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Topical calcineurin inhibitors might be effective for the treatment of oral lichen planus

Data suggest that the use of topical tacrolimus 0.1% ointment and pimecrolimus 1% cream appear to be superior or equally efficacious as traditional therapies for oral lichen planus, researchers reported in a study published in the Journal of Cutaneous Medicine and Surgery (Dec. 2015; 19(6):539–545).

“We have known for a long time now that strong topical steroids and systemic steroids have been used for the treatment of oral lichen planus,” said the corresponding author Dr. Bahman Sotoodian.

“In more recent times, however, topical calcineurin inhibitors (TCIs) have been used widely to treat oral lichen planus, and TCIs seem to offer a significant condition improvement with less side effects

compared with the traditional interventions,” said Dr. Sotoodian, a dermatology resident at the University of Alberta in Edmonton.

Dr. Sotoodian added that the aim of their investigation was to evaluate the safety and efficacy of TCIs in the treatment of oral lichen planus.

Literature reviewed

During the investigation, Dr. Sotoodian and his colleagues conducted Medline and Cochrane Database of Systematic Reviews searches using keywords such as “calcineurin inhibitor OR tacrolimus OR pimecrolimus” AND “oral lichen planus.”

The studies included in the review were published between 1999 and 2014. The accepted literature consisted of four retrospective studies that looked at the effects of tacrolimus on oral lichen planus; four randomized, double-blind clinical trials comparing tacrolimus with topical corticosteroids; and five trials comparing pimecrolimus with placebo or triamcinolone.

Additionally, the authors noted that six open prospective and multiple case reports assessing the efficacy of TCIs for treatment of diverse types of oral lichen planus were found.

Efficacy of TCIs examined

The findings based on the numerous studies reviewed by the investigators revealed that there is strong evidence to suggest that the use of tacrolimus 0.1% ointment and pimecrolimus 1% cream is superior or equally efficacious as some of the traditional therapies that have been used in the past to treat oral lichen planus, the authors wrote.

“It was very interesting for us to find out that TCIs are more efficacious and have better results than various strong topical corticosteroids used in the treatment of oral lichen planus, and that was the main significant finding of our literature review study,” Dr. Sotoodian said.

“Using TCIs for the treatment of oral lichen planus on a regular basis can significantly not only reduce the disease, but also may improve patients quality of life, and it can be used for the long term treatment of oral lichen planus. [Interestingly,] TCIs may help put oral lichen planus into remission for a long time.”

Both tacrolimus 0.1% ointment and pimecrolimus 1% cream appear to be well tolerated and few untoward reactions have been reported in the literature, the authors wrote. Dr. Sotoodian said that the reported side effects were minor and consisted of irritation and a burning sensation. Additionally, the authors reported that the systemic absorption of topical tacrolimus ointment in oral lichen planus has been reported, but there were no clinically significant adverse effects.

“There were two cases in the literature suggesting that long-term use of TCIs might be associated with squamous cell carcinoma (SCC) within the oral cavity, however, the problem is that the disease by itself can lead to a significant inflammatory presentation of it, which can cause SCC,” Dr. Sotoodian cautioned.

“More research is need to determine whether the medication is causing SCC or whether it is being caused by oral lichen planus by itself. It is unlikely the TCIs is causing the SCC because there were only two cases of SCC reported in an entire pool of data that we collected.”

Dr. Sotoodian indicated that they plan to investigate the potential connection between TCIs and SCC.

“I definitely think clinicians should be cautious about the potential of SCC. When treating patients with oral lichen planus, if the treating physician notices any significant changes within the area they should not hesitate to biopsy to rule out the possibility of a malignancy,” he said.

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