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      Comparative Efficacy of Topical Curcumin and Triamcinolone for Oral Lichen Planus: A Randomized, Controlled Clinical Trial

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          Abstract

          Objectives:

          Lichen planus (LP) is a chronic inflammatory mucocutaneous disease. Its treatment is often symptomatic and includes topical and systemic corticosteroids. Although corticosteroid therapy is usually successful, it has side effects and thus, an alternative treatment is favorable. The aim of this study was to compare the efficacy of topical curcumin and triamcinolone for treatment of oral lichen planus (OLP).

          Materials and Methods:

          In this study, 50 patients (36 women and 14 men) in the age range of 38 to 73 years with OLP were randomly divided into two groups. Each group received 0.1% triamcinolone or 5% curcumin oral paste three times a day for four weeks. Assessment of the appearance score and severity of pain was done at baseline and at the end of two and four weeks and recorded in the patients’ questionnaires. The data were analyzed by SPSS 17 software, using the Mann-Whitney and Spearman's tests.

          Results:

          With respect to pain reduction, nine patients (36%) in the curcumin group and eight patients (32%) in the triamcinolone group showed complete remission. With respect to the appearance score, one patient (4%) in each group showed complete remission. No statistically significant difference was noted between the two groups.

          Conclusion:

          Application of curcumin is suggested for treatment of OLP because of its desirable anti-inflammatory effects and insignificant side effects.

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          Most cited references16

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          Graphic representation of pain.

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            Anti-inflammatory properties of curcumin, a major constituent of Curcuma longa: a review of preclinical and clinical research.

            Curcuma longa (turmeric) has a long history of use in Ayurvedic medicine as a treatment for inflammatory conditions. Turmeric constituents include the three curcuminoids: curcumin (diferuloylmethane; the primary constituent and the one responsible for its vibrant yellow color), demethoxycurcumin, and bisdemethoxycurcumin, as well as volatile oils (tumerone, atlantone, and zingiberone), sugars, proteins, and resins. While numerous pharmacological activities, including antioxidant and antimicrobial properties, have been attributed to curcumin, this article focuses on curcumin's anti-inflammatory properties and its use for inflammatory conditions. Curcumin's effect on cancer (from an anti-inflammatory perspective) will also be discussed; however, an exhaustive review of its many anticancer mechanisms is outside the scope of this article. Research has shown curcumin to be a highly pleiotropic molecule capable of interacting with numerous molecular targets involved in inflammation. Based on early cell culture and animal research, clinical trials indicate curcumin may have potential as a therapeutic agent in diseases such as inflammatory bowel disease, pancreatitis, arthritis, and chronic anterior uveitis, as well as certain types of cancer. Because of curcumin's rapid plasma clearance and conjugation, its therapeutic usefulness has been somewhat limited, leading researchers to investigate the benefits of complexing curcumin with other substances to increase systemic bioavailability. Numerous in-progress clinical trials should provide an even deeper understanding of the mechanisms and therapeutic potential of curcumin.
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              Molecular mechanisms underlying chemopreventive activities of anti-inflammatory phytochemicals: down-regulation of COX-2 and iNOS through suppression of NF-kappa B activation.

              A wide array of phenolic substances, particularly those present in edible and medicinal plants, have been reported to possess substantial anticarcinogenic and antimutagenic activities. The majority of naturally occurring phenolics retain antioxidative and anti-inflammatory properties which appear to contribute to their chemopreventive or chemoprotective activity. Cyclooxygenase-2 (COX-2) inducible and nitric oxide synthase (iNOS) are important enzymes that mediate inflammatory processes. Improper up-regulation of COX-2 and/or iNOS has been associated with pathophysiology of certain types of human cancers as well as inflammatory disorders. Since inflammation is closely linked to tumor promotion, substances with potent anti-inflammatory activities are anticipated to exert chemopreventive effects on carcinogenesis, particularly in the promotion stage. Examples are curcumin, a yellow pigment of turmeric (Curcuma longa L., Zingiberaceae), the green tea polyphenol epigallocatechin gallate (EGCG), and resveratrol from grapes (Vitis vinifera, Vitaceae) that strongly suppress tumor promotion. Recent studies have demonstrated that eukaryotic transcription factor nuclear factor-kappa B (NF-kappa B) is involved in regulation of COX-2 and iNOS expression. Several chemopreventive phytochemicals have been shown to inhibit COX-2 and iNOS expression by blocking improper NF-kappa B activation. Multiple lines of compelling evidence indicate that extracellular-regulated protein kinase and p38 mitogen-activated protein kinase are key elements of the intracellular signaling cascades responsible for NF-kappa B activation in response to a wide array of external stimuli. Curcumin, EGCG and resveratrol have been shown to suppress activation of NF-kappa B. One of the plausible mechanisms underlying inhibition of NF-kappa B activation by aforementioned phytochemicals involves repression of degradation of the inhibitory unit I kappa B alpha, which hampers subsequent nuclear translocation of the functionally active subunit of NF-kappa B.
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                Author and article information

                Journal
                J Dent (Tehran)
                J Dent (Tehran)
                JOD
                JOD
                Journal of Dentistry (Tehran, Iran)
                Tehran University of Medical Sciences
                1735-2150
                2008-2185
                November 2015
                : 12
                : 11
                : 789-796
                Affiliations
                [1 ]Assistant Professor, Department of Oral Medicine, Faculty of Dentistry, Guilan University of Medical Sciences, Guilan, Iran
                [2 ]Assistant Professor, Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
                [3 ]Associate Professor, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
                [4 ]Dentist, Faculty of Dentistry, Guilan University of Medical Sciences, Guilan, Iran
                [5 ]Student, Scientific Research Center, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
                Author notes
                [* ] Corresponding author: A. Mansourian, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran, amansourian@ 123456tums.ac.ir
                Article
                jod-12-789
                4977402
                27507989
                504f10a5-b245-42ae-98a2-106200a7f658
                Copyright© Dental Research Center, Tehran University of Medical Sciences

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                : 3 May 2015
                : 16 October 2015
                Categories
                Original Article

                Dentistry
                curcumin,lichen planus,triamcinolone
                Dentistry
                curcumin, lichen planus, triamcinolone

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