tacrolimus and Vulvovaginitis

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

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