tacrolimus and Lichen-Planus

Annular atrophic lichen planus (AALP) is a rare variant of lichen planus. It is differentiated from other variants of lichen planus by a reduction of elastin fibers in the superficial dermis, which is a feature specific to this subtype. It has clinical features of both annular and atrophic lichen planus and has a chronic course. AALP does not usually respond to topical or systemic steroids, and a consensus regarding a treatment ladder is yet to be reached. Topical tacrolimus may be considered as a treatment option. Annular atrophic lichen planus is a relatively unknown condition, which may remain undiagnosed and difficult to manage, owing to a paucity of literature and lack of consensus on management.

Topics: Elastic Tissue; Humans; Lichen Planus; Tacrolimus

Vulvovaginal lichen planus (VVLP) is a debilitating disease that causes significant pain and psychological distress. Management is made difficult by the chronic course of the disease and its resistance to treatment. While topical steroids have been accepted as the first-line treatment, they fail to achieve symptomatic control in approximately 40% of patients. Second-line therapies include other topical treatments such as calcineurin inhibitors, systemic therapies including oral steroids, methotrexate, mycophenolate mofetil, biologics, and tacrolimus, and procedural options including surgery and dilation, photodynamic therapy, and ultrasound. This review provides an overview of the current treatments and explores the level of evidence supporting each of them.

Topics: Administration, Oral; Administration, Topical; Algorithms; Antibodies, Monoclonal; Calcineurin Inhibitors; Dermatologic Agents; Drug Therapy, Combination; Female; Glucocorticoids; Gynecologic Surgical Procedures; Humans; Lichen Planus; Methotrexate; Mycophenolic Acid; Photochemotherapy; Tacrolimus; Ultrasonic Therapy; Vulvovaginitis

Lichen planus (LP) is a chronic-relapsing inflammatory skin disease. Although many drugs have been used for the management of LP, some of them lack the backup by strong therapeutic evidence, while others are not suitable for some patients due to safety profile issues. The aim of this study was to review the recent status of available medical therapies for LP to help physicians make better decisions upon best medical practice while facing patients with this condition. A review of published articles on management of LP was conducted with the MEDLINE and PubMed databases. The quality of the evidence was graded as high, moderate, low or very low. A total of 1366 articles were retrieved, and 219 (16%) were included in the final analysis. Twenty-one different treatment modalities were analysed. The quality of evidence was high for topical steroid and calcineurin inhibitor, while it was moderate for oral steroids. All the other modalities reached low or very low quality of evidence. Topical steroids and calcineurin inhibitors are the current first-line therapies, while for other therapies the strength of recommendation is not so evident. Unfortunately, larger randomized, controlled trials to support the efficacy, safety and tolerability of other therapies in LP are lacking, and many of them are recommended based on studies with small sample sizes, lack of standardized outcome measures or lack of controlled duration or even in anecdotal evidence. Thus, large-scale randomized clinical trials are still warranted to establish the exact benefits of other topical treatments, phototherapy, immunosuppressant and new immunomodulators for an optimized treatment of LP.

Topics: Administration, Oral; Administration, Topical; Adrenal Cortex Hormones; Antifungal Agents; Calcineurin Inhibitors; Calcitriol; Cyclosporine; Dapsone; Dermatologic Agents; Enoxaparin; Evidence-Based Medicine; Humans; Hydroxychloroquine; Lichen Planus; Methotrexate; Mycophenolic Acid; Retinoids; Tacrolimus; Ultraviolet Therapy

Inflammatory mucosal disorders are treated conventionally with potent or superpotent topical corticosteroids. For more than 20 years, topical cyclosporine has been used in the management of oral mucous membrane affections. Recently other topically applied calcineurin inhibitors, namely tacrolimus and pimecrolimus, expanded the armamentarium for the treatment of inflammatory mucosal diseases. This chapter places its main emphasis on the efficacy and safety of topical calcineurin inhibitors in the management of different oral and genital conditions, including anogenital lichen sclerosus (LS), oral and genital lichen planus, plasma cell balanitis and vulvitis, mucous membrane pemphigoid and pemphigus vulgaris, all conditions having usually a protracted course, requiring long-lasting treatment. There is current evidence for the effectiveness of both pimecrolimus and tacrolimus in the topical treatment of inflammatory oral mucosal diseases and genital dermatoses, especially oral lichen planus and genital LS.

Topics: Administration, Topical; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Balanitis; Calcineurin Inhibitors; Carcinogens; Female; Genital Diseases, Female; Humans; Lichen Planus; Lichen Planus, Oral; Lichen Sclerosus et Atrophicus; Male; Mucositis; Paraneoplastic Syndromes; Pemphigoid, Benign Mucous Membrane; Pemphigus; Tacrolimus; Vulvitis

Clinically significant involvement of the esophagus is uncommon in patients who have lichen planus, a common disorder of squamous epithelium. In three patients who had oral, cutaneous, and esophageal lichen planus, endoscopic intralesional esophageal injection of corticosteroids (in all three patients) and oral tacrolimus (FH506) (in two patients) resulted in improvement in dysphagia, a less frequent need for dilation, and improvement in esophageal inflammation.

