Effects of Tacrolimus on Oral Lichen Planus: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

WU Bohai ¹ , LI Chengzhang ¹ ,  GUO Yi ²

1. Department of Periodontopathy, Medical School of Stomatology, Wuhan University, Wuhan 430079, China;2. Department of Epidemiology, School of Public Health, Wuhan University, Wuhan 430071, China;

Corresponding author：

GUO Yi, Email: yiguowhu@163.com

Keywords：

Oral lichen planus; Tacrolimus; Glucocorticoid; Systematic review

DOI：

10.7507/1672-2531.20110123

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Objective 　To systematically evaluate the efficacy and safety of tacrolimus and glucocorticoid for oral lichen planus (OLP).
Methods 　The Cochrane review’s method was adopted and computer-based retrieval was performed on The Cochrane Library, MEDLINE, EMbase, CBM, and CNKI (from their establishment to November 2010) to collect randomized controlled trials (RCTs) comparing the clinical efficacy of tacrolimus in treating OLP with that of triamcinolone. The study was selected according to the inclusion and exclusion criteria, the data were collected, and the methodological quality of the included studies was evaluated. The RevMan 5.0.25 software was applied for statistical analyses.
Results 　Four RCTs involving 164 patients were included. Two studies showed that the tacrolimus effectively reduced lesion area and alleviated pain of patients with OLP. The results of meta-analyses showed that the total effective rate of tacrolimus was not higher than that of glucocorticoid (OR=4.38, 95%CI 0.67 to 28.73), and there was no significant difference between the tacrolimus group and the glucocorticoid group in adverse events during the treatment session (OR=3.49, 95%CI 0.49 to 24.84), and there was no significant difference in recurrence rate between those two groups (OR=0.82, 95%CI 0.27 to 2.46).
Conclusion 　Topical tacrolimus can remarkably improve the OLP sign (lesion area) and symptom (pain), which is in line with the findings of other non-RCTs. The current evidence proves that the tacrolimus is similar to glucocorticoid in terms of the total effective rate of treating OLP, the incidence of side reaction during treatment, and the recurrence rate after stopping treatment. Some studies included in this systematic review apply different assessment methods, hence more RCTs with high-quality, multi-center, and therapeutic evaluation indexes with corresponding evaluation methods are required to provide more reliable evidence.

Citation： WU Bohai,LI Chengzhang,GUO Yi. Effects of Tacrolimus on Oral Lichen Planus: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2011, 11(6): 706-710. doi: 10.7507/1672-2531.20110123 Copy

