Treatment of oral lichen planus with topical pimecrolimus 1% cream

Sir, Oral lichen planus (OLP) is a chronic inflammatory disease that occurs in about 1·9% of the population.1 No cure for OLP exists. Treatment is focused primarily on reducing symptoms through immune response modulation, mainly using corticosteroids with widely known side‐effects.2 We describe the first three patients with OLP who were managed using topical pimecrolimus 1% cream. Patient 1. A 44‐year‐old woman was seen in November 2002, with plaques in the mouth and a moderate burning sensation first noticed in January 2002. She had been a heavy smoker for 25 years until 1996, and had received nystatin treatment from April to October 2002. Examination showed white homogeneous and reticular plaques covering the dorsum of the tongue, erosions and scars on the right upper and lower gingiva, and a reticular plaque on the left buccal mucosa. Three biopsy specimens were taken. Two samples established the diagnosis of OLP. One sample revealed hyperorthokeratosis with a slight dispersed chronic inflammatory infiltrate, which corresponded to the white homogeneous lingual plaque. Tests for hepatitis B and C virus were negative. Laboratory analyses were normal. Pimecrolimus cream 1% (Elidel®; Novartis, Mexico) was administered topically twice daily after meals and following oral hygiene; by itself in the morning but with the addition of adhesive denture paste (dilution 1 : 10) at night. Substantial pain relief was reported after the first week of treatment. At 4 weeks, clearance of OLP lesions was observed and all symptoms had resolved, with the exception of three small plaques on the tongue. Based on the previous biopsy and considering the possibility of tobacco‐related keratosis, the remaining three plaques on the tongue were removed surgically after 2 months of pimecrolimus treatment; these demonstrated hyperkeratosis microscopically. The patient continued pimecrolimus treatment at night, three times weekly, until April 2003. In May 2003, no recurrences were observed; also, oral candidosis was not detected by exfoliative cytology.