Treatment of Drug Resistant Oral Lichen Planus Using neodymium-doped yttrium aluminum garnet (Nd-YAG) Laser : A Case Report

Oral lichen planus (OLP) is one of the most common chronic diseases of oral cavity without any definitive cause and can involve 1-2% of the population.  Treatment of the symptomatic patients is challenging. Despite a variety of treatments, many routine treatment protocols fail. Treatment by laser beam can be an appropriate alternative method in the treatment of OLP.

A 43 year old woman presented with chief complaint of ulcers and burning sensation (visual analogue scale = 7) on the dorsal and lateral surface of the left side of her tongue from one year ago. The patient previously had used topical corticosteroids but she discontinued her medication 3 months ago due to lack of complete improvement of burning sensation of the tongue and prolongation of the treatment.  Skin and other mucosal surfaces had not been involved and the patient had no systemic problems. The patient was not taking any medication currently. No amalgam restoration was observed next to the lesion. In general no specific etiological factor was found. Incisional biopsy was performed for histopathological examination. Clinical symptoms and histopathologic findings led to definitive diagnosis of OLP . Topical steroids were given but the burning sensation of the tongue did not completely resolve and recurrence was observed upon discontinuation of the drug. At the next step we injected triamcinolone acetonide into erosive and atrophic mucosa which resulted to disappearance of the patient's symptoms. But after one month the symptoms recurred. At the third step lichenoid lesions with burning sensation were exposed to Nd-YAG laser with the power of 2.5W and wavelength of 1064nm.

During a two-month follow-up period, the patient was completely asymptomatic (VAS = 0). No mucosal lesions were seen on examination.

This study showed that laser can be used in the treatment of OLP as an alternative therapeutic method when there is drug resistance or steroids are contraindicated.