Topical immunomodulators for management of oral mucosal conditions, a systematic review; part II: miscellaneous agents

Abstract

Introduction: Topical immunomodulating preparations have utility in inflammatory/immune-mediated oral mucosal disease resistant to topical steroids, in immunologically mediated systemic disease with primary oral involvement or more severe lesions primarily involving the oral mucosa.

Areas covered: This paper is the second part of a systematic review of a variety of topical immunomodulators for management of immune/inflammatory oral mucosal conditions. The literature search revealed studies of azathioprine, benzydamine, GM-CSF and G-CSF, tetracyclines, retinoids, imiquimod, amlexanox, sirolimus and bacillus Calmette-Guerin polysaccharide nucleic acid. Weighted conclusions are provided for the topical use of each of the immunomodulators reviewed in the management of these oral diseases.

Expert opinion: Topical immunomodulators may be useful as second line treatment in several oral diseases, particularly oral lichen planus and recurrent aphthous stomatitis. Benzydamine was found to be preventive in radiotherapy-induced mucositis; however, it is unclear if this outcome is related to its immunomodulating effects or other mechanisms of action. Topical application of tetracyclines and retinoic acid also shows potential anti-inflammatory actions.

Keywords::

• azathioprine
• bacillus Calmette-Guerin polysaccharide nucleic acid
• benzydamine
• evidence-based
• G-CSF
• GM-CSF
• imiquimod
• mechanism
• mucosal
• oral
• retinoids
• tetracyclines
• therapy
• topical