SYSTEMATIC REVIEW AND META-ANALYSIS ON THE EFFICACY AND SAFETY OF TOPICAL TACROLIMUS IN ORAL LICHEN PLANUS

Background:The immune disorder known as oral lichen planus (OLP) causes permanent damage to oral mucosa through continuous T-cell migration and epithelial destruction. The first-line treatment for this condition involves corticosteroids but their extended application leads to mucosal tissue deterioration and fungal infections and treatment failure. The calcineurin inhibitor tacrolimus shows promise as a substitute but its therapeutic value and long-term safety effects continue to be debated by researchers. Objective:The research combined data to evaluate the effectiveness of topical tacrolimus against corticosteroids and other treatments for OLP patients. Methods:The research followed PRISMA 2020 guidelines to find randomized trials and observational studies about topical tacrolimus (0.03–0.1%) through PubMed and Scopus and Web of Science and Cochrane Library databases until January 2024. Pooled risk ratios (RRs) and weighted mean differences (WMDs) were calculated using randomor fixed-effects models based on heterogeneity. Results:Fourteen eligible studies demonstrated favorable outcomes, with 80–91% of patients achieving partial or complete remission within 4–8 weeks. The pooled RR for lesion resolution was 1.03 (95% CI: 0.89–1.21), confirming equivalence to corticosteroids. Tacrolimus provided faster symptomatic relief and a mean pain reduction of −0.65 versus placebo. Relapse after withdrawal reached 60–87%, but maintenance therapy prolonged remission. Adverse effects were mild and local; systemic absorption was negligible. Conclusion:Topical tacrolimus 0.1% offers a safe and effective steroid-sparing therapy for OLP, especially in refractory cases. Although relapse remains frequent, its rapid clinical response and favorable safety profile justify its role as a second-line treatment pending further long-term, biomarker-based trials.