Essay Example on Mechanism of action of corticosteroids in oral lichen Planus

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Mechanism of action of corticosteroids in oral lichen planus Corticosteroids block many abnormally activated inflammatory pathways and they have a very wide spectrum of anti inflammatory actions 24 They bind to glucocorticoid receptor GR which is localized to the cytoplasm of target cells The effect is produced on responsive cells by activating GR to regulate the transcription of certain target genes directly or indirectly 25 26 Activated GRs bind directly to several other activated transcription factors such as protein protein interaction This is the key mechanism by which corticosteroids switch off inflammatory genes 24 They also recruit histone deacetylase activity HDACs to the transcription sites causing decrease in inflammatory gene transcription 27 This also determines corticosteroid responsiveness Corticosteroids inhibit inflammation by inhibiting the synthesis of inflammatory proteins They increase the synthesis of anti inflammatory proteins like lipocortin 1 and 37 kDa They inhibit transcription and synthesis of many cytokines and chemokines such as 1L 1 beta and TNF alpha which also causes reduction in adhesion molecules too Steroids reduce the survival of certain inflammatory cells kike eosinophils and have direct inhibitory actions on several inflammatory cells like macrophages eosinophils T cells Mast cells and epithelial cells 24

As far as corticosteroids are concerned though they are found to be effective factors like the dosage concentration formulation ointment gel paste cream spray mouthwash etc and mode of application are not completely standardized because of lack of evidence 22 Also topical and systemic corticosteroids are associated with numerous side effects Topical preparations if used for longer durations are associated with tachyphylaxis thinning of oral mucosa candidiasis and burning or tingling on application If more potent steroids are used in larger amounts for longer periods they may lead to adrenal suppression 23 Short term systemic corticosteroids may cause insomnia diarrhoea hypertension hyperglycemia decreased resistance to infections muscle weakness psychological problems sodium and fluid retention and adrenal suppression 28 They are contraindicated in breastfeeding patients and are to be used with caution in conditions like pregnancy diabetes mellitus hypertension glaucoma herpetic and HIV infection tuberculosis etc If they are prescribed for more than 2 weeks the dose needs to be tapered gradually to avoid precipitating an adrenal crisis 23 



A new modality considered for oral lichen planus is Ozone therapy Ozone is a chemical compound which consists of three atoms of oxygen Its molecular weight is 4798 g mol 29 It forms naturally as a result of ultraviolet energy or lightning and is the elemental form of oxygen It is unstable and temporary recombination of oxygen atoms into groups of three It surrounds the earth at altitudes of 50 000 to 100 000 feet absorbs sun's harmful UV rays and protects living organisms It is the by product of smog but also helps clearing it The atmospheric air consists of 71 nitrogen 28 oxygen and 1 of other gases including ozone which may be related to altitude temperature and air pollution Fig 1 Ozone compound Fig 2 Formation of O3 Ozone compound Fig 3 Ozone production in the stratosphere The father of ozone therapy is the German chemist Christian Friedrich Schonbein Once in 1840 he passed an electrical discharge through water a strange smell was produced He called it Ozon which is derived form the Greek word ozein odor Dentist Edward Fisch was the first to use ozone in 1950 he used ozone to treat Australian surgeon Ernst Payr Later ozone gained its popularity in the field of healthcare It is indicated in over 260 different pathologies 30 Ozone has been successfully used in Medicine for over a hundred years thanks to its microbiological effects 31 medical grade ozone consists of mixture of pure oxygen and pure ozone in the ratio of 0 05 5 of O3 and 95 99 95 of O2

It must be prepared immediately before its use owing to its instability and hence cannot be stored over longer periods Storage results in quick decomposition of O3 into oxygen Three different systems are used to generate ozone gas UV system Corona discharge system commonly used in medical dental fields easy for handling produces high concentrations of ozone and has controlled ozone production rate Cold plasma system Fig 4 Production of Ozone in Medical Dental field Its use has been investigated in the treatment of ocular diseases viral fungal and bacterial infections dermatological disorders and in pulmonary renal haematological and neurodegenerative pathologies 32 In dental practice ozone therapy was first evaluated in 1933 for the treatment of oral lesions and chronic periodontal infections 31 The bactericidal fungicidal and viricidal properties of ozone are the result of its intense oxidizing capacity with the formation of free radicals and direct destruction of almost all microorganisms In addition ozone favors tissue healing and increases blood perfusion Intraorally ozone can be used to treat chronic periodontitis caries infections after dental extractions lesions caused by radiotherapy aphthae and mycoses and can be used for disinfecting root canals 31 32 33 34 35 36 The number of studies performed are very few in number 



Not many cases of Oral Lichen Planus OLP have been treated till date with ozone gas Further studies are required in this field DISCUSSION Current study was aimed to compare two treatment modalities for oral reticular lichen planus wiz conventional topical corticosteroid therapy and ozone gas therapy Patients with bilateral oral reticular lichen planus were selected Lesions on the right side were treated with topical corticosteroid i e Kenacort oral paste and lesions on the left side were treated with ozone gas 60 lesions were treated in total The improvement of OLP was assessed with respect to the following clinical criteria 1 Pain burning sensation as per NRS pre and post treatment 2 Reduction of the erythema redness recorded as present or absent before and after the treatment 3 Reduction of the size of the lesion Initial lesion was considered as 100


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