1.

betamethasone 1 ml and hyaluronidase 1500 IU, given intralesionally, weekly

once by multiple puncture method for 12 weeks. An oral antioxidant, alpha lipoic
acid, was administered once daily for 3 months

2. placental extract 2ml (market preparation manufactured from 0.1gm of fresh human placenta)
given at multiple sites at soft palate and anterior to anterior pillars (as shown in the figure with
red marking) every week for 10 weeks (Human placental extracts have shown to help collagen
synthesis leading to potent healing of wounds in rats. presence of various bioactive substances in
human placental extracts like NADPH,13 poly-deoxy-ribonucleotide (PDRN), RNA, DNA,
fragments, peptides, amino-acids, trace elements.8,9
Placental extract contains growth factors and anti-inflammatory agents10 and it has shown to have
anti-inflammatory and anti-platelet activity)
Lycopene (10%) 2000mcg orally , daily dose of 16 mg, Lycopene capsules 16 mg
(Lycostar, Mankind Pharma Ltd., New Delhi, India), one capsule/day along
with bi-weekly intralesional injections of Dexamethasone 1.5 ml & Hyaluronidase
1500 IU mixed with lignocaine. Lycostar contains Lycopene 5000 g along with
various micronutrients
Methylcobalmin injection (1500mcg) given intramuscularly every week.
Jaw dilators exercises explained to the patients to be taken every day
3. Intralesional injections of IFN-gamma, a known antifibrotic cytokine
4. pentoxifylline at 400 mg 3 times daily for advanced oral submucous fibrosis. for
the initial 30 days at a reduced dosage of 2 tablets daily and then the dose was
hiked to 3 tablets daily for 6 more months. Pentoxifylline is a tri-substituted
methylxanthine derivative, the biologic activities of which are numerous. It is
termed as a Rheologic modifier. It improves microcirculation and decreases
platelet aggregation as well as granulocyte adhesion. It increases leukocyte
deformability as well as inhibits neutrophil adhesion and activation. The medication
also has antithrombin, antiplasmin activities and fibrinolytic activity. In addition, it
causes degranulation of neutrophils, promotes natural killer cell activity and inhibits
T-cell and B-cell activation (Samlaska et al., 1994). It is said to maintain cellular
integrity and homeostasis after acute injury and has been tried in various medical
disorders like stroke, aphthous stomatitis, cerebrovascular insufficiency,
peripheral arterial occlusion and pretibial myxedema (Pineda et al., 2007). Rawlins
et al reported that Pentoxifylline has a direct effect on inhibiting burn scar
fibroblasts (Rawlins et al., 2006). Haddad et al treated 34 radiation-induced
superficial fibrotic lesions of the skin with Pentoxifylline and vitamin E for 3 months
and reported a significant effect of the Pentoxifylline-vitamin E combination in
improving radiation-induced fibrosis (Haddad et al., 2005). It has been

postulated that Pentoxifylline may be a valuable drug for reducing burn scar
contractures. Extrapolating this finding, the drug has been also been used to
alleviate the symptoms in patients with OSMF, in addition to its role in improving
the vascularity.
5. Lycopene 6 to 8 mg twice a day for 2 months, Pentoxyfilline 400 mg 3 times a
day for 7 months, Interferon gamma Intralesional injection of interferon gamma
(0.01 10.0 U/mL) 3 times a day for 6 months, Steroids Submucosal injections twice
a week in multiple sites for 3 months. Steroids Topical for 3 months, Placental
extracts Turmeric30 Alcoholic extracts of turmeric (3 g), turmeric oil (600 mg),
turmeric oleoresin (600 mg) daily for 3 months, Chymotripsin, hyaluronidase and
dexamethasone31 Chymotripsin (5000 IU), hyaluronidase (1500 IU) and
dexamethasone (4 mg), twice weekly submucosal injections for 10 weeks
6. combined therapy employing nutritional and iron supplements with intralesional
injection therapy using Hyalouronidase, Dexamethasone, and placentrex in
addition to local anaesthetic topical gel and topical application of Triamcinolone
Acetonide 0.1% caused a marked improvement in the patients signs and
symptom
7. oral tablet colchicine (Tablet Zycolchine, Zydus Cadila Healthcare Ltd.,
Ahmedabad, Gujrat, India) 0.5 mg twice daily