Efficacy of Topical Calcineurin Inhibitors in Oral Lichen Planus

BACKGROUND: Oral lichen planus (OLP) is associated with severe pain and significant impairment for patients. OBJECTIVE: To evaluate the safety and efficacy of topical calcineurin inhibitors (TCI) in the treatment of OLP. METHODS: Medline and the Cochrane Database were searched using the keywords "calcineurin inhibitor OR tacrolimus OR pimecrolimus" AND "oral lichen planus." RESULTS: Four retrospective studies that looked at the effects of tacrolimus on OLP; 4 randomized, double-blind clinical trials (RDBCT) comparing tacrolimus with topical corticosteroids; and 5 RDBCT comparing pimecrolimus with placebo or triamcinolone were noted. Six open prospective and multiple case reports assessing the efficacy of calcineurin inhibitor for treatment of diverse types of OLP were found. CONCLUSION: There is strong evidence to suggest that the use of tacrolimus 0.1% ointment and pimecrolimus 1% cream is superior or equally efficacious as traditional therapies for OLP. Topical calcineurin inhibitors are well tolerated, with no significant systemic adverse effects.