Efficacy

Topical ciclosporin

We found three RCTs and numerous small open trials, using various doses and methods of application.3 Most of these uncontrolled trials reported favourable results in severe resistant oral LP but poor efficacy was reported in three small case series.

The three RCTs also used different doses and modalities of application. The first RCT compared efficacy of three washes (1500 mg/ day) with placebo in 16 patients with symptomatic oral LP.30 When compared with the control group, erythema, reticulated lesions, erosions and functional signs were significantly attenuated after 8 weeks' treatment. In the second RCT, 14 patients with erosive oral LP were treated with dosed oral rinses containing either ciclosporin, 500 mg, or placebo.31 After 4 weeks' treatment, the rate of healing was significantly better with ciclosporin, with reduced pain. In the last RCT, 20 patients with erosive oral LP were treated with a bioadhesive gel containing either ciclosporin or placebo.32 After 10 weeks' treatment, the rate of complete healing was significantly higher with ciclosporin (50% versus 0%).

Tacrolimus

We found a small series of six cases33 and one single case34 reporting efficacy of topical tacrolimus in oral LP. In all cases, tacrolimus 0-1% was applied twice daily for at least 4 weeks. Complete resolution or good improvement was observed but a relapse was noted a few weeks after cessation of therapy.

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