A new study conducted by S. Utz and colleagues showed that when topical corticosteroids are ineffective for treating oral lichen planus (OLP), tacrolimus might be used as a second-line treatment. The findings of this study were published in the Journal of the European Academy of Dermatology and Venereology.

Oral lichen planus has been successfully treated with topical tacrolimus. Long-term consequences and the best application procedure with progressive lowering have not yet been investigated. With a focus on the ideal long-term therapy plan, this research evaluated the clinical response of OLP to tacrolimus in routine clinical practice.

All OLP patients who received topical tacrolimus (0.03% oral rinse) treatment in a clinical environment between 2015 and 2020 were retrospectively analyzed for this study. A 4-point scale (full remission, significant remission, partial remission, and no reaction) was used to assess the objective clinical response, while a 3-point scale was used to assess subjective impairment (severe, moderate and none).
The key findings of this study were as follows:

1. There were 57 patients total. 56 patients (98%) have previously had therapy with topical steroids.
2. After tacrolimus was introduced, 28%, 62%, 87%, and 97% of patients, respectively, obtained objective remission after 3, 6, 12, and 24 months. After 3, 6, and 12 months of therapy, respectively, 16%, 48%, 69%, and 83% of patients reported subjective remission.
3. After 3, 6, 12, and 24 months, the treatment frequency could gradually decrease from twice daily to once daily or less in 28%, 61%, 78%, and 87% of patients, respectively.
4. 41% of patients temporarily discontinued therapy, but 67% of them relapsed after a median of 3.3 months.
5. During the time of observation, four individuals (7%) had the development of squamous cell carcinoma (SCC).
6. Other than that, there weren't many very mild side effects.
In conclusion, during the maintenance phase, the frequency of therapy can frequently be decreased. Therapy should be guided by both objective impairment and clinical activity indicators. It's important to follow up often to detect potential SCC.
Reference:
Utz, S., Suter, V. G. A., Cazzaniga, S., Borradori, L., & Feldmeyer, L. (2022). Outcome and long‐term treatment protocol for topical tacrolimus in oral lichen planus. In Journal of the European Academy of Dermatology and Venereology. Wiley. https://doi.org/10.1111/jdv.18457