Topics: Administration, Oral; Adrenal Cortex Hormones; Aged; Biopsy, Needle; Esophagitis; Esophagoscopy; Female; Follow-Up Studies; Humans; Immunohistochemistry; Injections, Intralesional; Lichen Planus; Risk Assessment; Severity of Illness Index; Tacrolimus; Treatment Outcome

Treatment of frontal fibrosing alopecia (FFA) is complicated and challenging. In this study, we evaluated the efficacy of combining topical tacrolimus with isotretinoin versus finasteride in patients with FFA.. Thirty-one patients with FFA were divided randomly into two groups. Therapeutic regimen of the first group (group A, n = 16) was isotretinoin and tacrolimus (Capsule isotretinoin 20 mg daily and topical tacrolimus 0.1% BD). The second group (group B, n = 15) was given finasteride and tacrolimus (Tablet finasteride 2.5 mg daily and topical tacrolimus 0.1% BD). Patients were treated and followed up periodically for 12 weeks. Evaluation of the treatment efficacy was based on Patient Global Assessment and Physician Global Assessment scales. Objective evaluation was based on improving the severity of skin lesions by viewing serial images taken from the affected areas.. Physician Global Assessment (PGA) was significantly better in the group A as compared with the group B at 4 weeks (p = 0.038). Physician satisfaction in the group A was better than the group B at 12 weeks, but this was not statistically significant (p > 0.05). Patient Global Assessment and patient satisfaction in the group A was better than the group B at 8 and 12 weeks, but it was not statistically significant (p > 0.05).. Although both therapeutic regimens were effective in the treatment of FFA, treatment with tacrolimus and isotretinoin is significantly more effective than tacrolimus and finasteride.

Topics: Alopecia; Finasteride; Humans; Isotretinoin; Lichen Planus; Tacrolimus; Treatment Outcome

Lichen planus pigmentosus (LPP) is an uncommon variant of lichen planus, for which no effective treatment is available. Objectives The aim of this study was to determine the clinical, epidemiological and histopathological characteristics of LPP patients in Kuwait.. Thirty-three LPP patients who attended the Dermatology outpatient clinics at Farwaniya Hospital, Kuwait from the year 2002 to 2008 were studied for clinical, epidemiological and histopathological findings. Thirteen of these patients were treated with topical tacrolimus 0.03%. Ointment applied topically twice daily for the duration varying from 6 to 12 weeks.. Of the 33 patients, 21 were men and 12 were women. The duration of eruption ranged from 6 weeks to 3 years. The face and neck were the commonest sites, affecting 18 (54.5%) patients. The pattern of pigmentation was diffuse in 18 (54.54%) patients, reticular in seven (21.2%), blotchy in five (15.2%), linear in two (6.1%) and perifollicular in one (3%). Twenty patients had positive serology for hepatitis C virus (HCV), with significantly higher serum liver enzymes (ALT and AST). Of the 13 patients, who were treated with tacrolimus Ointment, seven (53.8%) showed appreciable lightening of the pigmentation after an average of 12 weeks.. We conclude that HCV may be one of the factors associated with LPP, in those who have a tendency to develop LPP. However, this possible association should be interpreted carefully. In addition, tacrolimus ointment could have a beneficial role in the treatment of LPP.

Topics: Adult; Female; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Ointments; Prospective Studies; Tacrolimus

Lichen striatus is a well-known, acquired, self-healing, linear inflammatory dermatosis. Lichen striatus occurring in adults tends to be more extensive and itchy than in children, sometimes requiring symptomatic treatment. The therapeutic approach usually adopted is topical steroids, even though prolonged use may lead to several side-effects, particularly cutaneous atrophy.. To report the results of an open, off-label study on the use of pimecrolimus 1% in the treatment of diffuse, nonresponsive forms of lichen striatus.. Three adult patients suffering from relapsing or disseminated and itchy lichen striatus received topical application of pimecrolimus 1% cream (Elidel, Novartis Pharma, Basle, Switzerland) twice daily for 6 weeks, or until complete disappearance of the cutaneous lesions.. All patients experienced rapid healing of the dermatosis, without any recurrence for at least 14 months.. Our preliminary results show that pimecrolimus may represent a useful therapeutic alternative for lichen striatus, although further studies on a larger number of cases are needed to confirm its safety and efficacy in the treatment of this condition.

Topics: Administration, Topical; Adult; Aged; Biopsy, Needle; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Immunohistochemistry; Lichen Planus; Severity of Illness Index; Tacrolimus; Treatment Outcome

Linear lichen planus pigmentosus (LPP) of the face is a rare variant of lichen planus, with only a few cases published in the literature.1 It is an inflammatory condition with unknown etiology, characterized by blue-gray hyperpigmented macules, and tends to affect sun-exposed areas of the head and neck.1-4 The pathophysiology of linear lichen pigmentosus is poorly understood, though it is postulated to be caused by T-lymphocyte autoimmunity against keratinocytes.5-7 LPP more frequently affects middle age woman and skin phototypes III-VI.1,3 Treatment for linear LPP is difficult and there is no established first-line therapy; however, tacrolimus ointment, topical corticosteroids, and various systemic agents have shown to be effective in improving the appearance.3,8,9 Prior reports have characterized linear LPP that follows the lines of Blashko as more commonly affecting the trunk.1 We present three cases of linear lichen planus pigmentosus (LPP) of the forehead, a unique novel presentation of linear LPP of the face. One of our cases also provides supporting evidence for tacrolimus to be used as a preferred therapy to treat linear LPP of the face; however, more research is needed to support this claim. To our knowledge, this case series is the largest case series of linear lichen planus pigmentosus (LPP) of the forehead to be reported. J Drugs Dermatol. 2023;22(1):94-97. doi:10.36849/JDD.7200.

Topics: Female; Forehead; Humans; Hyperpigmentation; Lichen Planus; Middle Aged; Skin; Tacrolimus

Topics: Administration, Topical; Boron Compounds; Bridged Bicyclo Compounds, Heterocyclic; Child; Humans; Lichen Planus; Tacrolimus

Topics: Alopecia; Humans; Lichen Planus; Tacrolimus

Unlike other types of lichen planus (LP), there are no series concerning male genital LP.. To describe the clinical characteristics, diagnosis, and response to treatment of male genital LP.. A retrospective study of male patients with genital LP consulting a dermatologist specialized in anogenital diseases between January 2010 and 2019. Demographic data, history, functional signs, clinical characteristics, pathology, complications, and treatment efficacy were collected.. Eighty-nine patients were included at four centers. The median age was 51 years. Most patients were uncircumcised and asymptomatic. In 88.8% of cases, only the genital mucosa was involved. Erythema (71%), papules (21.3%), lacy network (15.7%), atrophic lesions (15.7%), erosions (14.6%), and post-inflammatory hyperpigmentation (2.2%) were less frequently observed. Biopsy results confirmed LP in 61.3% of cases but could not rule out other inflammatory genital dermatoses in other cases. Anatomic complications were observed in 30.3% of patients. Topical corticosteroids (TCS) induced remission in most cases. Tacrolimus efficacy was comparable to that of TCS.. Male genital LP is a rare inflammatory disorder chiefly affecting uncircumcised men. It is found predominantly on the mucosal component of the penis and presents as non-erosive inflammatory balanitis in most cases, with frequent partial or complete remission on treatment with TCS.

Topics: Genitalia, Male; Glucocorticoids; Humans; Lichen Planus; Male; Middle Aged; Retrospective Studies; Tacrolimus

This study documented the response of erosive oral lichen planus (OLP) to exclusive treatment with 0.1% topical tacrolimus over a 12-month period or until the patient became unresponsive to therapy.. A retrospective cohort design was used to acquire data on 12 patients with recalcitrant OLP that were prescribed 0.1% tacrolimus. These patients were prescribed 0.1% tacrolimus after failing to respond to conventional corticosteroid therapy. Information about their response to medication initially and on flare ups were included in this study.. The sample consisted of nine women and three men. All patients were given 0.1% tacrolimus to be applied 3 times a day. Two patients did not respond to the treatment at all, 4 patients showed partial response to tacrolimus treatment. Six patients showed complete initial response to treatment.. 50% of our patients showed a suboptimal response to 0.1% tacrolimus use for erosive OLP, thus, suggesting that in some cases 0.1% tacrolimus may be an ineffective option for managing erosive OLP.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Drug Administration Schedule; Female; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Retrospective Studies; Tacrolimus; Treatment Outcome

Topics: Adrenal Cortex Hormones; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; COVID-19; Dermatitis, Atopic; Female; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Pemphigus; Psoriasis; SARS-CoV-2; Tacrolimus

Topics: Administration, Topical; Humans; Immunosuppressive Agents; Lichen Planus; Lichen Planus, Oral; Tacrolimus; Tympanic Membrane Perforation

Topics: Administration, Topical; Humans; Immunosuppressive Agents; Lichen Planus; Lichen Planus, Oral; Photosensitivity Disorders; Tacrolimus

Topics: Administration, Oral; Administration, Topical; Biopsy, Needle; Combined Modality Therapy; Facial Dermatoses; Female; Humans; Hydroxychloroquine; Immunohistochemistry; Lichen Planus; Low-Level Light Therapy; Middle Aged; Prognosis; Severity of Illness Index; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Anti-Inflammatory Agents, Non-Steroidal; Humans; Lichen Planus; Male; Middle Aged; Penile Diseases; Tacrolimus; Treatment Outcome

Ulcerative lichen planus (ULP) is a rare variant of lichen planus that is characterized by chronic, painful, and disabling ulcerations. Ulcerative lichen planus has been known to be resistant to many treatments, and therapeutic interventions often involve use of aggressive immunosuppressive medications without satisfactory remission of symptoms. We present the case of a 56-year-old man with an 8-year history of painful ulcerations on the right plantar foot as well as a large ulceration of the left lateral tongue. Biopsy confirmed a suspected diagnosis of plantar ULP. The patient developed marked clinical improvement of the cutaneous and oral mucosal lesions with oral and topical steroids, topical tacrolimus, and oral doxycycline after only 4 weeks of treatment. It is important for dermatologists to be aware of the potential diagnosis of plantar ULP, especially in the evaluation of chronic treatment-resistant ulcers that often have been previously misdiagnosed. We introduce this novel therapeutic regimen as a rapidly effective and relatively safe alternative to conventional immunosuppressive agents for long-term management of plantar ULP.

Topics: Biopsy; Doxycycline; Drug Therapy, Combination; Follow-Up Studies; Foot Ulcer; Glucocorticoids; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Oral Ulcer; Tacrolimus; Treatment Outcome

Frontal fibrosing alopecia (FFA) is a lichen planopilaris-variant scarring alopecia that has rarely been described in men.. To characterize the clinicopathologic findings of FFA in men by studying a series of 7 male patients.. We conducted a retrospective review of all cases of male patients with FFA at the Mayo Clinic from 1992 to 2016.. Seven male patients with FFA were identified. The frontal scalp (in 6 of 7 patients), sideburns (in 4 of 7), and temporal scalp (in 4 of 7) were most frequently involved. Three patients had involvement of the eyebrows. One patient had hair loss of the upper cutaneous lip. All patients had biopsy evidence of lichen planopilaris. None of the patients had associated autoimmune or thyroid disease. Two patients had hypogonadism upon testosterone studies.. Limitations include small sample size and varied follow-up.. Although most often reported among postmenopausal women, FFA also occurs among men. The clinical and histopathologic characteristics of FFA in men parallel those described in women with FFA. Unique areas of involvement in men include sideburns and facial hair. Concomitant mucocutaneous lichen planus, autoimmune disease, and thyroid disease are infrequent among men with FFA. Distribution of hair loss and associated hormonal abnormalities aid in the recognition of FFA in men.

Topics: Adult; Aged; Alopecia; Anti-Inflammatory Agents; Cheek; Cicatrix; Clobetasol; Dermatologic Agents; Eyebrows; Forehead; Humans; Hydroxychloroquine; Lichen Planus; Male; Middle Aged; Retrospective Studies; Scalp; Tacrolimus

Topics: Absorption, Physiological; Administration, Topical; Humans; Immunosuppressive Agents; Lichen Planus; Lichen Planus, Oral; Neoplasms; Tacrolimus

Topics: Administration, Topical; Humans; Immunosuppressive Agents; Lichen Planus; Lichen Planus, Oral; Tacrolimus

Topics: Administration, Topical; Humans; Immunosuppressive Agents; Lichen Planus; Lichen Planus, Oral; Retrospective Studies; Tacrolimus

Topics: Aged; Erythema; Female; Humans; Immunosuppressive Agents; Lichen Planus; Lichen Planus, Oral; Middle Aged; Psoriasis; Scalp; Tacrolimus; Treatment Outcome; Vulva

Topics: Aged; Alopecia; Chloroquine; Diagnosis, Differential; Female; Humans; Hyperpigmentation; Lichen Planus; Tacrolimus; Treatment Outcome

Topics: Abdominal Injuries; Adolescent; Animals; Bites and Stings; Cnidaria; Cnidarian Venoms; Dermis; Diagnosis, Differential; Female; Humans; Immunosuppressive Agents; Lichen Planus; Lichen Sclerosus et Atrophicus; Tacrolimus

Immunosuppressive drugs and other medications may predispose patients to oral diseases. Data on oral mucosal health in recipients of liver transplantation (LT) are limited. We, therefore, recruited 84 LT recipients (64 with chronic liver disease and 20 with acute liver failure) for clinical oral examinations in a cross-sectional, case-control study. Their oral health had been clinically examined before transplantation. The prevalence of oral mucosal lesions (OMLs) was assessed in groups with different etiologies of liver disease and in groups with different immunosuppressive medications, and these groups were compared to controls selected from a nationwide survey in Finland (n = 252). Risk factors for OMLs were evaluated with logistic regression. OMLs were more frequent in LT recipients versus controls (43% versus 15%, P < 0.001), and the use of steroids raised the prevalence to 53%. Drug-induced gingival overgrowth was the single most common type of lesion, and its prevalence was significantly higher for patients using cyclosporine A (CSA; 29%) versus patients using tacrolimus (TAC; 5%, P = 0.007); the prevalence was even higher with the simultaneous use of calcium channel blockers and CSA (47%) or TAC (8%, P = 0.002). Lesions with malignant potential such as drug-induced lichenoid reactions, oral lichen planus-like lesions, leukoplakias, and ulcers occurred in 13% of the patients with chronic liver disease and in 6% of the controls. Every third patient with chronic liver disease had reduced salivary flow, and more than half of all patients were positive for Candida; this risk was higher with steroids. In conclusion, the high frequency of OMLs among LT recipients can be explained not only by immunosuppressive drugs but also by other medications. Because dry mouth affects oral health and OMLs may have the potential for malignant transformation, annual oral examinations are indicated.

Topics: Adult; Aged; Calcium Channel Blockers; Case-Control Studies; Cross-Sectional Studies; Cyclosporine; End Stage Liver Disease; Female; Gingival Diseases; Humans; Immunosuppressive Agents; Leukoplakia; Lichen Planus; Liver Failure, Acute; Liver Transplantation; Logistic Models; Male; Middle Aged; Mouth Mucosa; Oral Ulcer; Prevalence; Risk Factors; Tacrolimus

Lichen planus is an autoimmune inflammatory dermatosis that typically affects the skin but can also involve the stratified squamous epithelium of the external auditory canals and tympanic membranes. Here we report our experience with the clinical presentation, diagnosis, and management of otic lichen planus.. We retrospectively reviewed medical records from January 1, 2001, through May 31, 2011, of patients with a diagnosis of otic lichen planus. Nineteen cases were identified (mean age at diagnosis, 57 years; 15 women). The most common concerns were persistent otorrhea and hearing loss. Other symptoms included plugging, pruritus, tinnitus, pain, and bleeding. The mean symptom duration was 4.0 years (n = 13). Most patients responded well to topical tacrolimus within several months. One patient had a dramatic positive response to rituximab.. Otic lichen planus can lead to persistent hearing loss and should be considered in the differential diagnosis of relentless otorrhea and external auditory canal stenosis. In our experience, topical tacrolimus is the best primary treatment, but alternative therapies could be instituted in severe cases. Early recognition of the nonspecific symptoms of otic lichen planus may lead to prompt treatment and avoidance of irreparable late sequelae.

Topics: Adult; Aged; Antibodies, Monoclonal, Murine-Derived; Diagnosis, Differential; Ear Canal; Ear Diseases; Female; Follow-Up Studies; Hearing Loss; Humans; Immunologic Factors; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Retrospective Studies; Rituximab; Tacrolimus; Treatment Outcome; Tympanic Membrane; Young Adult

This study aimed to report on a novel approach to therapy in a large private dermatogynecology practice using multimodal therapies with adjunctive use of systemic agents where necessary.. This was a retrospective audit of the presentation and management of 131 patients with a clinical diagnosis of vulvovaginal lichen planus.. The most frequently presenting symptoms were genital soreness, itch, and burning. Of the 131 patients, 39 (30%) had extragenital disease, mainly oral. Eighty-four (64%) had no external disease. Twenty-two (17%) had introital erosions as the only visible abnormality. Fifty-five (42%) had some degree of labial fusion. Two had full-thickness vulval intraepithelial neoplasia (VIN). Remission induction was achieved in most patients with superpotent topical steroids, but 53 (40%) of 131 patients used oral prednisolone either as an adjunct therapy or alone. All compliant patients achieved symptomatic and objective disease control in a mean of 7.5 weeks. Of the 131 patients, 48 (37%) required multimodal therapy to maintain their initial improvement. Forty-five (34.3%) patients used topical tacrolimus, usually with topical corticosteroids, for maintenance. Eleven (8.5%) required low-dose weekly methotrexate. Fourteen patients experienced adverse reactions severe enough to lead to the cessation of that treatment. The mean length of follow-up was 6.4 years (range = 1 mo to 15 y). The 2 patients with VIN at presentation have had no recurrence. No other patient has yet developed VIN or carcinoma.. Long-term symptomatic and objective control of vulvovaginal lichen planus is possible but requires multimodal therapies, flexible treatment programs, and the judicious use of oral agents.

Topics: Administration, Oral; Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Inflammatory Agents; Drug Therapy, Combination; Female; Humans; Lichen Planus; Middle Aged; Retrospective Studies; Steroids; Tacrolimus; Treatment Outcome; Vulvar Diseases; Young Adult

Frontal fibrosing alopecia (FFA) is a type of scarring hair loss primarily observed in postmenopausal women and characterized by fronto-tempero-parietal hairline recession, perifollicular erythema, and loss of eyebrows. The incidence is unknown, but the number of women presenting with this condition has significantly increased in recent years. No effective therapy has been established.. The purpose of this study is to present pertinent demographic and clinical findings of patients with FFA seen at an academic hair loss clinic and their responses to various therapeutic interventions.. Patients seen at the Duke University Hair Disorders Research and Treatment Center, Durham, NC, between 2004 and 2011 who met FFA inclusion criteria and signed an informed consent form for participation in the Duke University Hair Disorders Research and Treatment Center database were included in this review.. Nineteen female patients with FFA met our inclusion criteria, the majority of whom were white and postmenopausal. A number of treatments, including topical and intralesional steroids, antibiotics, and immunomodulators, were used with disappointing results in most patients. However, the majority of patients on dutasteride experienced disease stabilization.. This was a retrospective review and outside clinic records were occasionally incomplete.. FFA is an increasingly common form of scarring hair loss, but the origin remains unknown. Without clear understanding of the pathogenesis and evolution of this condition, it is not surprising that treatments to date have been minimally or not effective. At our institution, dutasteride was most effective in halting disease progression, although no therapy was associated with significant hair regrowth.

Topics: 5-alpha Reductase Inhibitors; Adult; Aged; Alopecia; Anti-Bacterial Agents; Azasteroids; Cicatrix; Dutasteride; Enzyme Inhibitors; Eyebrows; Female; Fibrosis; Forehead; Hospitals, University; Humans; Hydroxychloroquine; Immunosuppressive Agents; Lichen Planus; Methotrexate; Middle Aged; Minocycline; Osteoporosis, Postmenopausal; Retrospective Studies; Scalp; Tacrolimus; Treatment Outcome

Topics: Adrenergic beta-Antagonists; Angiotensin Receptor Antagonists; Diabetes Mellitus; Forehead; Humans; Hypoglycemic Agents; Immunosuppressive Agents; Kidney Failure, Chronic; Lasers, Solid-State; Lichen Planus; Low-Level Light Therapy; Male; Middle Aged; Sulfonylurea Compounds; Tacrolimus; Treatment Outcome

Topics: Biopsy; Child, Preschool; Humans; Immunosuppressive Agents; Lichen Planus; Male; Phenotype; Skin; Tacrolimus

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Child; Drug Therapy, Combination; Female; Histamine Antagonists; Humans; Immunosuppressive Agents; Lichen Planus; Obesity; Pruritus; Remission Induction; Tacrolimus

Topics: Aged; Female; Foot Dermatoses; Humans; Immunosuppressive Agents; Lichen Planus; Skin Ulcer; Tacrolimus

Topics: Administration, Topical; Adolescent; Adult; Child; Female; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Nail Diseases; Tacrolimus; Treatment Outcome; Young Adult

A specialized Vulva Clinic with dedicated gynecologists and dermatologists was established in Oslo, Norway, in 2003. Fifty-eight women referred to the clinic in 2003-2009 were diagnosed with genital erosive lichen planus. All patients filled out a questionnaire. Gynecological examination, including vaginal inspection, was performed, if necessary in general anesthesia. Median age at symptom start was 51 years (range 17-78 years) with 15 women (26%) being younger than 40 years old. Sexual abstinence was reported by 36 women and dyspareunia by another 10. On examination, vaginal involvement was seen in 49 women, including vaginal synechiae in 29 and total obliteration of the vagina in 9. Of 56 women treated with topical corticosteroids for at least three months, two had complete response and 36 partial responses. Similarly, of 22 women treated with tacrolimus, three had complete and six partial response. We conclude that vaginal involvement is more common in genital erosive lichen planus than previously reported.

Topics: Adolescent; Adult; Age Distribution; Aged; Biopsy, Needle; Cohort Studies; Female; Follow-Up Studies; Humans; Immunohistochemistry; Immunosuppressive Agents; Incidence; Lichen Planus; Middle Aged; Mucous Membrane; Norway; Quality of Life; Retrospective Studies; Risk Assessment; Severity of Illness Index; Tacrolimus; Treatment Outcome; Vaginal Diseases; Vulvar Diseases; Young Adult

Linear lichen planopilaris of the face is a rare variant of lichen plano- pilaris. Asymptomatic follicular papules in a linear configuration are the characteristic clinical features. The incidence is still unknown, but there are a few cases reported exclusively in male adults. We present the case of a fourteen-year-old girl with linear lichen planopilaris of the face. Improvement was obtained with the use of tacrolimus 0.03 percent ointment.

Topics: Adolescent; Facial Dermatoses; Female; Humans; Lichen Planus; Ointments; Tacrolimus

Topics: Administration, Topical; Dermatologic Agents; Face; Humans; Lichen Planus; Male; Middle Aged; Photosensitivity Disorders; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Aged; Humans; Immunosuppressive Agents; Lichen Planus; Male; Tacrolimus

Topics: Administration, Topical; Child, Preschool; Follow-Up Studies; Hand Dermatoses; Humans; Immunosuppressive Agents; Lichen Planus; Male; Nails, Malformed; Risk Assessment; Tacrolimus; Treatment Outcome

Lichen planopilaris (LPP) is an inflammatory condition of unknown etiology that affects pilosebaceous units, mainly of the scalp, and results in scaring alopecia.. A 51-year-old male presented with a pruritic eruption on the cheek consisting of atrophic macules and erythematous folliculocentric papules.. Biopsy revealed a perifollicular lymphocytic infiltrate and vacuolar degeneration of the dermoepidermal junction consistent with LPP. Many treatment modalities have been utilized, with varying degrees of success. Our patient responded poorly to topical steroids. After nine months of topical tacrolimus therapy, his lesions resolved entirely.. The treatment of our patient demonstrates tacrolimus as a novel topical therapeutic option for patients with LPP.

Topics: Erythema; Facial Dermatoses; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Tacrolimus; Treatment Outcome

Topics: Adrenal Cortex Hormones; Biopsy, Needle; Chronic Disease; Disease Progression; Drug Therapy, Combination; Female; Humans; Immunohistochemistry; Lichen Planus; Needs Assessment; Prognosis; Quality of Life; Risk Assessment; Severity of Illness Index; Tacrolimus; Vulvovaginitis

Topics: Administration, Oral; Administration, Topical; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Child; Cross-Sectional Studies; Female; Humans; Immunosuppressive Agents; International Cooperation; Lichen Planus; Male; Middle Aged; Prognosis; Severity of Illness Index; Tacrolimus; Treatment Outcome; Vaginal Diseases; Vulvar Diseases; Vulvovaginitis; Young Adult

Topics: Administration, Topical; Aged; Anti-Inflammatory Agents; Clobetasol; Drug Resistance; Humans; Immunosuppressive Agents; Lichen Planus; Male; Ointments; Tacrolimus

Ulcerative lichen planus of the sole is a rare variant of lichen planus, characterized by chronic painful disabling ulceration of the soles. Despite many treatment modalities used to treat ulcerative lichen planus, it is still considered a resistant disease. We report a Saudi female patient with ulcerative lichen planus of the soles resistant to many systemic and topical agents. We used topical tacrolimus 0.1% ointment with excellent response and complete healing in a few weeks as well as good maintenance during a follow-up period of more than 2 years.

Topics: Administration, Cutaneous; Aged; Female; Foot; Foot Dermatoses; Foot Ulcer; Humans; Immunosuppressive Agents; Lichen Planus; Skin; Tacrolimus

To describe the characteristics of women diagnosed with erosive vulvar lichen planus and the outcome of treatment utilized by a single practitioner.. A retrospective review of 113 women with erosive vulvar lichen planus. Data were abstracted, including demographic information, medical history, vulvar symptom scores and treatments utilized. Dyspareunia and vulvar symptom scores before and following treatment were compared.. The mean age at presentation for women with lichen planus was 50 years. Comorbid medical and vulvar conditions were commonly noted. Sexually active women noted an improvement in dyspareunia symptom score and report of pain-free intercourse. Other symptoms described by women at the first visit included: burning (n = 76), itching (69), pain (43) and abnormal discharge (71). While these symptoms were significantly reduced at the final visit (p < 0.05 for each), the presence of vulvovaginal symptoms commonly waxed and waned in this group. Overall, 33% had resolution of symptoms, and 19% had improvement without resolution of symptoms.. This cohort extends our understanding of the characteristics of women with erosive vulvar lichen planus and emphasizes its characteristically chronic course. While the recognition of erosive vulvar lichen planus may prevent unnecessary medical and surgical procedures, continued efforts to improve treatment should be investigated.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Female; Humans; Immunosuppressive Agents; Lichen Planus; Middle Aged; Retrospective Studies; Tacrolimus; Vulvar Diseases

The ulcerative variant of lichen planus (LP) commonly involves the oral mucosa but is uncommon and difficult to treat when located on other areas. We describe an unusual case of ulcerative LP involving several surfaces, including the palms and scrotum, in a 50-year-old man with hepatitis C. The patient was recalcitrant to treatment with conventional therapy but obtained clearance with a sustained response using low molecular weight heparin (LMWH). This treatment is an option for patients with LP who are not ideal candidates for standard therapy.

Topics: Anti-Inflammatory Agents; Anticoagulants; Clobetasol; Genital Diseases, Male; Hand Dermatoses; Heparin, Low-Molecular-Weight; Hepatitis C; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Scrotum; Skin Ulcer; Tacrolimus

A 23-year-old man with hepatitis C was observed with brownish dome-shaped papules in a linear pattern on the chest. The papules were determined clinically and pathologically to be linear lichen planus. These lesions appeared during an interferon-alpha therapy for his hepatitis and resolved after topical treatment with tacrolimus ointment. Linear lichen planus and hepatitis C have been reported only twice previously. The association between these disorders and the potential role of interferon therapy are discussed.

Topics: Adult; Antiviral Agents; Hepatitis C; Humans; Immunosuppressive Agents; Interferon-alpha; Lichen Planus; Male; Tacrolimus

Topics: Administration, Topical; Humans; Immunosuppressive Agents; Lichen Planus; Lichen Planus, Oral; Male; Middle Aged; Penile Diseases; Tacrolimus; Thalidomide

Topics: Adult; Diagnosis, Differential; Female; Humans; Immunosuppressive Agents; Laser Therapy; Lichen Planus; Lichen Planus, Oral; Nails; Prognosis; Steroids; Tacrolimus; Tongue; Treatment Outcome

Topics: Administration, Cutaneous; Female; Herpes Simplex; Humans; Immunosuppressive Agents; Lichen Planus; Middle Aged; Tacrolimus; Vulvar Diseases

Metoprolol, a widely prescribed beta-adrenergic receptor blocker, has occasionally been associated with a diversity of cutaneous reactions. We present a 79-year-old male patient with erosive lichen planus (LP) on the feet and hands who was successfully treated with topical tacrolimus. Six months after the lesions had been cured the patient received the beta-receptor blocker metoprolol for the treatment of hypertonus. Within only 2 weeks of metoprolol intake the erosive lesions on the palms and feet recurred. After discontinuation of the drug and repetitive topical treatment with tacrolimus a complete remission of the lesions could be achieved. The recurrence of erosive LP probably secondary to metoprolol and the therapeutic success of topical tacrolimus in the treatment of LP are discussed.

Topics: Administration, Topical; Adrenergic beta-Antagonists; Aged; Foot Dermatoses; Humans; Immunosuppressive Agents; Lichen Planus; Male; Metoprolol; Tacrolimus

A potent topical steroid is the conventional therapy for genital lichen planus (GLP). Side-effects or steroid resistance can be encountered and second-line therapy such as topical tacrolimus may be required. In our experience tacrolimus may be poorly tolerated in genital skin because of a burning sensation. In addition, there is impairment of Langerhans cell function, raising concerns about its long-term use. These adverse effects may not be as marked with pimecrolimus. To our knowledge, pimecrolimus has not been used in the treatment of GLP.. To assess the efficacy and tolerability of topical pimecrolimus in the treatment of GLP.. Eleven women with GLP were recruited: 10 had erosive vulval disease and one had classical lichen planus of perianal skin. Ten patients had poor disease control, and despite using topical steroids appropriately, two of these also had steroid-related side-effects in adjacent unaffected skin. The eleventh patient had adequate disease control but marked steroid atrophy. Topical pimecrolimus 1% cream (Elidel cream; Novartis, Camberley, U.K.) was applied twice daily to affected areas. Patients were followed up between 4 and 6 weeks later. They remain under regular review and at the time of writing mean follow-up is 5.2 months (range 2-10).. Nine patients (82%) tolerated pimecrolimus, including three patients previously intolerant of tacrolimus. These nine patients showed a clinical response at 4-6 weeks: two showed a complete response with no residual disease activity visible and seven had a partial response. With longer follow-up, six (55%) of the women had a complete response and three (27%) were considered to have a partial response. Eight patients noted symptomatic improvement and one felt that her symptoms were the same as with steroid use. Two patients (18%) with erosive lichen planus were unable to tolerate pimecrolimus due to local irritation.. We have found that topical pimecrolimus 1% cream is an effective treatment for GLP. Local irritation can limit its use, but it may be better tolerated than topical tacrolimus: three of our complete responders had previously been intolerant of tacrolimus. Topical pimecrolimus may be a valuable second-line treatment for patients with steroid-related side-effects or steroid-resistant GLP.

Topics: Administration, Topical; Aged; Aged, 80 and over; Dermatologic Agents; Female; Genital Diseases, Female; Genitalia, Female; Humans; Lichen Planus; Middle Aged; Prospective Studies; Tacrolimus; Treatment Outcome

A 79-year-old woman has had chronically eroded and ulcerated flexural lichen planus for 12 years, resistant to many forms of treatment. She was successfully treated initially with a combination of topical 0.1% tacrolimus ointment and oral thalidomide and then with topical tacrolimus alone. She has remained free of exacerbations for 12 months and treatment has been well tolerated. Erosive lichen planus involving flexures alone is rare. All reports on treatment of this condition address erosive oral or mucosal lichen planus and both thalidomide and topical tacrolimus have been reported individually to be beneficial.

Topics: Aged; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Lichen Planus; Tacrolimus; Thalidomide

Topical tacrolimus has been reported to be an effective treatment for genital lichen planus in small case series. We retrospectively reviewed the medical records of 16 patients with symptomatic vulvar lichen planus who received treatment with tacrolimus ointment.. All patients had symptomatic vulvar lichen planus recalcitrant to other treatments. Of 16 patients, 15 (94%) experienced a symptomatic response to tacrolimus treatment within 3 months (mean, 4.2 weeks) and had a partial or complete resolution of the lesions. Six patients (38%) reported mild adverse effects, including irritation, burning, and tingling. With continued use of the medication, these adverse effects resolved. When patients stopped treatment, lichen planus returned in 10 (83%) of 12 patients within 6 months after discontinuation of therapy (median, 1 week; range, 0.3-24 weeks), but in 6 patients the lesions were less severe than the lesions before treatment; all 10 patients resumed use of topical tacrolimus.. In this retrospective series of 16 women with vulvar lichen planus, topical tacrolimus therapy effectively controlled symptoms and improved lesions in all but 1 patient. The effect may be temporary, requiring continued use of tacrolimus, which appears to be safe and effective in controlling disease activity.

Topics: Administration, Cutaneous; Aged; Drug Administration Schedule; Female; Humans; Immunosuppressive Agents; Lichen Planus; Medical Records; Middle Aged; Minnesota; Recurrence; Retrospective Studies; Tacrolimus; Treatment Outcome; Vulvar Diseases

The purpose of this study was to compare patient satisfaction with the topical immune system modulator tacrolimus to topical clobetasol during treatment for vulvovaginal erosive lichen planus.. Subjects who had been diagnosed with vulvovaginal erosive lichen planus between June 2000 and May 2001 received a mail survey regarding clinical satisfaction and response to treatment with clobetasol and tacrolimus. Satisfaction was assessed with a 100-mm visual analogue scale (very unsatisfied, 0; very satisfied, 100). Satisfaction was compared with the use of a paired t-test.. Nineteen subjects met the inclusion criteria; 17 subjects (89%) returned completed surveys. Sixteen of the 17 women reported clobetasol therapy, and 11 of the 17 subjects acknowledged the use of tacrolimus therapy. All but 1 of the women who received tacrolimus had been treated previously with clobetasol therapy. All subjects reported experiencing sexual pain before their initial examination. After treatment with clobetasol, 2 of 16 women reported pain-free intercourse. Two additional women reported pain-free intercourse after switching to tacrolimus therapy. Ten subjects who had used both treatments rated tacrolimus therapy as significantly more satisfactory than clobetasol therapy (63 vs 38 mm; P=.03).. The use of topical tacrolimus improves satisfaction and may result in better clinical outcomes than therapy with clobetasol for the treatment of vulvovaginal erosive lichen planus.

Topics: Administration, Topical; Adult; Aged; Clobetasol; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Health Care Surveys; Humans; Lichen Planus; Middle Aged; Patient Satisfaction; Probability; Severity of Illness Index; Surveys and Questionnaires; Tacrolimus; Treatment Outcome; Vaginal Diseases; Vulvar Diseases

Topics: Administration, Cutaneous; Aged; Diagnosis, Differential; Humans; Immunosuppressive Agents; Keratoderma, Palmoplantar; Lichen Planus; Male; Tacrolimus

Topics: Administration, Topical; Anus Diseases; Diagnosis, Differential; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Tacrolimus

Erosive lichen planus causes erosion of the vulva and vagina and characteristic oral lesions. Dyspareunia is usual, and vaginal stenosis may occur. This report highlights the clinical features and the response to medical therapy.. We report the case histories of three women who presented to the Vulvovaginal Disorders Clinic of the University of Iowa with long histories of dyspareunia and advanced vaginal scarring. In each case, the clinical diagnosis of erosive lichen planus was obvious but had not been made previously. All three women have responded well to topical treatment with tacrolimus 0.1% ointment.. Erosive lichen planus should be suspected in a case of vaginal erosion or narrowing. Surgical management is inappropriate when the mucosa is eroded. Inspection of the mouth may confirm the diagnosis.

Topics: Female; Humans; Immunosuppressive Agents; Lichen Planus; Middle Aged; Tacrolimus; Vaginal Diseases; Vulvar Diseases

Topics: Administration, Topical; Female; Humans; Lichen Planus; Prognosis; Tacrolimus; Treatment Outcome; Vaginal Diseases; Vulvar Diseases

Topics: Female; Humans; Immunosuppressive Agents; Lichen Planus; Middle Aged; Ointments; Tacrolimus; Vaginal Diseases; Vulvar Diseases

Topics: Administration, Topical; Amyloidosis; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Lichen Planus; Middle Aged; Severity of Illness Index; Tacrolimus; Treatment Outcome

Erosive mucosal lichen planus is a painful and disabling inflammatory skin disease that is highly resistant to topical treatment. We report on six patients with severe recalcitrant erosive mucosal lichen planus who benefited from topical application of tacrolimus ointment. After 4 weeks of treatment, complete resolution was observed in three cases, and substantial improvement was achieved in the other three patients. In these cases, prolonged treatment resulted either in further improvement or in complete healing. All patients reported rapid relief from pain and burning. No severe side-effects were observed.

Topics: Administration, Topical; Aged; Chronic Disease; Female; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Tacrolimus