Efficacy of Topical Calcineurin Inhibitors in Lichen Planus

Abstract

Topical calcineurin inhibitors have been studied in many skin disorders, including lichen planus. To evaluate published reports of the use of topical calcineurin inhibitors in lichen planus. We searched PubMed, Ovid/Cochrane, and Embase using the keywords "tacrolimus," "pimecrolimus," "topical calcineurin inhibitors," and "lichen planus. " 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. 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.