Successful treatment of severe recalcitrant erosive oral lichen planus with topical tacrolimus

Abstract

Oral lichen planus (LP) is a severe, painful form of LP, and is often resistant to topical corticosteroid therapy. Recently, open trials demonstrated that topical tacrolimus therapy was effective for the treatment of chronic erosive oral LP. We report two cases with severe recalcitrant erosive oral LP, who dramatically benefited from topical tacrolimus therapy. In case 1, a 64-year-old man presented with a 5-month history of painful erosions on his entire lower lip and buccal mucosa. Physical and histological examination confirmed a diagnosis of LP. He experienced rapid relief from pain and a dramatic improvement was obtained within 5 weeks of topical tacrolimus treatment. No significant irritation was observed and blood tacrolimus level was kept within a safe level (2.5 ng/mL). In case 2, a 68-year-old man developed painful erosions on his right lower lip and buccal mucosa 2 months before his arrival at our hospital. Histopathological analysis confirmed a diagnosis of oral LP. He experienced a rapid dramatic improvement of both lesions within 4 weeks of the start of tacrolimus application. No significant irritation or recurrence was observed. Thus, topical tacrolimus is suggested as a well-tolerated, effective therapy for oral LP.

Topical Therapies for Oral Lichen Planus Management and their Efficacy: A Narrative Review

“…Pimecrolimus 1% cream was superior to vehicle in reducing pain, erythema, decreasing erosion size, and improving overall severity of disease when compared with vehicle treatment [19,63]. To our knowledge, a medium/long term follow up has been reported only from cases report studies [64][65][66] with a confirmation of pimecrolimus as an efficient potential treatment for OLP, although more research is needed to evaluate the efficacy of pimecrolimus and to study potential , as well as to establish its true role in comparison with other treatments for OLP.…”

Calcineurin inhibitors in oral medicine

“…With regard to the management of oral mucosal diseases, topical tacrolimus has been reported to be effective in the treatment of symptomatic OLP [13][14][15][16][17][18][19][20][21][22] and desquamative gingivitis. 23 Topical tacrolimus has also been reported to be effective in the management of oral mucosal lesions of GvHD, 24-26 MMP, [27][28][29] pemphigus vulgaris of the lip, 30 and the oral ulceration and labial enlargement of OFG and oral Crohn disease.…”

Líquen plano bucal: considerações clínicas e histopatológicas

“…[31][32] Theoretically, these drugs may increase the likelihood of malignant transformation, as they not only affect the immune systems, but act directly on cells. 23 Becker et al 33 (2006), for instance, believe that the relation between topical use of tacrolimus and the development of epidermoid carcinoma in patients with oral lichen planus is not limited only to immune suppression.…”