Objective To evaluate the efficacy and safety of pimecrolimus for oral lichen planus (OLP). Methods We searched The Cochrane Library, MEDLINE (1990 to 2007), EMBASE (1990 to 2007), and the Chinese Biomedicine Database (1990 to 2007) to collect parallel group randomized controlled trials (RCTs) and cross-over trials comparing pimecrolimus with triamcinolone acctonide or placebo. The Cochrane Collaboration’s RevMan 4.2 software was used for data analyses. Results Three RCTs were included. Meta-analyses showed that pimecrolimus did not improve oral cavity ache measured by VAS (visual analogue scale) (WMD –0.5, 95%CI –9.77 to 8.77), OHIP (oral health impact profile) (WMD 0.9, 95%CI –0.6 to 2.4) and CSS (clinical status score) (WMD 0.00mm2, 95%CI –0.40 to 0.40); compared with triamcinolone acctonide. In comparison to placebo, pimecrolimus did not improve oral cavity ache measured by VAS (WMD –3.30, 95%CI –20.20 to 13.92) or CSS (WMD –56.57, 95%CI -134.02 to 20.88) and did not reduce burning sensations (OR 4.98, 95%CI 0.49 to 50.22) as well. Conclusion Pimecrolimus should not be regarded as a better choice than triamcinolone acctonide or placebo for improving the VAS, OHIP or CSS of patients with oral lichen planus. Since the RCTs available for this systematic review are too small, further high-quality large-scale RCTs with standard clinical evaluation are required to provide more reliable evidence.