[Pimecrolimus (Elidel) for therapy of lichen ruber mucosae]

Oral lichen planus (OLP) is a common chronic inflammatory disorder with criteria of auto-reactive disease. Treatment consists on topical application of corticosteroids, vitamin A derivates or cyclosporin. Calcineurin inhibitors as tacrolimus and pimecrolimus decrease the production of cytokines and inhibit T-cell proliferation. These substances have recently been introduced for local therapy of chronic inflammatory skin disorders. The aim of our study was to evaluate the effectiveness and side effects of local pimecrolimus in OLP. A group of five patients with histological proven OLP were treated with topical pimecrolimus 1% ointment twice daily to the affected area. Prior to treatment and after 7, 14, 28 and 42 days the lesions were assessed clinically and by photographs. The discomfort scores were evaluated by visual analogue scale (VAS) weekly. All five patients (median age 65.6 years) were female and showed involvement of the buccal mucosa. All lesions showed a reduction of inflammation activity during the treating period. The VAS scores decreased significantly under treatment (p=0,0014). Pimecrolimus ointment was tolerated well with no signs of itching or burning. However, 4 out of 5 patients complained about the reduced adherence properties of the cream. Although no complete remission of OLP has been observed in our series, signs of inflammatory activity of OLP as redness and burning sensations were reduced by topical pimecrolimus. Further controlled randomized studies have to be conducted to compare topical pimecrolimus with topical corticosteroid as standard therapy. The adherence properties of pimecrolimus 1% cream should be improved for intra-oral application.