1.	1 Setterfield JF, Black MM, Challacombe SJ. The management of oral lichen planus. Clin Exp Dermatol , 2000, 25(3): 176-182.
2.	2 Dissemond J. Oral lichen planus: an overview. J Dermatolog Treat , 2004, 15(3): 136-140.
3.	4 López-Jornet P, Camacho-Alonso F, Salazar-Sanchez N. Topical tacrolimus and pimecrolimus in the treatment of oral lichen planus: an update. J Oral Pathol Med , 2010, 39(3): 201-205.
4.	7 Corrocher G, Di Lorenzo G, Martinelli N, et al . Comparative effect of tacrolimus 0.1% ointment and clobetasol 0.05% ointment in patients with oral lichen planus. J Clin Periodontol , 2008, 35(3): 244-249.
5.	8 Radfar L, Wild RC, Suresh L. A comparative treatment study of topical tacrolimus and clobetasol in oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod , 2008, 105(2): 187-193.
6.	9 Laeijendecker R, Tank B, Dekker SK, et al . A comparison of treatment of oral lichen planus with topical tacrolimus and triamcinolone acetonide ointment. Acta Derm Venereol , 2006, 86(3): 227-229.
7.	10 Vente C, Reich K, Rupprecht R, et al . Erosive mucosal lichen planus: response to topical treatment with tacrolimus. Br J Dermatol , 1999, 140(2): 338-342.
8.	11 Rozycki TW, Rogers RS 3rd, Pittelkow MR, et al . Topical tacrolimus in the treatment of symptomatic oral lichen planus: a series of 13 patients. J Am Acad Dermatol , 2002, 46(1): 27-34.
9.	12 Kaliakatsou F, Hodgson TA, Lewsey JD, et al . Management of recalcitrant ulcerative oral lichen planus with topical tacrolimus. J Am Acad Dermatol , 2002, 46(1): 35-41.
10.	13 Olivier V, Lacour JP, Mousnier A, et al . Treatment of chronic erosive oral lichen planus with low concentrations of topical tacrolimus: an open prospective study. Arch Dermatol , 2002, 138(10): 1335-1338.
11.	14 Morrison L, Kratochvil FJ 3rd, Gorman A. An open trial of topical tacrolimus for erosive oral lichen planus. J Am Acad Dermatol , 2002, 47(4): 617-620.
12.	15 Byrd JA, Davis MD, Bruce AJ, et al . Response of oral lichen planus to topical tacrolimus in 37 patients. Arch Dermatol , 2004, 140(12): 1508-1512.
13.	16 Hodgson TA, Sahni N, Kaliakatsou F, et al . Long-term efficacy and safety of topical tacrolimus in the management of ulcerative/erosive oral lichen planus. Eur J Dermatol , 2003, 13(5): 466-470.
14.	17 Eckardt A, Volker B, Starke O, et al . Topical tacrolimus in erosive oral lichen planus: an eﬀective treatment approach. Oral Biosci Med , 2005, 4: 235-240.
15.	18 Thomson MA, Hamburger J, Stewart DG, et al . Treatment of erosive oral lichen planus with topical tacrolimus. J Dermatolog Treat , 2004, 15(5): 308-314.
16.	19 Fricain JC, Sibaud V, Campana F, et al . Mucosal pigmentation after oral lichen planus treatment with topical tacrolimus. Dermatology , 2005, 210(3): 229-232.
17.	20 Lozada-Nur FI, Sroussi HY. Tacrolimus powder in Orabase 0.1% for the treatment of oral lichen planus and oral lichenoid lesions: an open clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod , 2006, 102(6): 744-749.
18.	21 Niwa Y, Terashima T, Sumi H. Topical application of the immunosuppressant tacrolimus accelerates carcinogenesis in mouse skin. Br J Dermatol , 2003, 149(5): 960-967.
19.	22 Spergel JM, Leung DY. Safety of topical calcineurin inhibitors in atopic dermatitis: evaluation of the evidence. Curr Allergy Asthma Rep , 2006, 6(4): 270-274.
20.	孙玉亮, 赵今, 吴泰相, 等. 口腔扁平苔藓治疗的系统评价. 中国循证医学杂志, 2009, 9(3): 323-330.
21.	苏士文, 程喆, 闫俊杰. 他克莫司软膏治疗糜烂型口腔扁平苔藓的效果观察. 海峡药学, 2010, 22(3): 153-154.
22.	杨卫平, 杨建强. 他克莫司软膏治疗口腔糜烂型扁平苔藓的疗效观察. 实用口腔医学杂志, 2010, 26(1): 108-109.

