Efficacy and safety of tacrolimus for local steroid-ineffective oral lichen planus

Objective

Local steroid therapy is the first-line treatment for oral lichen planus (OLP); however, steroid-resistant cases are often observed. Local tacrolimus therapy is a good candidate as an effective treatment option for steroid-ineffectiveness. In this study, we retrospectively investigated the efficacy and safety of local tacrolimus for local steroid-ineffective OLP.

Materials and methods

Twenty one patients with OLP who visited our clinic between January 2017 and December 2022 and received local tacrolimus therapy were included. We evaluated the clinical type, histopathological features, therapeutic efficacy, and side effects. Therapeutic efficacy was assessed by Reticulation/keratosis, Erythema, and Ulceration scores (REUs) and Numerical Rating Scale (NRS) scores and compared between local steroid and tacrolimus.

Results

When we evaluated the clinical characteristics of the patients, red type was predominant (90.5%), and histologically, epithelium thinning was prominent (76.2%). No significant reduction of REUs was observed after steroid treatment (p = 0.227, rate of change score; +0.7%); however, tacrolimus-switching showed a significant effect not only on REUs but also NRS scores (p = 0.0000639, rate of change score; −73.5%). Oral candidiasis (five cases) and irritation (one case) were observed as side effects; however, no patients showed canceration.

Conclusions

Local tacrolimus should be one of the treatment options for steroid-resistant OLP.