenolate mofetil. Arch Dermatol. 1999;135:1420–1.CrossRefPubMedGoogle Scholar
  16. 16.
    Ferguson MM, Simpson NB, Hammersley N. The treatment of erosive lichen planus with a retinoid-etretinate. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1984;58:283–7.CrossRefGoogle Scholar
  17. 17.
    EL-Komy MH, Hassan AS, Abdel Raheem HM, et al. Platelet-rich plasma for resistant oral erosions of pemphigus vulgaris: a pilot study. Wound Repair Regen. 2015;23:953–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Anitua E, Alkhraisat MH, Orive G. Perspectives and challenges in regenerative medicine using plasma rich in growth factors. J Control Release. 2012;157:29–38.CrossRefPubMedGoogle Scholar
  19. 19.
    Anitua E, Murias-Freijo A, Alkhraisat MH, Orive G. Clinical, radiographical, and histological outcomes of plasma rich in growth factors in extraction socket: a randomized controlled clinical trial. Clin Oral Investig. 2015;19:589–600.CrossRefPubMedGoogle Scholar
  20. 20.
    Anitua E, Troya M, Orive G. Plasma rich in growth factors promote gingival tissue regeneration by stimulating fibroblast proliferation and migration and by blocking transforming growth factor-β1-induced myodifferentiation. J Periodontol. 2012;83:1028–37.CrossRefPubMedGoogle Scholar
  21. 21.
    Zhou L, Cao T, Wang Y, et al. Frequently increased but functionally impaired CD4+CD25+ regulatory T cells in patients with oral lichen planus. Inflammation. 2016;39:1205–15.PubMedGoogle Scholar
  22. 22.
    Tao XA, Xia J, Chen XB, et al. FOXP3 T regulatory cells in lesions of oral lichen planus correlated with disease activity. Oral Dis. 2010;16:76–82.CrossRefPubMedGoogle Scholar
  23. 23.
    Wan YY, Flavell RA. ‘Yin-Yang’ functions of transforming growth factor beta and T regulatory cells in immune regulation. Immunol Rev. 2007;220:199–213.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Cao T, Zhang H, Zhou L, et al. In vitro cell culture system optimization of keratinocytes from oral lichen planus (OLP) patients. Oral Dis. 2017;23:225–32.CrossRefPubMedGoogle Scholar
  25. 25.
    Danielsson K, Ebrahimi M, Nylander E, et al. Alterations in factors involved in differentiation and barrier function in the epithelium in oral and genital lichen planus. Acta Derm Venereol. 2017;97:214–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Anitua E, Zalduendo MM, Prado R, et al. Morphogen and proinflammatory cytokine release kinetics from PRGF-Endoret fibrin scaffolds: evaluation of the effect of leukocyte inclusion. J Biomed Mater Res A. 2015;103:1011–20.CrossRefPubMedGoogle Scholar
  27. 27.
    Anitua E, Zalduendo M, Troya M, Orive G. PRGF exerts a cytoprotective role in zoledronic acid-treated oral cells. Clin Oral Investig. 2016;20:513–21.CrossRefPubMedGoogle Scholar
  28. 28.
    Anitua E, Zalduendo M, Troya M, et al. Leukocyte inclusion within a platelet rich plasma-derived fibrin scaffold stimulates a more pro-inflammatory environment and alters fibrin properties. PLoS One. 2015;10:e0121713.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Gunduz K, Demireli P, Inanir I, Nese N. Expression of matrix metalloproteinases (MMP-2, MMP-3, and MMP-9) and fibronectin in lichen planus. J Cutan Pathol. 2006;33:545–50.CrossRefPubMedGoogle Scholar
  30. 30.
    Anitua E, Muruzabal F, Pino A, et al. Biological stability of plasma rich in growth factors eye drops after storage of 3 months. Cornea. 2013;32:1380–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Laura Piñas
    • 1
  • Mohammad Hamdan Alkhraisat
    • 2
  • Ricardo Suarez Fernández
    • 3
  • Eduardo Anitua
    • 2
    • 4
    Email author
  1. 1.Universidad Europea de MadridMadridSpain
  2. 2.Eduardo Anitua FoundationVitoriaSpain
  3. 3.University General Hospital Gregorio MarañónMadridSpain
  4. 4.Clínica Eduardo AnituaVitoriaSpain

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