The Effectiveness of Intralesional Platelet Rich Plasma in Recurrent Aphthous Stomatitis Compared With Triamcinolone Acetonide

April 2023 | Volume 22 | Issue 4 | 398 | Copyright © April 2023


Published online March 21, 2023

doi:10.36849/JDD.7218 Citation: Kadhim MAA, Musa HD, Barzanji HAA. The effectiveness of intralesional platelet rich plasma in recurrent aphthous stomatitis in comparison with triamcinolone acetonide. J Drugs Dermatol. 2023;22(4):398-403. doi:10.36849/JDD.7218

Mohanad A.A. Kadhim BDS MSca, Hashim Dawood Musa BDS MSc PhDb, Ali Al Barzanji BDS MSc PhDc

aDepartment of Oral Medicine, College of Dentistry, University of Duhok, Kurdistan Region, Iraq
bDepartment of Periodontics and Oral Diagnosis, College of Dentistry, University of Duhok, Kurdistan Region, Iraq
cDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Hewler Medical University, Kurdistan Region, Iraq

Abstract
Background: Recurrent aphthous stomatitis (RAS) is an autoimmune disease that affects 25% of the population, with no cure until now. Intralesional triamcinolone acetonide (TA) injections are an effective classic treatment for RAS; and, more recently, intralesional platelet rich plasma (PRP) has been used to manage oral lesions of some autoimmune diseases.
Objectives: To try intralesional PRP injections in the management of recurrent oral ulceration of Behcet's disease and compare their clinical effect with intralesional TA injections; and to study the effects of both treatments on the serum level of interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α.
Methods: Thirty patients diagnosed with RAS were recruited for this trial, with a male to female ratio of 1:1, and ages ranging from 12 to 66 years. For 6 months, 15 patients were treated monthly with intralesional PRP injections and the other 15 were treated monthly with intralesional TA injections. The clinical effects of both treatments were registered in the oral clinical manifestation index (OCMI), as were their effects on the serum levels of IL-1β, IL-6, and TNF-α.
Results: The OCMI of PRP-treated patients initially ranged from 8 to 23 with a mean±SD of (13.5±4.6). This mean decreased to 5.7 by the end of month 6, with a statistically highly significant P-value compared with baseline. The OCMI of TA-treated patients initially ranged from 8 to 20 with a mean±SD of (13.5±3.8). This mean decreased to 10.5 by the end of month 6, with a statistically significant P-value compared with baseline. Both treatments significantly decreased the serum levels of IL-1β, while only PRP significantly decreased the TNF-α.
Conclusion: Intralesional PRP injections are a new, safe, and effective treatment for RAS.

J Drugs Dermatol. 2023;22(4): doi:10.36849/JDD.7218

Citation: Kadhim MAA, Musa HD, Barzanji HAA. The effectiveness of intralesional platelet rich plasma in recurrent aphthous stomatitis in comparison with triamcinolone acetonide. J Drugs Dermatol. 2023;22(4):398-403. doi:10.36849/JDD.7218

INTRODUCTION

Recurrent aphthous stomatitis (RAS) is the most common oral lesion; it has unknown etiology and is characterized by periodic oval, shallow, painful ulcers, gray or yellowish in color, which are surrounded by a red halo in keratinized or non-keratinized epithelium. These ulcers can interfere with eating and drinking, and they affect quality of life.1

The definitive cause of RAS is unclear. Multiple factors may be included in the etiology by activation of cellular mediated immunity, including: local trauma, microorganisms, nutritional deficiency, allergy, genetics, psychological stress, and systemic diseases.2 RAS can be divided clinically into: 1) minor RAS or Mikulicz's aphthae; 2) major RAS or Sutton's disease or periadenitis mucosa necrotica recurrens; and 3) herpetiform ulcers or Cooke's ulcers.3 The diagnosis of RAS depends on taking a careful and detailed patient history, with a clinical examination of the lesion, lymph nodes, and surrounding area. The periodicity of the ulcer is very important for the diagnosis.4 Some studies have found that the serum levels of interleukin (IL)-1B, IL-6, and tumor necrosis factor (TNF)-α were elevated in RAS patients.5,6

There are many treatment modalities for RAS, but until now no treatment has been curative so the most important targets are to decrease pain, shorten the period of ulcers by inducing re-epithelialization, decrease the number of ulcers in each episode, and decrease the frequency of ulceration.7

Steroids have been used for a long time to treat many autoimmune diseases including RAS.8 One commonly used steroid in the treatment of RAS is triamcinolone acetonide
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