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Dr. Sangita Singh
Dr. J. P. Swain
Dr. Atul Dilip Mohankar
Dr. Silpi Lakra


Topical tacrolimus, Oral lichen planus, Topical calcineurin inhibitor


Background & objective - With limited resources of therapeutic options for the management of oral lichen planus (OLP), treatment is often challenging. With promising results of topical tacrolimus, we initiated our study to evaluate its efficacy in OLP on an outpatient basis in daily clinical practice.

Methods - This prospective study enrolled 42 clinically and histopathologically diagnosed OLP patients in a tertiary clinical setup and then were treated with 0.1% topical tacrolimus and evaluated between the years 2020 to 2022. Initially, topical tacrolimus 0.1% ointment was advised for twice daily application and then the dose was reduced to twice weekly to once in a week application for patients who improved after treatment. For the measurement of objective clinical response 4- point scale (complete remission (CR), major remission (MR), partial remission (PR), no response (NO), and for subjective response (pain assessment) 3- point scale (severe, mild to moderate and none) were used.

Results - Complete remission (CR) of objective clinical response was achieved in 9 (21.4%) out of 42 patients at 3 months and in 8 patients (19%) at 6 months. For patients who belonged to MR group 11(26.1%) and PR 16 (38%) at 3 months, the therapy was continued for further 6 months. Of those at 6 months, 8 patients showed CR, 11 patients MR, and 5 patients PR. After 3 months of therapy, all 6 patients with initial severe score of pain achieved a significant improvement. 11 out of 15 patients with mild to moderate score reported complete loss of pain. Overall, the pain improvement was very good. No relevant side effects other than transitory burning sensation and altered taste sensation were reported. No squamous cell carcinoma (SCC) was reported.

Conclusions- Topical tacrolimus could be a good treatment alternative for all forms of OLP where other treatment modalities have failed for initial therapy. For the maintenance therapy, the frequency of application should be reduced guided by both signs of clinical activity and subjective impairment. Possibility of developing SCC mandates for regular follow-up.

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