Systemic tacrolimus in the treatment of recalcitrant mucosal lichen planus

INTRODUCTION Lichen planus is a chronic, inflammatory, autoimmune skin condition that can affect the skin, mucosal surfaces, and nails. Mucosal lichen planus might occur in conjunction with or without cutaneous involvement. Current treatment options include both topical and systemic medications. Tacrolimus (FK-506 or fujimycin) is a macrolide immunosuppressant that inhibits calcineurin. Topical tacrolimus has been shown to be effective in treating oral lichen planus, but systemic tacrolimus is not commonly used for lichen planus. Herein, we report 2 cases of patients with oral lichen planus and 1 case of a patientwith oral and vaginal lichen planus (mean age 52.3 years) who responded to systemic tacrolimus after failing multiple medication regimens. The diagnosis was confirmed by a biopsy in all 3 patients. They also denied starting any new medications and tested negative for hepatitis B and C.