1. 1 Setterfield JF, Black MM, Challacombe SJ. The management of oral lichen planus. Clin Exp Dermatol , 2000, 25(3): 176-182.
2. 2 Dissemond J. Oral lichen planus: an overview. J Dermatolog Treat , 2004, 15(3): 136-140.
3. 4 López-Jornet P, Camacho-Alonso F, Salazar-Sanchez N. Topical tacrolimus and pimecrolimus in the treatment of oral lichen planus: an update. J Oral Pathol Med , 2010, 39(3): 201-205.
4. 7 Corrocher G, Di Lorenzo G, Martinelli N, et al . Comparative effect of tacrolimus 0.1% ointment and clobetasol 0.05% ointment in patients with oral lichen planus. J Clin Periodontol , 2008, 35(3): 244-249.
5. 8 Radfar L, Wild RC, Suresh L. A comparative treatment study of topical tacrolimus and clobetasol in oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod , 2008, 105(2): 187-193.
6. 9 Laeijendecker R, Tank B, Dekker SK, et al . A comparison of treatment of oral lichen planus with topical tacrolimus and triamcinolone acetonide ointment. Acta Derm Venereol , 2006, 86(3): 227-229.
7. 10 Vente C, Reich K, Rupprecht R, et al . Erosive mucosal lichen planus: response to topical treatment with tacrolimus. Br J Dermatol , 1999, 140(2): 338-342.
8. 11 Rozycki TW, Rogers RS 3rd, Pittelkow MR, et al . Topical tacrolimus in the treatment of symptomatic oral lichen planus: a series of 13 patients. J Am Acad Dermatol , 2002, 46(1): 27-34.
9. 12 Kaliakatsou F, Hodgson TA, Lewsey JD, et al . Management of recalcitrant ulcerative oral lichen planus with topical tacrolimus. J Am Acad Dermatol , 2002, 46(1): 35-41.
10. 13 Olivier V, Lacour JP, Mousnier A, et al . Treatment of chronic erosive oral lichen planus with low concentrations of topical tacrolimus: an open prospective study. Arch Dermatol , 2002, 138(10): 1335-1338.
11. 14 Morrison L, Kratochvil FJ 3rd, Gorman A. An open trial of topical tacrolimus for erosive oral lichen planus. J Am Acad Dermatol , 2002, 47(4): 617-620.
12. 15 Byrd JA, Davis MD, Bruce AJ, et al . Response of oral lichen planus to topical tacrolimus in 37 patients. Arch Dermatol , 2004, 140(12): 1508-1512.
13. 16 Hodgson TA, Sahni N, Kaliakatsou F, et al . Long-term efficacy and safety of topical tacrolimus in the management of ulcerative/erosive oral lichen planus. Eur J Dermatol , 2003, 13(5): 466-470.
14. 17 Eckardt A, Volker B, Starke O, et al . Topical tacrolimus in erosive oral lichen planus: an eﬀective treatment approach. Oral Biosci Med , 2005, 4: 235-240.
15. 18 Thomson MA, Hamburger J, Stewart DG, et al . Treatment of erosive oral lichen planus with topical tacrolimus. J Dermatolog Treat , 2004, 15(5): 308-314.
16. 19 Fricain JC, Sibaud V, Campana F, et al . Mucosal pigmentation after oral lichen planus treatment with topical tacrolimus. Dermatology , 2005, 210(3): 229-232.
17. 20 Lozada-Nur FI, Sroussi HY. Tacrolimus powder in Orabase 0.1% for the treatment of oral lichen planus and oral lichenoid lesions: an open clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod , 2006, 102(6): 744-749.
18. 21 Niwa Y, Terashima T, Sumi H. Topical application of the immunosuppressant tacrolimus accelerates carcinogenesis in mouse skin. Br J Dermatol , 2003, 149(5): 960-967.
19. 22 Spergel JM, Leung DY. Safety of topical calcineurin inhibitors in atopic dermatitis: evaluation of the evidence. Curr Allergy Asthma Rep , 2006, 6(4): 270-274.
20. 孙玉亮, 赵今, 吴泰相, 等. 口腔扁平苔藓治疗的系统评价. 中国循证医学杂志, 2009, 9(3): 323-330.
21. 苏士文, 程喆, 闫俊杰. 他克莫司软膏治疗糜烂型口腔扁平苔藓的效果观察. 海峡药学, 2010, 22(3): 153-154.
22. 杨卫平, 杨建强. 他克莫司软膏治疗口腔糜烂型扁平苔藓的疗效观察. 实用口腔医学杂志, 2010, 26(1): 108-109.

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