Objectives:The study aimed to evaluate the effect of topical tacrolimus as adjunctive to systemic corticosteroids in treatment of mucous membrane pemphigoid. Material & Methods:The present study was conducted on 76 patients with severe mucous membrane pemphigoid according to chan et al classification. Patients were allocated (1:1) to a group. Group A (control group) patients treated with 40 mg systemic corticosteroids alone and group B (Study group) patients were treated with 40 mg systemic corticosteroids and topical tacrolimus as adjunctive to corticosteroids. Total ulcers score (site, activity, and pain score) was recorded in both groups on weekly basis till the full recovery of oral, oropharyngeal and nasal lesions.Results: Both treatment regimen had shown a significant improvement in total ulcer scores with (P<0.001) of the oral and nasal lesion scores from the beginning of the study to its end, but the study group (combination of corticosteroids and tacrolimus) revealed significant decrease (P<0.001) compared to the study (corticosteroid alone) group. Conclusion:The use of topical tacrolimus as adjunctive to systemic corticosteroids could improve healing and total ulcer score in severe cases of mucous membrane pemphigoid than solo treatment with systemic corticosteroids