Medical management of oral submucous fibrosis

Dear Editor,

About 5 million people in India have oral submucous fibrosis and recent data suggest a male predominance. Age group between second and third decade is commonly involved. Risk of malignant transformation ranges from 7% to 30%.[1] Restricted mouth opening in oral submucous fibrosis makes examination and early diagnosis of cancer difficult. Medical management is the treatment of choice in early stages of this chronic precancerous condition. A patient has to undergo dietary habit counseling and stop intaking arecanut, tobacco and spicy food. Patient's diet should include proteins, vitamin D, E and B complex and micronutrients.

Intralesional steroids such as dexamethasone are the main treatment modality. These are injected submucosally into the fibrotic bands weekly for 6 to 8 weeks with regular monitoring of mouth opening. They are commonly used with hyaluronidase, a proteolytic enzyme. Antioxidants like alpha lipoic acid and lycopene are also commonly used as first line of treatment. Lycopene is anti-poliferative, anti-inflammatory and anti-oxidant. Antioxidants restrict the damage caused by reactive free radicals to cells and cellular components.[1,2] Novel therapies include zinc actetate tablets for 4 months, 50 mg three times daily, and vitamin A 25,000 IU, once daily, with regular follow-up at an interval of 1 month.[3] Also, Salvianolic acid B, an antifibrotic, which is used with triamcinolone acetonide represents the promising newest mode of management. Salvianolic acid B has antifibrosis, anticoagulation, antitumor activities.[4] Turmeric, immunomodulatory drug levamisole, vasodilator pentoxyfilline, placental extract, interferon gamma, spirulina, colchicine, herbal antioxidants oxitard and Aloe vera are also promising in the management of this chronic disease.[1,2,5,6,7] Antioxidant property of spirulina is attributed to high amount of beta carotene and superoxide dismutase. Colchicine has antifibrotic and anti-inflammatory properties.[5,6]