Lichen planus actinicus treated successfully with topical tacrolimus 0.1%: A report of six cases (original) (raw)
Related papers
Journal of the European Academy of Dermatology and Venereology, 2010
Background Lichen planus pigmentosus (LPP) is an uncommon variant of lichen planus, for which no effective treatment is available. Objectives The aim of this study was to determine the clinical, epidemiological and histopathological characteristics of LPP patients in Kuwait. Methods Thirty-three LPP patients who attended the Dermatology outpatient clinics at Farwaniya Hospital, Kuwait from the year 2002 to 2008 were studied for clinical, epidemiological and histopathological findings. Thirteen of these patients were treated with topical tacrolimus 0.03%. Ointment applied topically twice daily for the duration varying from 6 to 12 weeks. Results Of the 33 patients, 21 were men and 12 were women. The duration of eruption ranged from 6 weeks to 3 years. The face and neck were the commonest sites, affecting 18 (54.5%) patients. The pattern of pigmentation was diffuse in 18 (54.54%) patients, reticular in seven (21.2%), blotchy in five (15.2%), linear in two (6.1%) and perifollicular in one (3%). Twenty patients had positive serology for hepatitis C virus (HCV), with significantly higher serum liver enzymes (ALT and AST). Of the 13 patients, who were treated with tacrolimus Ointment, seven (53.8%) showed appreciable lightening of the pigmentation after an average of 12 weeks. Conclusions We conclude that HCV may be one of the factors associated with LPP, in those who have a tendency to develop LPP. However, this possible association should be interpreted carefully. In addition, tacrolimus ointment could have a beneficial role in the treatment of LPP.
Acta Dermato-Venereologica, 2006
Treatment of symptomatic oral lichen planus remains a challenging problem. This study compared the efficacy of topical tacrolimus ointment with triamcinolone acetonide ointment in patients with oral lichen planus. Twenty patients (group I) were treated with topical tacrolimus 0.1% ointment 4 times daily, and 20 (group II) were treated with triamcinolone acetonide 0.1% ointment 4 times daily. The clinical effect was graded after 6 weeks. In group I, 6 patients healed, 12 showed improvement and 2 showed no improvement. In group II, 2 patients healed, 7 improved and 11 showed no improvement. The most commonly reported side-effect in both groups was temporary burning or stinging at the site of application. Unfortunately, oral lesions recurred within 3-9 weeks of cessation of treatment in 13 of the 18 patients who had initially shown an improvement or were healed in group I and in 7 of the 9 patients in group II. Topical tacrolimus 0.1% ointment induced a better initial therapeutic response than triamcinolone acetonide 0.1% ointment. However, relapses occurred frequently within 3-9 weeks of the cessation of treatment.
Oral Diseases, 2017
Objective To carry out a double-blind RCT to compare the effectiveness of topical tacrolimus (TAC), triamcinolone acetonide (TRI) and placebo (PLA) in symptomatic OLP. Subjects and methods A clinical score (CS, range 0-130) was developed to measure the clinical signs and symptoms of OLP. Twenty-seven OLP patients with a CS of ≥ 20 were randomly allocated to receive 0.1% TAC ointment (n=11), 0.1% TRI paste (n=7) or Orabase® paste as PLA (n=9) for 3 weeks. If the CS dropped ≥ 20% (interpreted as response), the patients continued the same medication for another 3 weeks. If the CS dropped < 20% or increased (nonresponse), the patients were switched to TAC for 6 weeks. A 6-month follow-up period ensued. The primary outcome variable was the change in CS from baseline to week 3. In primary outcome analysis, CS values between the treatment arms were compared. Results TAC and TRI were more effective (p=0.012 and 0.031, respectively) than PLA in reducing the CS at week 3. No difference in the efficacy was noted between TAC and TRI (p=0.997).
Efficacy of 0.1% tacrolimus in long-term management of erosive lichen planus
Journal of Dermatological Treatment, 2019
This study documented the response of erosive oral lichen planus to exclusive treatment with 0.1% topical tacrolimus over a 12-month period or until the patient became unresponsive to therapy. MATERIALS AND METHODS: A retrospective cohort design was used to acquire data on 12 patients with recalcitrant OLP that were prescribed 0.1% tacrolimus. These patients were prescribed 0.1% tacrolimus after failing to respond to conventional corticosteroid therapy. Information about their response to medication initially and on flare ups were included in this study. RESULTS: The sample consisted of 9 women and 3 men. All patients were given 0.1% tacrolimus to be applied 3 times a day. Two patients did not respond to the treatment at all, 4 patients showed partial response to tacrolimus treatment. Six patients showed complete initial response to treatment. CONCLUSION: 50% of our patients showed a suboptimal response to 0.1% tacrolimus use for erosive OLP, thus suggesting that in some cases 0.1% tacrolimus may be an ineffective option for managing erosive OLP.
