Efficacy of Topical Calcineurin Inhibitors in Oral Lichen Planus

Background: Oral lichen planus (OLP) is associated with severe pain and significant impairment for patients. Objective: To evaluate the safety and efficacy of topical calcineurin inhibitors (TCI) in the treatment of OLP. Methods: Medline and the Cochrane Database were searched using the keywords “calcineurin inhibitor OR tacrolimus OR pimecrolimus” AND “oral lichen planus.” Results: Four retrospective studies that looked at the effects of tacrolimus on OLP; 4 randomized, double-blind clinical trials (RDBCT) comparing tacrolimus with topical corticosteroids; and 5 RDBCT comparing pimecrolimus with placebo or triamcinolone were noted. Six open prospective and multiple case reports assessing the efficacy of calcineurin inhibitor for treatment of diverse types of OLP were found. Conclusion: There is strong evidence to suggest that the use of tacrolimus 0.1% ointment and pimecrolimus 1% cream is superior or equally efficacious as traditional therapies for OLP. Topical calcineurin inhibitors are well tolerated, with no significant systemic adverse effects.

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Efficacy of Topical Calcineurin Inhibitors in Lichen Planus

Journal of Cutaneous Medicine and Surgery ◽

10.1177/120347541201600403 ◽

2012 ◽

Vol 16 (4) ◽

pp. 221-229 ◽

Cited By ~ 15

Author(s):

Michael Samycia ◽

Andrew N. Lin

Keyword(s):

Lichen Planus ◽

Strong Evidence ◽

Oral Lichen Planus ◽

Case Reports ◽

Calcineurin Inhibitors ◽

Double Blind ◽

Tacrolimus Ointment ◽

Topical Tacrolimus ◽

Topical Calcineurin Inhibitors ◽

Oral Lichen

Background: Topical calcineurin inhibitors have been studied in many skin disorders, including lichen planus. Objective: To evaluate published reports of the use of topical calcineurin inhibitors in lichen planus. Methods: We searched PubMed, Ovid/Cochrane, and Embase using the keywords “tacrolimus,” “pimecrolimus,” “topical calcineurin inhibitors,” and “lichen planus.” Results: We examined 5 double-blind studies, 1 investigator-blinded study, 10 open prospective studies, 6 retrospective studies, and 28 case reports evaluating tacrolimus or pimecrolimus for oral, vulvovaginal, and cutaneous lichen planus. Conclusions: Strong evidence (double-blind and open studies) supports the use of topical tacrolimus ointment in oral lichen planus, with efficacy at least equal to topical clobetasol propionate 0.05% ointment. Treatment of oral lichen planus with topical tacrolimus ointment can result in demonstrable blood tacrolimus levels, but without clinically significant adverse events. Strong evidence (double-blind and open studies) supports the use of topical pimecrolimus 1% cream in oral lichen planus, with efficacy equal to that of topical triamcinolone acetonide 0.1% paste. For vulvovaginal lichen planus, pimecrolimus was superior to placebo in one double-blind study, and tacrolimus was effective in open studies. Only case reports support the efficacy of topical calcineurin inhibitors in cutaneous lichen planus.

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Faculty Opinions recommendation of Challenges in using topical calcineurin inhibitors as a treatment for recalcitrant oral lichen planus.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736383711.793572589 ◽

2020 ◽

Author(s):

Neil Shear

Keyword(s):

Lichen Planus ◽

Oral Lichen Planus ◽

Calcineurin Inhibitors ◽

Topical Calcineurin Inhibitors ◽

Oral Lichen

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Clinical and serological efficacy of topical calcineurin inhibitors in oral lichen planus: a prospective randomized controlled trial

International Journal of Dermatology ◽

10.1111/ijd.12887 ◽

2015 ◽

Vol 55 (1) ◽

pp. 101-105 ◽

Cited By ~ 8

Author(s):

Suruchi Vohra ◽

Archana Singal ◽

Suman Bala Sharma

Keyword(s):

Randomized Controlled Trial ◽

Lichen Planus ◽

Oral Lichen Planus ◽

Controlled Trial ◽

Calcineurin Inhibitors ◽

Randomized Controlled ◽

Topical Calcineurin Inhibitors ◽

Prospective Randomized Controlled Trial ◽

Oral Lichen

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Challenges in using topical calcineurin inhibitors as a treatment for recalcitrant oral lichen planus

