Treatment of Oral Erosive Lichen Planus With Pimecrolimus Cream
Treatment of Oral Erosive Lichen Planus With Pimecrolimus Cream
Background and hypothesis. Oral erosive lichen planus (OELP) is a severe form of mucosal
 lichen planus. Lesions often induce intense pain and limit feeding. Its course is chronic
 with flares and spontaneous remissions are rare. Treatment is difficult: topical steroids are
 usually used first but antimalarials, oral retinoids, systemic steroids, immunosuppressive
 drugs and even extracorporeal photochemotherapy can be necessary for treating severe forms.
 The need for novel therapies with less morbidity is obvious. Calcineurin inhibitors have a
 theoretical interest in treating OELP: this has been emphasized by several open studies
 performed with topical tacrolimus. The effectiveness of 1% pimecrolimus cream has been
 suggested by a few case reports and by one recent comparative study which confirmed the
 potential interest of topical pimecrolimus in treating OELP. The absorption of pimecrolimus
 through human mucosa is still unknown. Its application on ulcerative lesions such as OELP
 ones, could lead to significant systemic levels of the molecule.

 Objective: To evaluate the efficacy of 1% pimecrolimus cream in treating oral erosive lichen
 planus (OELP) and to assess its tolerance.
Background and hypothesis. Oral erosive lichen planus (OELP) is a severe form of mucosal
 lichen planus. Lesions often induce intense pain and limit feeding. Its course is chronic
 with flares and spontaneous remissions are rare. Treatment is difficult: topical steroids are
 usually used first but antimalarials, oral retinoids, systemic steroids, immunosuppressive
 drugs and even extracorporeal photochemotherapy can be necessary for treating severe forms.
 The need for novel therapies with less morbidity is obvious. Calcineurin inhibitors have a
 theoretical interest in treating OELP: this has been emphasized by several open studies
 performed with topical tacrolimus. The effectiveness of 1% pimecrolimus cream has been
 suggested by a few case reports and by one recent comparative study which confirmed the
 potential interest of topical pimecrolimus in treating OELP. The absorption of pimecrolimus
 through human mucosa is still unknown. Its application on ulcerative lesions such as OELP
 ones, could lead to significant systemic levels of the molecule.

 Objective: To evaluate the efficacy of 1% pimecrolimus cream in treating oral erosive lichen
 planus (OELP) and to assess its tolerance.

 Design: Double blind randomized trial with placebo control.

 Settings: Outpatients of the Department of Dermatology of the University hospital of Nice,
 France.

 Patients: Fourteen consecutive patients with OELP confirmed by histological examination and
 with a clinical score superior to 3. 1% pimecrolimus cream or its vehicle were applied on
 ulcerated lesions twice a day for 4 weeks.

 Main outcome measures; the efficacy of the treatment was quantified using a 12 points
 clinical score. Blood level of pimecrolimus was analyzed at D0, D14 and D28.
Inclusion Criteria:

 -  Confirmation of the diagnosis of OELP by histological examination and a clinical score
 superior to 3

 Exclusion Criteria:

 -  Patients under 18 years

 -  Pregnancy or breast feeding

 -  Malignancy

 -  Severe or recurrent infections

 -  Uncontrolled chronic disorders

 -  Congenital or acquired immunosuppression and concomitant treatments potentially
 effective on OELP such as antimalarials, oral retinoids, steroids or immunosuppressive
 drugs