What do systematic reviews say?

Betamethasone oral mini-pulse therapy vs Topical triamcinolone acetonide paste

• Interventions for erosive lichen planus affecting mucosal sites 2012 · Cochrane All outcomes
  Table 3 (Side-effects). Malhotra 2008: betamethasone oral mini-pulse - transient oedema over the face (7), oedema over hands and feet (4), epigastric discomfort (7), weakness/fatigue (5), loose stools (1), headache…
  1 study · 22 participants
  GRADE not reported

Clobetasol-17-propionate 0.025% lipid-loaded microspheres vs Clobetasol propionate 0.025% ointment

• Interventions for erosive lichen planus affecting mucosal sites 2012 · Cochrane All outcomes
  Table 3 (Side-effects). Campisi 2004: oral candidiasis (1 in the lipid-loaded microspheres group, 2 in the conventional ointment group). None serious.
  1 study · 50 participants
  GRADE not reported

Camel thorn (plant distillate) vs placebo

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  up to 14 days
  The authors report lower pain and smaller lesions in the camel thorn group up to 10 days after referral; a statistically significant difference in pain intensity was also reported.
  1 study · 93 participants
  GRADE not reported

Tacrolimus 0.1% vs Topical clobetasol propionate 0.05% ointment

• Interventions for erosive lichen planus affecting mucosal sites 2012 · Cochrane All outcomes
  Table 3 (Side-effects). Radfar 2008: burning sensation with topical tacrolimus; transient burning within the first 2 weeks resulted in withdrawal of therapy in 1 participant.
  1 study · 29 participants
  GRADE not reported

Prednisone (oral, commencing 25 mg with phased dose reduction over 2 months) vs placebo

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  2 months
  Femiano 2003 (high risk of bias) reports days to resolution of pain and days to epithelialization of aphthae at 1 month, and number of aphthae per month after the first and second months; data presented as…
  1 study · 20 participants
  GRADE not reported

Beta-glucan (1.3/1.6 beta-glucan 10 mg twice daily for 20 days) vs placebo

Beta-glucan (1.3/1.6 beta-glucan 10 mg twice daily for 20 days) led to lower ulcer severity score (USS) compared with placebo; GRADE not reported.

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  20 days
  MD -4.38 [-6.17, -2.59]
  1 study · 31 participants
  GRADE not reported

Camel thorn (plant distillate) vs placebo

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  up to 14 days
  A single trial (Pourahmad 2010, unclear risk of bias) randomised 93 participants to camel thorn distillate (n=49) or placebo (n=44). Mean time to complete resolution was 4.02 days (range 3 to 7) for camel thorn…
  1 study · 93 participants
  GRADE not reported

Prednisone (oral, commencing 25 mg with phased dose reduction over 2 months) vs placebo

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  2 months
  Femiano 2003: one significant adverse event (gastritis) for the prednisone group versus none for placebo. Femiano 2010: more drug-related adverse effects for those treated with prednisone than placebo.
  2 studies
  GRADE not reported

Fluticasone propionate spray vs Betamethasone sodium phosphate mouthwash

• Interventions for erosive lichen planus affecting mucosal sites 2012 · Cochrane All outcomes
  No statistical testing of the mean surface area of lesions was reported in Hegarty 2002 (fluticasone mean score 547.2 mm2 versus betamethasone mean score 671.9 mm2).
  1 study · 22 participants
  GRADE not reported

Vitamin B12 (sublingual, 1000 mcg daily for 6 months) vs placebo

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  6 months
  No adverse events were associated with receiving vitamin B12 or placebo in this study.
  1 study · 58 participants
  GRADE not reported

1% pimecrolimus cream vs Placebo (vehicle cream)

1% pimecrolimus cream showed no clear difference in complete clinical response (complete clearance) compared with placebo (vehicle cream); GRADE not reported.

• Interventions for erosive lichen planus affecting mucosal sites 2012 · Cochrane All outcomes
  RR 3.50 [0.95, 12.90]
  1 study · 20 participants
  GRADE not reported

LongoVital (herbal component alone) vs placebo

LongoVital (herbal component alone) showed no clear difference in general degree of discomfort compared with placebo; GRADE not reported.

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  4 to 6 months
  MD -0.30 [-0.37, 0.97]
  1 study · 50 participants
  GRADE not reported

Sulodexide (heparin plus dermatan sulphate chains) vs prednisone

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes
  Sulodexide was without significant adverse events; one significant adverse event (gastritis) was reported for the prednisone group.
  1 study · 20 participants
  GRADE not reported

Topical ciclosporin 1.5% gel vs Topical clobetasol propionate 0.025% gel

Topical ciclosporin 1.5% gel led to higher partial response (partial or complete response) compared with topical clobetasol propionate 0.025% gel; GRADE not reported.

• Interventions for erosive lichen planus affecting mucosal sites 2012 · Cochrane All outcomes
  RR 1.46 [1.04, 2.04]
  1 study · 40 participants
  GRADE not reported

Bee propolis (one 500 mg capsule per day) vs placebo

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  6 months (minimum)
  Propolis was associated with low rates of minimal side effects.
  1 study · 19 participants
  GRADE not reported

Individualised homeopathic medicine (two doses over 24 hours) vs placebo

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  6 days
  A statistically significant difference was reported in mean pain score and mean ulcer size favouring the homeopathic group (P<0.05). Summary data not presented, precluding further analysis.
  1 study · 100 participants
  GRADE not reported

Subantimicrobial dose doxycycline (20 mg twice daily for 90 days) vs placebo

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  90 days
  No differences in adverse events were reported.
  1 study · 50 participants
  GRADE not reported

Individualised homeopathic medicine (two doses over 24 hours) vs placebo

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  6 days
  No participant needed to discontinue treatment due to adverse events.
  1 study · 100 participants
  GRADE not reported

1% pimecrolimus cream vs Placebo (vehicle cream)

• Interventions for erosive lichen planus affecting mucosal sites 2012 · Cochrane All outcomes
  In Passeron 2007 (n=12), all participants who improved during treatment relapsed within 1 month of ceasing treatment.
  1 study · 12 participants
  GRADE not reported

Clofazimine (100 mg daily for 30 days, then 100 mg every other day) vs placebo

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  6 months
  One trial at high risk of bias compared clofazimine (n=23) with placebo (n=20). The number of individuals in the clofazimine group who had no further aphthous episodes from beginning treatment until completion at 6…
  1 study · 43 participants
  GRADE not reported