Pimecrolimus in an adhesive ointment as a new treatment option for oral lichen planus

Sir, Lichen planus (LP) is a chronic inflammatory mucocutaneous disease. The involvement of mucous membranes is frequently seen. Although usually asymptomatic, the disorder is occasionally complicated by extensive painful erosions, causing a considerable loss of quality of life. We report for the first time the successful treatment of oral LP (OLP) with topical pimecrolimus in an adhesive ointment vehicle. An 81‐year‐old woman was referred to our outpatient clinic with a 5‐year history of relapsing painful erosive stomatitis resistant even to potent topical steroids. The diagnosis of OLP was verified clinically and histologically. The remaining integument showed no further pathological findings; the patient had OLP exclusively. Examination showed persistent typical clinical features of OLP (Fig. 1A,B) and treatment with pimecrolimus was initiated. Pimecrolimus adhesive ointment was prepared by mixing Elidel® 1% cream (Novartis, Nürnberg, Germany) 1:1 with a hydrophilic adhesive gel base and was applied twice daily. Components of this adhesive gel base, which is chiefly utilized in patients with mucosal disorders, are: hydroxyethylcellulose 250 G (Ph. Eur. 4·00) 9·0 g, propylene glycol (Ph. Eur. 4·00) 7·5 g, disodium edetate (Ph. Eur. 4·00) 0·075 g, methyl 4‐hydroxybenzoate (Ph. Eur. 4·00) 0·06 g, propyl 4‐hydroxybenzoate (Ph. Eur. 4·00) 0·02 g and purified water (Ph. Eur. 4·00) added to 100·0 g. The final concentration obtained was 5 mg g−1 pimecrolimus. After 4 months of treatment nearly complete resolution of the OLP was documented (Fig. 2A,B). No side‐effects were observed, except for a slight burning sensation immediately following the application of the pimecrolimus ointment.