Department of Dermatology, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
J Eur Acad Dermatol Venereol. 2022 Dec;36(12):2459-2465. doi: 10.1111/jdv.18457. Epub 2022 Aug 3.
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.
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).
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.
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.
局部他克莫司已被证明对口腔扁平苔藓（OLP）的治疗有益。然而，长期效果及其最佳应用方案（逐渐减少）尚未得到研究。因此，我们在日常临床实践中分析了 OLP 对他克莫司的临床反应，重点关注最佳的长期治疗方案。
回顾性分析 2015 年至 2020 年间在临床环境中使用局部他克莫司（0.03%漱口液）治疗的所有连续诊断为 OLP 的患者。客观临床反应通过 4 分制（完全缓解、主要缓解、部分缓解和无反应）进行测量，主观损害通过 3 分制（严重、中度和无）进行测量。
共纳入 57 例患者（74%为女性；中位年龄：66 岁）。56 例（98%）患者曾接受过局部皮质类固醇治疗。在使用他克莫司后，分别有 28%、62%、87%和 97%的患者在 3、6、12 和 24 个月时达到客观缓解（主要或完全缓解）。分别有 16%、48%、69%和 83%的患者在治疗 3、6、12 和 24 个月后报告主观缓解。治疗频率可逐渐从最初的每日两次减少至每日一次或更少，分别在 3、6、12 和 24 个月后减少至 28%、61%、78%和 87%；41%的患者曾一度完全停止治疗，但 67%的患者在中位时间为 3.3 个月后复发。4 例（7%）患者在观察期间发生鳞状细胞癌（SCC）。否则，只有少数轻微的副作用。
局部他克莫司可能是对强效局部皮质类固醇治疗反应不佳的 OLP 的有效二线治疗方法。在维持治疗期间，治疗频率通常可以降低。临床活动和主观损害的迹象都应指导治疗。需要定期随访以识别可能的 SCC。
