The Journal of Prosthetic Dentistry Management of a patient with severe erosive lichen planus in need of an immediate complete denture: A clinical report Alejandro Rabanal, DDS, a Michael Bral, DDS, b and Gary Goldstein, DDS c New York University College of Dentistry, New York, NY a Former Resident, Advanced Education Program in Prosthodontics. b Professor, Department of Periodontics. c Professor, Department of Prosthodontics. Lichen planus is a chronic inflam- matory mucocutaneous disease that is considered to be an immunologi- cally mediated process. It was first described by Erasmus Wilson in 1869 and affects almost 1% of the world population. Most patients are middle- aged, with women more commonly affected than men. 1 T-cell–secreted tumor necrosis factor alpha (TNF-α) and matrix metalloproteinase (MMP- 9) may be implicated in the pathogen- esis of this condition. 2 This condition can affect the skin, oral mucosa, or both. The histological presentation is characterized by a subepithelial lym- pho-histiocytic infiltrate, an increase in the number of intraepithelial lym- phocytes, degeneration of basal kera- tinocytes, and changes in the epithe- lial basement membrane that result in microscopic gaps between the epithe- lium and the connective tissue. 3 Clinically, the central area of the lesion is ulcerated, and a fibrinous plaque or pseudomembrane covers the ulcer. The periphery of the lesion is usually surrounded by reticular or radiating keratotic striae that become painful when the pseudomembrane is disturbed. 3 As part of the dental treatment, irritating factors must be removed. Scaling and root planing should be performed on a regular ba- sis, ill-fitting restorations should be replaced, and teeth with sharp angles must be reshaped. 2 Erosive lichen planus can be treat- ed systemically and locally. Systemic therapy with corticosteroids is indi- cated for lesions that do not respond to a local treatment. Local therapy includes dexamethasone mouth rins- es and triamcinolone or fluorinated steroids applied over the lesions on a daily basis. Combinations of systemic and local therapy are also used suc- cessfully. Other agents such as cyclo- sporine, azathioprine, and levamisole are also used in the treatment of ero- sive lichen planus. 2 The use of the immunosuppressive agent tacrolimus (Protopic; Fujisawa Healthcare, Inc, Deerfield, Ill) is re- ported in the literature as an effective agent for the control of symptoms of erosive lichen planus. 4,5,6,7 Lener et al 4 treated a patient with erosive lichen planus lesions of the lip and oral mu- cosa with 0.1% tacrolimus ointment and reported complete healing of the lip lesions after daily application for 1 month. The ulcerations of oral mucosa that were treated with the same concentration were in remission 3 months after the start of the treat- ment. The authors reported that the lesions were in complete remission for a year without maintenance therapy. 4 Olivier et al 5 evaluated the efficacy of a topical preparation of a 0.5-mg tacrolimus capsule diluted in 500 mL of distilled water. Patients were instructed to rinse with 15 mL for 2 minutes, 4 times a day. The frequency of the rinses was adjusted according to the severity of the symptoms. The author concluded that palliative ef- fects were rapid and significant but not curative. Byrd et al, 6 using a ques- tionnaire mailed to 37 patients treat- ed with topical tacrolimus, found that the majority of the patients reported an improvement in the lichen planus lesions and that maintenance ther- apy was necessary. Thomson et al, 7 in a retrospective study, reported on 23 patients with oral lichen planus treated with 0.1% topical tacrolimus. Six weeks after the treatment began, This clinical report describes the treatment of a patient in need of an immediate complete denture who presented with severe erosive lichen planus. In conjunction with an immediate complete denture, tacrolimus (0.1%) ointment, an immunosuppressive agent, was applied topically over the lesions. There was a significant reduction in the size of the lesions at the second week of treatment, allowing the patient to tolerate the prosthesis without pain, thereby im- proving her quality of life. (J Prosthet Dent 2007;98:256-259) Rabanal et al