HypnOLP Trial Hypnotherapy for Oral Lichen Planus - a Single Blind Randomized Controlled Trial

Background:

Lichen planus (LP) is an immune-mediated skin and mucous membrane disease that mainly affects middle-aged adults of both sexes with a slight tendency to women. The precise prevalence of LP is unknown, but it is estimated that the oral form (OLP) alone is expressed in about 1-2% of the population. OLP is a chronic disease and it is considered by the World Health Organization (WHO) as a pre-malignant condition. OLP presents in five clinical forms - reticular, plaque-like, erythematous/atrophic, erosive/ulcerative and bullous. The reticular form is the most common and is characterized by white papules and/or white mesh-like stripes called Wickham's striae, typically bilaterally and symmetrically distributed. The most affected site is the posterior buccal mucosa followed by the tongue, gingiva and labial mucosa.2 Usually, this condition is asymptomatic even if it is diffuse, but the erythematous, erosive and ulcerative forms might cause a painful burning sensation. In 1978 the WHO published diagnostic criteria for OLP based on clinical and histopathological characteristics and in 2003 van der Meij and van der Waal modified these criteria, which are accepted till this day.

Despite a vast number of studies, the etiology of OLP remains unknown. It is believed that OLP is a result of a local cell-mediated immune response, involving antigen-presenting cells and inflammatory infiltrate predominantly of T lymphocytes, but its precipitating factors have not been determined. Some conditions have been associated with OLP, including among others, genetic predisposition, specific microorganisms, several systemic health conditions, and emotional disorders. The latter have been thoroughly investigated and some studies have showed that OLP patients, especially those with the erythematous/erosive forms, have higher state of anxiety and depression than non-OLP individuals. It has been suggested that psychological factors can alter the functionality of the immune system, leading to the development of autoimmune diseases. To date, no study has conclusively demonstrated a cause-and-effect relationship and more investigations about the possible correlation of anxiety and emotions with the severity of OLP are needed.

Hypnosis is a natural human phenomenon and every human tends to have trance like events several times a day. Techniques for induction and deepening of the hypnotic trance can be utilized in order to maintain this state and access aspects of psyche and physiology that are not readily accessible in the ordinary waking state.

Ample literature is available on the use of hypnosis for treatment of medical conditions that are exacerbated by emotions such as autoimmune and autoinflammatory conditions. That being said there are only anecdotal reports of hypnotherapy being used for Lichen Planus of the skin and non for OLP.