INTRODUCTION
Oral lichen planus (OLP) is a common, chronic mucosal inflammatory disease associated with T-cell-mediated immunologic dysfunction.1 Although the buccal mucosa and tongue are the most frequent sites of involvement, gingival lesions are also especially common. In fact, up to 10% of patients have their disease confined to the gingiva.2
Gingival lichen planus may appear as asymptomatic, small, raised white, lacy papules or plaques, sometimes resembling keratotic diseases such as leukoplakia.3 Gingival lichen planus most frequently presents as erythematous lesions, often accompanied by desquamation and erosions (desquamative gingivitis).4 Erosive OLP lesions may resemble other oral inflammatory diseases, including pemphigoid, pemphigus, linear IgA disease, and foreign body gingivitis. All these disorders result in desquamative gingivitis not easily identified as lichen planus unless there are coexistent reticular lesions on the gingiva or elsewhere in the oral cavity. Because of the wide variations in the clinical appearance of gingival OLP, delay in diagnosis and misdiagnosis are frequent.5
The treatment of OLP is aimed at eliminating erythematous and erosive lesions, alleviating symptoms, and potentially decreasing the risk of malignant transformation. Useful agents for the treatment of gingival OLP are potent topical corticosteroids and topical immunomodulators (i.e., tacrolimus, pimecrolimus, and cyclosporin), which may be used as alternatives to, or in conjunction with, topical corticosteroids.6 In patients who fail to respond to topical agents alone or who exhibit erosive disease or desquamative gingivitis, systemic agents, including hydroxychloroquine, methotrexate, mycophenolate, azathioprine, and other immunosuppressive agents, result in significantly better results than topical agents alone, although direct comparative studies are lacking.7 All these agents require careful monitoring for lab abnormalities, and furthermore, none produce long-term remission when discontinued.
Gingival OLP lesions, when inflamed or erosive, are especially difficult to palliate, and sensitivity and bleeding can significantly impact eating, drinking, and oral hygiene. In this retrospective analysis of patients with inflammatory gingival OLP, the response to therapy with a second-generation tetracycline antibiotic, minocycline or doxycycline, is presented.
Gingival lichen planus may appear as asymptomatic, small, raised white, lacy papules or plaques, sometimes resembling keratotic diseases such as leukoplakia.3 Gingival lichen planus most frequently presents as erythematous lesions, often accompanied by desquamation and erosions (desquamative gingivitis).4 Erosive OLP lesions may resemble other oral inflammatory diseases, including pemphigoid, pemphigus, linear IgA disease, and foreign body gingivitis. All these disorders result in desquamative gingivitis not easily identified as lichen planus unless there are coexistent reticular lesions on the gingiva or elsewhere in the oral cavity. Because of the wide variations in the clinical appearance of gingival OLP, delay in diagnosis and misdiagnosis are frequent.5
The treatment of OLP is aimed at eliminating erythematous and erosive lesions, alleviating symptoms, and potentially decreasing the risk of malignant transformation. Useful agents for the treatment of gingival OLP are potent topical corticosteroids and topical immunomodulators (i.e., tacrolimus, pimecrolimus, and cyclosporin), which may be used as alternatives to, or in conjunction with, topical corticosteroids.6 In patients who fail to respond to topical agents alone or who exhibit erosive disease or desquamative gingivitis, systemic agents, including hydroxychloroquine, methotrexate, mycophenolate, azathioprine, and other immunosuppressive agents, result in significantly better results than topical agents alone, although direct comparative studies are lacking.7 All these agents require careful monitoring for lab abnormalities, and furthermore, none produce long-term remission when discontinued.
Gingival OLP lesions, when inflamed or erosive, are especially difficult to palliate, and sensitivity and bleeding can significantly impact eating, drinking, and oral hygiene. In this retrospective analysis of patients with inflammatory gingival OLP, the response to therapy with a second-generation tetracycline antibiotic, minocycline or doxycycline, is presented.
MATERIALS AND METHODS
The records of patients treated between 2015 and 2023 with clinical evidence of inflammatory gingival OLP treated with either doxycycline or minocycline were examined. Only patients with
