[Topical treatment of vulvar lichen sclerosus with calcineurin inhibitors].

OBJECTIVE: To provide an overview of the literature concerning the topical treatment of vulvar lichen sclerosus, a chronic inflammatory skin disease, with calcineurin inhibitors, such as pimecrolimus and tacrolimus. DESIGN: A literature review into the use of topical calcineurin inhibitors (TCIs) in the treatment of vulvar lichen sclerosus. METHOD: A literature search was performed using PubMed and EMBASE and the search terms 'tacrolimus', 'pimecrolimus' or 'calcineurin inhibitors' and 'lichen sclerosus et atrophicus', 'vulvar lichen sclerosus', 'vulvar dermatoses' or 'vulvar diseases'. RESULTS: The search produced 6 case reports, 5 patient series, 3 pilot studies, 2 open-label studies and 1 RCT concerning the use of TCIs for the treatment of vulvar lichen sclerosus. The literature shows that both medications are effective and well tolerated. However, glucocorticoids seem to be effective in more patients than TCIs. Tacrolimus has a stronger immunosuppressant effect than pimecrolimus and therefore seems to be more effective without having more observed side-effects. CONCLUSIONS: TCIs may represent a useful second-line therapeutic option for patients for whom treatment with glucocorticoids is not effective or who do not tolerate them well. Randomized clinical studies are required to determine the role of TCIs in the treatment of lichen sclerosus. CONFLICT OF INTEREST: none declared. Financial support: none declared.