Oral lichen planus treated with tacrolimus 0.1%
International Journal of Clinical and Experimental Medicine
Oral lichen planus (OLP) is considered a chronic autoimmune inflammatory disease and its presence may be related to increased emotional stress. The clinical relevance of OLP is the possibility of developing a squamous cell carcinoma, the etiology of which is still unknown. The aim of this study is to treat OLP lesions resistant to conventional treatment with corticosteroids, using topical tacrolimus 0.1% (Protopic(®)) twice a day for a period of eight weeks. Fifteen patients were selected who had filled out a history form and a visual analog scale for pain before and after treatment. All patients underwent an initial biopsy to diagnose the disease and another at the end of the treatment period to evaluate the effect of the medication on the infiltrate. A weekly check was carried out, observing the clinical appearance, pain symptoms and occurrence of side effects which, where present, were mild and transient. The results showed twelve patients (80%) with total or nearly total remission of pain symptoms and lesions, two patients (13.33%) showed clearer lesions and only one patient (6.67%) had no change in clinical symptoms or pain. Histopathological analysis showed OLP had a moderate or strong regression in twelve patients (80%) and an absent or mild regression in three patients (20%). Based on these results, it was concluded that tacrolimus 0.1% (Protopic(®)) is a safe and effective medication that improves the clinical appearance of the lesion, reduces pain as well as the histopathological features of OLP.
Topical tacrolimus and pimecrolimus in the treatment of oral lichen planus: an update
Journal of Oral Pathology & Medicine, 2010
BACKGROUND: The search for new drugs capable of controlling the symptoms and signs of oral lichen planus (OLP) with minimal side-effects remains an important challenge. OBJECTIVE: A literature review is made to evaluate the effectiveness and safety of topical tacrolimus and pimecrolimus in the treatment of OLP. MATERIAL AND METHOD: A review was made of the studies published between 1999 and 2008 in relation to the topical application of tacrolimus and pimecrolimus in OLP. RESULTS: The data obtained point to the need for larger randomized, placebo-controlled studies with carefully selected and standardized endpoints, to allow adequate comparison between treatments. The adverse effects were fundamentally of a local nature, and in particular included burning sensation in the application zone. All the studies consulted found the treatment to be effective over short periods of time, with lesion recurrences after suppression of the drug. The long-term safety remains to be established. CONCLUSION: There is need for larger placebo-controlled, randomized studies with carefully selected and standardized outcome measures.
Topical Tacrolimus in the Treatment of Symptomatic Oral Lichen Planus -A Systematic Review
IOSR Journals , 2019
Background and Aim: Tacrolimus (FK506) is an immunomodulatory agent which is used topically for the treatment of Oral Lichen Planus.There is variation in the concentration of topical tacrolimus used, frequency and duration of the treatment among different authors. Also, vast literature wherein tacrolimus is compared with other therapeutic modalities is available. The aim of this systematic review is to evaluate the efficiency of Tacrolimus in the treatment of symptomatic Oral Lichen Planus. Methods: A systematic literature search was conducted until December 2018 using PubMed, Scopus, Cochrane library,Science Direct and Google scholar databases to identify human clinical trials with topical tacrolimus as one of the interventionsand published in English. Studies for which complete electronic data was available on internet was included in the study. Quality assessment was done based on recommendation of CONSORT statement and 'Cochrane Hand Book'. Results: A total of 409 articles were initially identified. From these only those articles which fulfilled the inclusion and exclusion criteria were chosen. Finally, a total of 15 articles were included in the study. After quality assessment it was found that 4 articles had low risk of bias, 6 had moderate risk of bias and 5 studies had high risk of bias. Conclusion:The existing evidence proves with no doubt that topical 0.1% and 0.03% tacrolimus are effective in the treatment of lichen planus. More studies that have a low risk of bias and long term follow up may be required to standardise the protocol for usage of topical tacrolimus for treating oral lichen planus.
Medicina oral, patología oral y cirugía bucal
The lichen planus is a mucocutaneous disease with unknown etiology and auto-immune pathogenia. There have been three variants of lichen planus: the reticular, the plaque-like and the atrophic-erosive lesions. It s a chronic disease with acute relapses that generally affects more frequently to women from the fourties. The diagnostic is based on the clinic identification of the lesions joined with the histopathologic study (basal cells hidropic degeneration, linfoplasmocitic infiltration and absence of displasy signs). The great number of therapeutic options are explained for its high prevalency (0.5-2%), its recurrence and its risk for malignant transformation. We present a case of oral erosive lichen planus, refractory to numerous treatments, mainly corticosteroids. During 15 days the lesion responded to the administration of a 0.1% tacrolimus in topic application. This article tries to show the new indication of tacrolimus, a calcineurin inhibitor immunosuppressor, that it is effec...
Ulcerative lichen planus of the sole: excellent response to topical tacrolimus
International journal of dermatology, 2008
Ulcerative lichen planus of the sole is a rare variant of lichen planus, characterized by chronic painful disabling ulceration of the soles. Despite many treatment modalities used to treat ulcerative lichen planus, it is still considered a resistant disease. We report a Saudi female patient with ulcerative lichen planus of the soles resistant to many systemic and topical agents. We used topical tacrolimus 0.1% ointment with excellent response and complete healing in a few weeks as well as good maintenance during a follow-up period of more than 2 years.