Topical calcineurin inhibitors in the management of anogenital lichen sclerosus unresponsiveto ultra-potent corticosteroids: our experience

Lichen sclerosus (LS) is a chronic disease with evidence of a lymphocyte- mediated origin. Corticosteroids have been the mainstay of therapy for LS. The potential for side-effects and tachyphylaxis limit their utility in providing long-term disease control. Topical calcineurin inhibitors (TCIs) (tacrolimus and pimecrolimus) approved for atopic dermatitis, have a potential in other inflammatory skin diseases. We investigated the efficacy and safety of tacrolimus ointment 0.1% and pimecrolimus 1% cream in anogenital LS unresponsive to ultra-potent corticosteroids. Ten patients (four woman and six men) aged between 52 and 76 years with histologically proven active anogenital LS, were treated for 16 weeks twice daily with either topical tacrolimus (one woman and three men) or pimecrolimus (three woman and three men) in an observational study. Clinical examination and recording of patients symptoms were performed before, after four and eight weeks, and after three and four months of therapy, respectively. Of the ten subjects enrolled, one individual (a man treated with tacrolimus) discontinued the study due to severe pain at week 2. Eight patients experienced improvement in symptoms with remarkable relief of pain and pruritus after the first weeks of treatment. At the end of therapy, complete remission of symptoms was achieved in eight patients, and clearance of active LS was reached in two cases (one woman treated with tacrolimus and one man treated with pimecrolimus). Partial resolution was reached in six patients (one woman and one man treated with tacrolimus, two woman and two men treated with pimecrolimus). All patients showed no recurrence of disease activity during the follow-up period of 21 months. In our opinion TCIs seem to be effective in LS, expecially in anogenital LS unresponsive to ultrapotent corticosteroid