Topical Calcipotriol Versus Photodynamic Therapy in the Treatment of Oral Leukoplakia

Oral leukoplakia (OL) is a prevalent, potentially malignant disorder of the oral mucosa, characterized by white patches that cannot be scraped off and are not attributable to any other definable disease. Affecting a significant portion of the adult population, OL carries a considerable risk of malignant transformation to oral squamous cell carcinoma (OSCC). Current management strategies for OL range from watchful waiting and surgical excision to various topical and systemic pharmacological interventions, all with varying degrees of success and potential side effects. Topical calcipotriol gel helps reverse dysplastic changes (OL) by promoting normal cell differentiation. Photo dynamic therapy using 5- aminolevulonic acid can selectively destroys abnormal cells. Treatment effectiveness can be monitored non-invasively through salivary levels of Matrix metallo proteinases-9 (MMP-9) and Tumor necrosis factor-alpha (TNF-α), biomarkers that reflect disease progression and treatment response.

Aim: Evaluate and compare the effectiveness of topical calcipotriol gel and photodynamic therapy using 5- aminolevulonic acid as a photosensitizer in the regression of OL which will be measured by a clinical score. The impact of these treatment modalities on levels of salivary MMP-9 and TNF-alpha will also be investigated. Materials and Methods: A randomized clinical trial will be carried out on 30 patients diagnosed clinically with OL and histologically confirmed dysplasia. Group I (n=15 patients) will be treated using topical calcipotriol gel 0.005% twice daily for 4 weeks.

Group II (n=15 patients) will be treated by photodynamic therapy using 635nm diode laser and 20% aminolevulonic acid gel. Each point will receive 3 minutes of irradiation at 500 mW/cm2 power density at a dosage of 150 J/cm2. Lesions will be evaluated clinically at baseline,,2,4,8 and 12 weeks using Femiano et al clinical scoring key. Salivary levels of MMP-9 and TNF-α will be evaluated at baseline, 4 and 12 weeks.

Inclusion criteria

• Patients, both males and females, 25 to 55years old will be included in this clinical trial.
• Patients with oral leukoplakia with histologically confirmed mild and moderate epithelial dysplasia.
• Patients willing and able to return for multiple follow up visits

Exclusion criteria

• Presence of any visible oral lesions other than leukoplakia.
• Periodontitis patients: since chronic periodontitis may affect salivary TNF-alpha and MMP-9 level.
• Contraindications for the use of calcipotriol or amino levulonic acid as allergy.
• History of topical and/or systemic therapy for 2 months before the start of study.
• Patients with conditions that could affect saliva collection as xerostomia.