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Outcome and long‐term treatment protocol for topical tacrolimus in oral lichen planus

BACKGROUND AND OBJECTIVE: Topical tacrolimus has been shown to be beneficial in the treatment of oral lichen planus (OLP). However, long‐term effects and its optimal application protocol with gradual reduction have not been studied. Accordingly, we analysed the clinical response of OLP to tacrolimus...

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Autores principales: Utz, S., Suter, V.G.A., Cazzaniga, S., Borradori, L., Feldmeyer, L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9804806/
https://www.ncbi.nlm.nih.gov/pubmed/35870137
http://dx.doi.org/10.1111/jdv.18457
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author Utz, S.
Suter, V.G.A.
Cazzaniga, S.
Borradori, L.
Feldmeyer, L.
author_facet Utz, S.
Suter, V.G.A.
Cazzaniga, S.
Borradori, L.
Feldmeyer, L.
author_sort Utz, S.
collection PubMed
description BACKGROUND AND OBJECTIVE: Topical tacrolimus has been shown to be beneficial in the treatment of oral lichen planus (OLP). However, long‐term effects and its optimal application protocol with gradual reduction have not been studied. Accordingly, we analysed the clinical response of OLP to tacrolimus in our daily clinical practice with a focus on the optimal long‐term therapeutic scheme. METHODS: Retrospective analysis of all consecutive patients diagnosed with OLP and treated with topical tacrolimus (0.03% oral rinse) in a clinical setting between 2015 and 2020. The objective clinical response was measured by a 4‐point scale (complete remission, major remission, partial remission and no response), and subjective impairment by a 3‐point scale (severe, moderate and none). RESULTS: Fifty‐seven patients (74% women; median age: 66 years) were included. Fifty‐six (98%) patients had prior treatment with topical steroids. After introduction of tacrolimus, objective remission (major or complete) was reached by 28%, 62%, 87% and 97% of patients after 3, 6, 12 and 24 months respectively. Subjective remission was reported by 16%, 48%, 69% and 83% after 3, 6, 12 and 24 months of treatment respectively. The treatment frequency could be gradually reduced from initially twice daily to once daily or less in 28%, 61%, 78% and 87% after 3, 6, 12 and 24 months respectively; 41% of patients completely suspended the treatment at one point, but 67% of them experienced a relapse after a median time of 3.3 months. Four patients (7%) developed a squamous cell carcinoma (SCC) during the observation period. Otherwise, there were only few and minor side‐effects. CONCLUSION: Topical tacrolimus can be an effective second‐line therapy for OLP refractory to potent topical corticosteroids. The therapy frequency can often be reduced during the maintenance period. Both signs of clinical activity and subjective impairment should guide therapy. Regular follow‐up is necessary to recognize possible SCC.
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spelling pubmed-98048062023-01-06 Outcome and long‐term treatment protocol for topical tacrolimus in oral lichen planus Utz, S. Suter, V.G.A. Cazzaniga, S. Borradori, L. Feldmeyer, L. J Eur Acad Dermatol Venereol Original Articles and Short Reports BACKGROUND AND OBJECTIVE: Topical tacrolimus has been shown to be beneficial in the treatment of oral lichen planus (OLP). However, long‐term effects and its optimal application protocol with gradual reduction have not been studied. Accordingly, we analysed the clinical response of OLP to tacrolimus in our daily clinical practice with a focus on the optimal long‐term therapeutic scheme. METHODS: Retrospective analysis of all consecutive patients diagnosed with OLP and treated with topical tacrolimus (0.03% oral rinse) in a clinical setting between 2015 and 2020. The objective clinical response was measured by a 4‐point scale (complete remission, major remission, partial remission and no response), and subjective impairment by a 3‐point scale (severe, moderate and none). RESULTS: Fifty‐seven patients (74% women; median age: 66 years) were included. Fifty‐six (98%) patients had prior treatment with topical steroids. After introduction of tacrolimus, objective remission (major or complete) was reached by 28%, 62%, 87% and 97% of patients after 3, 6, 12 and 24 months respectively. Subjective remission was reported by 16%, 48%, 69% and 83% after 3, 6, 12 and 24 months of treatment respectively. The treatment frequency could be gradually reduced from initially twice daily to once daily or less in 28%, 61%, 78% and 87% after 3, 6, 12 and 24 months respectively; 41% of patients completely suspended the treatment at one point, but 67% of them experienced a relapse after a median time of 3.3 months. Four patients (7%) developed a squamous cell carcinoma (SCC) during the observation period. Otherwise, there were only few and minor side‐effects. CONCLUSION: Topical tacrolimus can be an effective second‐line therapy for OLP refractory to potent topical corticosteroids. The therapy frequency can often be reduced during the maintenance period. Both signs of clinical activity and subjective impairment should guide therapy. Regular follow‐up is necessary to recognize possible SCC. John Wiley and Sons Inc. 2022-08-03 2022-12 /pmc/articles/PMC9804806/ /pubmed/35870137 http://dx.doi.org/10.1111/jdv.18457 Text en © 2022 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles and Short Reports
Utz, S.
Suter, V.G.A.
Cazzaniga, S.
Borradori, L.
Feldmeyer, L.
Outcome and long‐term treatment protocol for topical tacrolimus in oral lichen planus
title Outcome and long‐term treatment protocol for topical tacrolimus in oral lichen planus
title_full Outcome and long‐term treatment protocol for topical tacrolimus in oral lichen planus
title_fullStr Outcome and long‐term treatment protocol for topical tacrolimus in oral lichen planus
title_full_unstemmed Outcome and long‐term treatment protocol for topical tacrolimus in oral lichen planus
title_short Outcome and long‐term treatment protocol for topical tacrolimus in oral lichen planus
title_sort outcome and long‐term treatment protocol for topical tacrolimus in oral lichen planus
topic Original Articles and Short Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9804806/
https://www.ncbi.nlm.nih.gov/pubmed/35870137
http://dx.doi.org/10.1111/jdv.18457
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