Abstract

After a FDA warning, dermatologists are concerned about a potential cancer risk inherent to the use of topical calcineurin inhibitors and increasingly reluctant to prescribe them. Yet those drugs have proved to be extremely active in atopic dermatitis and erosive lichen planus, to mention some of the responsive skin disorders. The results derived from the survey of the literature are exceedingly contentious and prevent any definite conclusion to be drawn, also in consideration that the alternative therapies for both diseases are also, if not more, dangerous and that lichenoid features are common in oral premalignant and malignant lesions. Diagnostic flaws are possible even for expert pathologists. The author believe that patients with erosive lichen planus should be immediately biopsied and topical calcineurin inhibitors prescribed to ameliorate the severe impairment of the quality of life. Patients should be constantly monitored and never abandoned to self-therapy.

Keywords: Calcineurin inhibitors; Lichen planus; