A Review of the Effectiveness and Side-Effects of Fluocinolone Acetonide 0.1% in the Treatment of Oral Mucosal Diseases


Abstract

Topical steroids have been widely used in the treatment of symptomatic oral lesions to reduce pain and inflammation. Potent topical steroids such as clobetasol propionate, fluocinolone acetonide (FA), and fluocinonide have been widely used in the treatment of severe oral mucosal lesions. Many reports have demonstrated that these steroids were effective in treating oral lesions with only minor side-effects. This review describes the effectiveness and side-effects of using FA 0.1% in the treatment of symptomatic oral lichen planus (OLP), oral lichenoid drug reaction (OLDR), oral pemphigus, and herpes associated erythema multiforme (HAEM). FA 0.1% was effective and safe in the treatment of patients with multiple systemic diseases and a pregnant patient with HAEM. Moreover, this topical steroid rapidly reduced pain, inflammation, and enhanced lesion healing with no serious side-effects other than pseudomembranous candidiasis, which is easily treated. In some cases, a long-term treatment with FA 0.1% resulted in hyperpigmentation at the areas of previously healed oral lesions; however, this hyperpigmentation was gradually resolved after discontinuing topical steroid treatment.

Keywords: Candidiasis; Erythema Multiforme; Fluocinolone Acetonide; Lichen Planus; Lichenoid; Pemphigus.

Figures

Figure 1
Figure 1
Chemical structure of fluocinolone acetonide
Figure 2
Figure 2
a Recalcitrant ulcerative OLP on the right buccal mucosa that was unresponsive to any medications. Figure 2b OLP lesion on the right buccal mucosa showing nearly complete remission after treatment with FAO 0.1% for 2 weeks.
Figure 3
Figure 3
a Atrophic OLP on the right buccal mucosa that was unresponsive to any medications. Figure 3b Lesions resolved after treatment with FAO 0.1% for 22 months.
Figure 4
Figure 4
a White striae and severe bleeding seen on the left buccal mucosa. Figure 4b After a treatment with FAO 0.1% and changing the type of insulin injected, the buccal mucosa returned to normal.
Figure 5
Figure 5
a Severe generalized desquamative gingival lesions in a patient with pemphigus. Figure 5b Pemphigus lesions on the gingiva showing nearly complete remission after treatment with prednisolone 40–60 mg/day and FAS 0.1% for 6 weeks.
Figure 6
Figure 6
Patient with pemphigus developed Cushing syndrome characterized by moon face, steroid acne, and hirsutism after treatment with a systemic steroid and FAS 0.1% for 6 weeks.
Figure 7
Figure 7
a Pseudomembranous candidiasis that developed after treatment with FAO for 1 month. Figure 7b after treatment with topical antifungal- miconazole gel, the buccal mucosa showed nearly complete remission.
Figure 8
Figure 8
a Hyperpigmentation on the right buccal mucosa after treatment with FAO 0.1% for 5 years. Figure 8b Hyperpigmentation on the right buccal mucosa gradually resolved within 3 years after discontinuing FAO 0.1% treatment.
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