Recently, lichen planus has been reported to occur with chronic hepatitis C (HCV). This study was conducted to evaluate the effect of silymarin liver support as an adjunctive to local triamcinolone acetonide orabase in the treatment of atrophic/erosive oral lichen planus in hepatitis C positive patients. Methods: Twenty HCV patients with erosive lichen planus were divided into two groups, 10 patients each: Group I was treated with topical triamicinolone acetonide in orabase, group II was treated with topical triamicinolone acetonide in orabase and systemic silymarin 140 mg capsule 3 times daily for 3 months. Each patient was examined at baseline, 2, weeks and 1, 2 and 4 months of therapy. Pain was scored using the visual analogue scale. Serum level of TNF-alpha (TNF-α), AST and ALT were estimated at baseline 1, 2 and 4 months’ evaluation periods. Results: Significant decrease in pain score was observed in both groups and there was a statistically significant difference between them at all treatment periods in favor to group II. Additionally, both groups showed a decrease in the size of lesions which was greater in group II compared to the control group. A significant reduction of the mean TNF-α continued up to 6 months in both groups with statistically insignificant difference between them at one month, while statistically significant difference in favor to group II at 2 and 4 months was observed. Conclusion: The combination of topical triamicinlone and systemic silymarin could be suggested as a promising therapeutic alternative to systemic corticosteroid for hepatitis C virus associated oral lichen planus, and immunocompromised patients.
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