title: Role of serum interleukin-6 in deciding therapy for multidrug resistant oral lichen planus.
abstract: BACKGROUND
  Oral lichen planus (OLP) is a T cell mediated immune response. T cells locally present in the involved tissues release cytokines like interleukin-6 (IL-6), which contributes to pathogenesis of OLP. Also IL-6 has been associated with multidrug resistance protein (MRP) expression by keratinocytes. Correspondingly, upregulation of MRP was found in OLP. We conducted this study to evaluate the effects of various drugs on serum IL-6 in OLP; and correlation of these effects with the nature of clinical response and resistance pattern seen in OLP lesions with various therapeutic modalities. Thus we evaluated the role of serum IL-6 in deciding therapy for multidrug resistant OLP.
  
  
  METHODS
  Serum IL-6 was evaluated in 42 erosive OLP (EOLP) patients and 10 normal mucosa and 10 oral squamous cell carcinoma cases using ELISA technique. OLP patients were randomly divided into 3 groups of 14 patients each and were subjected to Pimecrolimus local application, oral Mycophenolate Mofetil (MMF) and Methotrexate (MTX) alongwith Pimecrolimus local application. IL-6 levels were evaluated before and after treatment.
  
  
  RESULTS
  Serum IL-6 levels were raised above 3pg/ml in 26.19% erosive OLP (EOLP) cases (mean- 3.72±8.14). EOLP (5%) cases with IL-6 levels above 5pg/ml were resistant in MTX group. However significant decrease in serum IL-6 corresponding with the clinical resolution was seen in MMF group.
  
  
  CONCLUSIONS
  Significantly raised IL-6 levels in EOLP reflect the chronic inflammatory nature of the disease. As serum IL-6 levels significantly decreased in MMF group, correspondingly no resistance to treatment was noted. However with MTX there was no significant decrease in IL-6 and resistance to treatment was noted in some, especially plaque type lesions. Thus IL-6 can be a possible biomarker in deciding the best possible therapy for treatment resistant OLP.
  
  
  BACKGROUND
  Lichen planus, biological markers, cytokines, enzyme-linked immunosorbent assay, immunosuppressive agents.
authors.affiliation: MDS, Postgraduate student, Dept. of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, Delhi.
authors.forename: Sinny
authors.initials: S
authors.lastname: Goel
authors.affiliation: MSc. Research associate, Dept. of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, Delhi.
authors.forename: Akanksha
authors.initials: A
authors.lastname: Marwah
authors.affiliation: MD, Professor, Dept. of Biochemistry, Maulana Azad Medical College, Delhi.
authors.forename: Smita
authors.initials: S
authors.lastname: Kaushik
authors.affiliation: MD, MNAMS, Director Professor & Head, Department of Dermatology & STD, Maulana Azad Medical College and Associated Lok Nayak Hospital.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Garg
authors.affiliation: MDS, MBA (HCA), FICD (USA), Professor and Head, Dept. of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, Delhi.
authors.forename: Sunita
authors.initials: S
authors.lastname: Gupta