Treatment of refractory oral erosive lichen planus with topical rapamycin: 7 cases.

BACKGROUND: Chronic erosive oral lichen planus (CEOLP) is a painful disease. Topical steroids constitute the mainstay of treatment. Given the reports of a slightly greater risk of squamous-cell carcinoma, rapamycin may be a good candidate for recalcitrant CEOLP, as it has both immunosuppressive and antitumour properties.

OBJECTIVES: To investigate the therapeutic effect and evaluate the blood absorption of topical rapamycin in patients with CEOLP.

PATIENTS AND METHODS: We carried out an open prospective study: 7 women with CEOLP applied topical rapamycin (1 mg/ml) on oral erosive lesions twice a day for 3 months. Four patients also had erosive vulvar lesions and applied the same solution on both mucosae. We monitored blood sirolimus levels 15 days after the initiation of treatment. Complete remission was defined by the disappearance of oral erosions and partial remission when the surface of oral erosions was 50% less than the surface of the initial erosion.

RESULTS: At 3 months, 4 women had complete remission and 2 women had partial remission. One patient stopped treatment due to local discomfort. Only 1 woman had blood sirolimus levels that were detectable.

CONCLUSION: Topical rapamycin may be effective in some cases of refractory CEOLP, with negligible absorption into blood and minimal side effects.