Clinical efficacy of a two-step management strategy for oral lichen planus: prioritizing microenvironmental stabilization before corticosteroid therapy

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OBJECTIVE: We evaluated the clinical efficacy of a structured therapeutic protocol prioritizing oral microenvironment stabilization by targeting Candida colonization and periodontal inflammation prior to corticosteroid therapy for oral lichen planus (OLP). STUDY DESIGN: This prospective observational cohort study followed STROBE guidelines. From 51 screened patients, 42 with histopathologically confirmed OLP were analyzed. Phase 1 induction therapy focused on microenvironmental stabilization. Clinical severity was evaluated via a visual analogue scale (VAS), and anatomic extent scores. Phase 2 corticosteroid therapy was initiated only for cases with persistent symptoms. The median follow-up duration was 11 months. RESULTS: Candida colonization was identified in 57.1% (24/42) of patients. Following Phase 1 induction therapy, the median VAS score decreased significantly from 64 mm to 52 mm (P < .01). Eleven patients (26.2%; 8 Candida-positive and 3 Candida-negative) achieved clinical improvement without the need for corticosteroid therapy. The remaining 31 patients transitioned to Phase 2, resulting in further reductions in both VAS and anatomic extent scores, with stable disease control maintained throughout the follow-up period. CONCLUSIONS: Microenvironment-first induction therapy significantly reduces symptom severity and steroid dependency in OLP. These findings clinically validate an immunopathogenesis-based management model.

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