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The efficacy of Punica granatum extract gel in the treatment of oral lichen planus.

1. THE EFFICACY OF PUNICA GRANATUM EXTRACT GEL IN THE TREATMENT OF SYMPTOMATIC ORAL LICHEN PLANUS IN AN INDIAN POPULATION: A CLINICAL STUDY PRESENTED BY M.GAYATHRI DEPT OF ORAL MEDICINE AND RADIOLOGY

2. ABOUT THE ARTICLE JOURNAL: Indian Journal of Pharmacology Authors: Mahapatra, Subharina; Hebbale, Manjula; Mhapuskar, Amit; Halli, Rajshekhar 1 ; Jadhav, Santosh. Published: 30-Apr-2024 in the Department of Oral Medicine and Radiology, Bharati Vidyapeeth (Deemed to be) University, Dental College and Hospital, Pune, Maharashtra, India.

3. NEED FOR THE STUDY Need for the study was to compare the effectiveness of steroids and ayurvedic medicine for the treatment of OLP which decreases side effects for the patient.

4. INTRODUCTION Oral lichen planus (OLP)- chronic T cell-mediated inflammatory disorder of unknown etiology, Clinical features : burning sensation and pain Mild to severe itching and burning sensation ( hinder functional activities, quality of life) Females>males >40 years of age Buccal mucosa and tongue CLASSIFIED : reticular, papular , plaque-like, atrophic, erosive, and bullous forms.

5. Etiology Stress, anxiety, depression Nutritional deficiencies (iron, vitamin A, C, D, E, B12 deficiencies), Viruses (most common-hepatitis C virus)

6. Pathogenesis Believed- “ CD 8+ T cell–mediated autoimmune disorder” of an unidentified antigen Antigen Expression of MHC II Secrete interleukin-2 (IL-2)- activating the CD4+ T cells Activated CD4+ T cells & continuous expression- IL-2 & INF- 𝛾 Promotes cytotoxic CD8+ T cells induction Keratinocyte apoptosis, epithelial basal cell layer damage Hyperkeratosis

7. Pomegranate, or punica granatum L., Is a member of the family punicaceae. The many health benefits of pomegranates, such as their antibacterial, antimicrobial, antifungal, anti‑inflammatory, antioxidant, anti‑carcinogenic, and immunomodulatory properties, have made them a popular natural treatment option for 100 of years.

8. AIMS AND OBJECTIVE AIM- was to assess the efficacy of topical P. Granatum extract gel in comparison with topical steroids. Objectives were to determine the effectiveness of P. Granatum extracts gel, topical steroids in reducing pain, burning sensation, and size of the lesion.

9. MATERIALS AND METHODS 30 clinically and histopathologically proven OLP patients and divided into two groups.(Group A and Group B). age group of 18–60 years.

10. EXCLUSION CRITERIA Pregnant or breastfeeding women allergies, on any other drugs, or using steroids either topically or systemically during the previous 2 months, uncontrolled diabetes and hypertension, Any lesion adjacent to amalgam/metallic restoration, whose biopsy specimens show signs of dysplasia, patients who had undergone alternative treatment for OLP

11. Clinical evaluation- the visual analog scale- to assess pain and burning sensation, Thongprasom etal .’S scoring criteria were used to determine the lesion’s size.

12. Group A patients - topical P. Granatum seed extract gel. Group B patients - 0.1% triamcinolone acetonide oral mucosal paste. use the medicine 4–5 times per day on the impacted area -for 4 weeks Patients were recalled once a week for 4 consecutive weeks .

13. RESULTS

14. Pain SCORES

15. Burning sensation

16. Size of the lesion

17. DISCUSSION Pomegranate contains compounds that fight cancer, inflammation, atherosclerosis, diabetes, and free radicals, and these properties are found in every part of the fruit.

18. PAIN REDUCTION Steroids reduce pain by preventing cells from releasing chemicals that cause inflammation in response to a variety of stimuli. analgesic effects polyphenols, flavonoids, or fatty acids Ellagic acid can inhibit the production of interleukin‑8 and nitric oxide Anti inflammatory mediators- ellagitannins, punicalagins, anthocyanins, gallic acid. inhibit cyclooxygenase, lipoxygenase, and matrix metalloproteinase enzymes.

19. BURNING SENSATION Topical corticosteroids’ vasoconstriction soothes burning. Pomegranates contain polyphenols- reduce neuroinflammation by Inhibiting NF- kB Reducing expression of genes that causes inflammation and oxidative stress. Increasing expression of endothelial nitric oxide synthase.

20. SIZE OF LESION Topical corticosteroids help heal by vasoconstriction, phospholipase A2 inhibition, and DNA and inflammatory transcription factor inhibition. Pomegranate extracts boost wound healing by stimulating fibroblast production and angiogenesis. This may explain why clinical OLP has shrunk. Ellagic acid , vit C stimulates collagen production Flavonoids and tannins Antimicrobial agents Anthocyanins, tannins, ellagic acid Wound healing property

21. LIMITATIONS Short shelf life of 6 months due to the risk of moisture contamination. Future research should focus on the bioavailability of different pomegranate compounds, concentrations, and parts of pomegranate.

22. CONCLUSION Topical p. Granatum extract gel is as effective as topical corticosteroids without the side effects of long‑term use. In conclusion, the symptomatic OLP can be treated with topical p. Granatum seed extract gel, an alternative medication to corticosteroids

23. REFERENCE ARTICLES Zakaria M, said A, abd el-kader A, mostafa B. Evaluation of topical pomegranate extracts in management of oral lichen planus: A randomized clinical trial. Advanced dental journal. 2020 jan 1;2(1):1-1. Tavangar a, aslani a, nikbakht n. Comparative study of punica granatum gel and triadent oral paste effect on recurrent aphthous stomatitis, a double blind clinical trial. Journal of dentistry. 2019 sep;20(3):184. Ghalayani p, zolfaghary b, farhad ar , tavangar a, soleymani b. The efficacy of punica granatum extract in the management of recurrent aphthous stomatitis. Journal of research in pharmacy practice. 2013 apr 1;2(2):88-92.