Two cases of oral steroid and local tacrolimus combination therapy for oral lichen planus ineffective with local steroid therapy

Abstract

Oral lichen planus is a T cell-dependent chronic inflammatory disease. Local steroid therapy is the first choice of drug therapy, but there are cases where this proves to be ineffective, with side effects such as candidiasis and mucosal atrophy. Oral steroid therapy is considered in refractory cases; however, the long-term prognosis after tapering off is similar to that of local steroid therapy. Therefore, it may be necessary to combine oral steroid therapy with a treatment that is more effective and has fewer side effects than the local steroid therapy. Local tacrolimus therapy has been reported to be associated with a lower risk of mucosal atrophy and oral candidiasis and is more effective than local steroid therapy. Here, we report two cases of refractory ulcer-type oral lichen planus in which local steroid therapy was ineffective, and long-term improvement was achieved by combination therapy with oral steroids and local tacrolimus therapy.