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Journal of the American Academy of Dermatology
Volume 61, n° 5
pages 829-840 (novembre 2009)
Doi : 10.1016/j.jaad.2009.03.012

Calcineurin inhibitors in oral medicine

Khalid A. Al Johani, BDS, MSc a, , Anne M. Hegarty, MSc, MFD RCSI, MBBS b, Stephen R. Porter, PhD, MD, FDSRCS, FDSRCSE a, Stefano Fedele, DDS, PhD a
a Oral Medicine, University College London (UCL) Eastman Dental Institute, London, United Kingdom 
b Eastman Dental Hospital University, College London Hospital Trust (UCLHT), London, United Kingdom 

Reprint requests: Khalid A. Al-Johani, BDS, MSc, Oral Medicine, UCL Eastman Dental Institute, 256 Gray’s Inn Rd, London WC1X 8LD United Kingdom.

Topically applied calcineurin inhibitors have been suggested to be of some benefit in the treatment of immunologically mediated oral mucosal disorders, particularly oral lichen planus. This article reviews the current evidence of the efficacy and safety of topical calcineurin inhibitor agents in the management of different oral conditions. Current evidence suggests that topical tacrolimus and pimecrolimus may be of benefit (at least in the short term) in the treatment of immunologically mediated oral mucosal disease, especially oral lichen planus that has not responded to topical corticosteroids. Both tacrolimus and pimecrolimus are minimally absorbed through the oral mucosa and give rise to few clinically significant local or systemic adverse side effects. There is little evidence to indicate that topical cyclosporine is more effective than topical corticosteroids for the treatment of immunologically mediated oral mucosal disease. Currently, there is no objective evidence suggesting that topical tacrolimus or pimecrolimus increase the risk of oral malignancy associated with oral lichen planus. There is a need for well-designed randomized controlled trials to establish the precise efficacy of topical calcineurin inhibitors for the treatment of immunologically mediated oral mucosal disease.

The full text of this article is available in PDF format.

Key words : calcineurin inhibitors, cyclosporine, mucous membrane pemphigoid, oral cancer, oral lichen planus, orofacial granulomatosis, pemphigus vulgaris, pimecrolimus, tacrolimus

Abbreviations used : AD, FDA, GvHD, IL, MMP, OFG, OLP, SCC

 This work was undertaken at UCL/UCLHT, which received a proportion of funding from the Department of Health’s National Institute for Health Research Biomedical Research Center funding scheme. Dr. Al-Johani received sponsorship from the King Abdulaziz University, Saudi Arabia.
 Conflicts of interest: None declared.

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