Topical cyclosporine in a bioadhesive for treatment of oral lichenoid mucosal reactions - An open label clinical trial

Oral lichenoid reactions may present as chronic symptomatic mucosal reactions. Lichen planus-like reactions include those associated with drug reactions, graft-versus-host disease after bone marrow transplantation, and idiopathic lichen planus. The mainstay of management is topical steroids; in resistant cases, topical and systemic corticosteroids may be used. We evaluated the use of cyclosporine administered in an adhesive hydroxypropyl cellulose base in patients with oral lichenoid reactions that remained active despite the prior use of high-potency topical steroids and in some cases despite the combined use of topical and systemic immunosuppression. Signs and symptoms of ulcerative oral graft-versus-host-disease improved more than 50% in three of four patients with oral graft-versus-host disease treated with the addition of topical cyclosporine. However, in patients with persistent oral lichen planus less effect was seen with 7 of 14 patients demonstrating a partial reduction in signs and symptoms. The topical use of cyclosporine in a bioadhesive base may represent a useful adjunctive approach in management of oral lichenoid reactions, although dose escalation and placebo-controlled studies are needed.