British Journal of Dermatology ◽

10.1111/bjd.18304 ◽

2019 ◽

Vol 181 (6) ◽

pp. 1120-1120 ◽

Cited By ~ 1

Author(s):

K. Thongprasom

Keyword(s):

Lichen Planus ◽

Oral Lichen Planus ◽

Calcineurin Inhibitors ◽

Topical Calcineurin Inhibitors ◽

Oral Lichen

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The use of topical calcineurin inhibitors in the management of oral lichen planus

Journal of the European Academy of Dermatology and Venereology ◽

10.1111/j.1468-3083.2006.01953.x ◽

2006 ◽

Vol 0 (0) ◽

pp. 070209222700080-???

Author(s):

SI Chaudhry ◽

S Pabari ◽

TA Hodgson ◽

SR Porter

Keyword(s):

Lichen Planus ◽

Oral Lichen Planus ◽

Calcineurin Inhibitors ◽

Topical Calcineurin Inhibitors ◽

Oral Lichen

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Topical calcineurin inhibitors in the treatment of oral lichen planus: a systematic review and meta‐analysis

British Journal of Dermatology ◽

10.1111/bjd.17898 ◽

2019 ◽

Vol 181 (6) ◽

pp. 1166-1176 ◽

Cited By ~ 8

Author(s):

S.‐L. Sun ◽

J.‐J. Liu ◽

B. Zhong ◽

J.‐K. Wang ◽

X. Jin ◽

...

Keyword(s):

Systematic Review ◽

Lichen Planus ◽

Oral Lichen Planus ◽

Meta Analysis ◽

Calcineurin Inhibitors ◽

Topical Calcineurin Inhibitors ◽

Oral Lichen

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Pimecrolimus cream 1% in erosive oral lichen planus–a prospective randomized double-blind vehicle-controlled study

Yearbook of Dermatology and Dermatologic Surgery ◽

10.1016/s0093-3619(08)79170-6 ◽

2009 ◽

Vol 2009 ◽

pp. 153-154

Author(s):

B.H. Thiers

Keyword(s):

Lichen Planus ◽

Oral Lichen Planus ◽

Controlled Study ◽

Double Blind ◽

Oral Lichen

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Salivary Antioxidant Status in Patients with Oral Lichen Planus: Correlation with Clinical Signs and Evolution during Treatment withChamaemelum nobile

BioMed Research International ◽

10.1155/2018/5187549 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Asta Tvarijonaviciute ◽

Cristina Aznar-Cayuela ◽

Camila P. Rubio ◽

Fernando Tecles ◽

Jose J. Ceron ◽

...

Keyword(s):

Antioxidant Capacity ◽

Lichen Planus ◽

Antioxidant Status ◽

Oral Lichen Planus ◽

Clinical Signs ◽

Total Antioxidant Status ◽

Double Blind ◽

Reducing Ability ◽

Chamaemelum Nobile ◽

Oral Lichen

Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disease, which manifests as a succession of outbreaks. OLP was associated with salivary oxidative stress. Randomized, double blind, parallel-group study was performed. The sample consisted of 55 clinically and histopathologically diagnosed OLP patients. Twenty-six patients were treated with 2%Chamaemelum nobilegel and 29 with a placebo. Nonstimulated (basal) saliva was collected on the first day of the study and 4 weeks later. Salivary total antioxidant status (TAS) was evaluated by four different methods: two TAC (6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid) equivalent antioxidant capacity methods (TAC1 and TAC2), cupric reducing antioxidant capacity (CUPRAC), and ferric reducing ability of plasma (FRAP). At baseline (T1), no statistically significant differences were detected in any of the TAS analytes between the two groups of patients. After four weeks of treatment, a statistically significant increase was detected in FRAP in the placebo group (0.323 [0.090–0.467] versus 0.406 [0.197–0.848] mmol/g⁎10-3) (P<0.05). Significant correlations were observed between pain and drainage and TAC1, CUPRAC, and FRAP and between xerostomia and the TAC1, TAC2, CUPRAC, and FRAP. The results of the present study showed that in patients with OLP increases of TAS in saliva are associated with increase in pain and xerostomia and decrease in drainage, suggesting a worsening condition of the patient. The use ofChamaemelum nobilegel would be recommended for disease stabilization.

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