Desquamative gingivitis treatment with topical tacrolimus applied to a custom tray: an open trial regarding its efficacy on patients' symptoms

OBJECTIVE

To evaluate the efficacy of topical tacrolimus offered on a custom tray to treat desquamative gingivitis (DG).

STUDY DESIGN

Eighteen patients with symptomatic DG related to oral lichen planus (OLP) or mucous membrane pemphigoid (MMP) were selected, of which 13 completed the study. Periodontal treatment was followed by the fabrication of a custom silicone tray to apply a tacrolimus gel formulation (0.1%). Clinical evaluation (complaint of pain and burning - visual analog scale from 0 to 10; and the presence of erythema, desquamation, vesicle/blister, erosion, ulcer, and bleeding) was performed by the same examiner on day 1, and every 15 days for 90 days.

RESULTS

Total remission was found in 4 patients (30.76%). Partial remission was found in 69.24% of the patients, classified with an excellent (30.76%), good (30.76%), and regular (7.69%) recovery, respectively. There was a reduction of about 60% in pain and 65% in burning sensation complaints. Wilcoxon test revealed significant differences between pre- and post-treatment pain and burning sensation symptoms (P < .01).

CONCLUSION

Topical application of 0.1% tacrolimus gel was effective in the treatment of DG in controlling pain and burning sensation, leading to the clinical remission of gingival lesions in patients with OLP and MMP.

Possible alternative therapies for oral lichen planus cases refractory to steroid therapies

Oral lichen planus (OLP) is a chronic inflammatory disorder with a multifactorial etiopathogenesis. Immune dysregulation plays a critical role in the development and progression of this disease. Patients' lives may be affected by pain caused by atrophic-erosive lesions. Given the obscure etiology, treatment is usually symptomatic. Topical steroids remain the mainstay of management. However, their therapeutic benefits are not always evident. There are substantial data on the possible therapeutic strategies that are effective in OLP cases refractory to steroids. This review provides an overview of the current approaches for the management of steroid-refractory OLP. The miscellaneous treatment regimens include tacrolimus, pimecrolimus, thalidomide, low-level laser therapy, photodynamic therapy, and surgical excision. Some results obtained from these studies were promising. However, further studies, especially randomized controlled trials with strict inclusion and exclusion criteria and larger sample sizes, are required for the evaluation of the long-term safety and efficacy of these therapies.

Efficacy of Topical Calcineurin Inhibitors in Oral Lichen Planus

Background:

Oral lichen planus (OLP) is associated with severe pain and significant impairment for patients.

Objective:

To evaluate the safety and efficacy of topical calcineurin inhibitors (TCI) in the treatment of OLP.

Methods:

Medline and the Cochrane Database were searched using the keywords “calcineurin inhibitor OR tacrolimus OR pimecrolimus” AND “oral lichen planus.”

Results:

Four retrospective studies that looked at the effects of tacrolimus on OLP; 4 randomized, double-blind clinical trials (RDBCT) comparing tacrolimus with topical corticosteroids; and 5 RDBCT comparing pimecrolimus with placebo or triamcinolone were noted. Six open prospective and multiple case reports assessing the efficacy of calcineurin inhibitor for treatment of diverse types of OLP were found.

Conclusion:

There is strong evidence to suggest that the use of tacrolimus 0.1% ointment and pimecrolimus 1% cream is superior or equally efficacious as traditional therapies for OLP. Topical calcineurin inhibitors are well tolerated, with no significant systemic adverse effects.

Isolated lichen planus of the lip

Oral lichen planus (OLP) is a relatively common disorder whose cause is still unknown. It occurs mostly on the buccal mucosa, but the gingivae, tongue, floor of the mouth and retromalar pads may also be affected. It rarely occurs on the lips and usually in association with oral lesions. We report a case series of ten patients with a history of isolated swelling of the lower and/or upper lip, erosions and crusting. General medical history, examination of the oral cavity and recording of signs and symptoms were carried out for each patient. Among the six different clinical variants of OLP described by Andreasen, the atrophic-erosive form was the most common in the course of isolated LP of the lip in our series. Five cases presented HCV hepatitis. A complete remission of lesions was observed in eight patients after topical treatment with clobetasol propionate 0.05 percent and tocopherol oil, while partial improvement was noted in those remaining. Isolated LP of the lip is unusual and presents a diagnostic challenge; however an appropriate differential diagnosis is fundamental. Lesions of the lips might represent a more or less precocious phase of oral involvement. Moreover the reasons for the unique localization on the lips need to be explored. Several variables, including age, duration of lesions, concomitance of other diseases, and genetic predisposition may be involved. Isolated LP of the lip is a well-known condition which responds well to topical treatment with corticosteroids. A thorough medical management and active early treatment are necessary to improve symptoms and might also be a relevant prevention strategy from squamous cell carcinoma risk, although data to fully support this statement still need investigation.