Clinical Efficacy of Second-Generation Tetracyclines as First-Line Systemic Agents for Gingival Lichen Planus

BACKGROUND: Oral lichen planus (OLP) patients with erythematous or erosive gingival lesions frequently fail topical therapy. The aim of this study was to determine the efficacy of minocycline and doxycycline for inflammatory and refractory gingival OLP. METHODS: In this retrospective analysis, the data of 254 patients with biopsy-confirmed OLP who displayed inflammatory gingival lesions and failed treatment with topical agents were analyzed. Patients treated between 2015 and 2023 with a 2-month course of either doxycycline 100 mg twice daily or minocycline 100 mg twice daily, concomitantly with topical agents, were included. RESULTS: After 2 months of treatment with doxycycline or minocycline, 60.6% patients improved with a marked reduction in erythema (95% CI 54.6%-66.6%). More specifically, in patients with mild gingival inflammation at baseline, 80.3% improved (95% CI 71.3%-89.2%) compared to 29.4% of patients with desquamative gingivitis at baseline (95% CI 16.9%-41.9%). Acute flare-ups after discontinuing therapy, which developed in approximately 25% of patients, responded to additional courses of antibiotics for 1to 2 months. Mild adverse effects were noted in 10 patients, which all resolved rapidly when the drug was discontinued. CONCLUSIONS: This study demonstrates that both doxycycline and minocycline are highly effective agents for inflammatory gingival OLP lesions that are difficult to palliate. As these patients often fail to respond to topical agents and require more aggressive systemic drugs that are immunosuppressive with significant adverse effects, second-generation tetracyclines should be considered first-line systemic agents for inflammatory gingival OLP lesions.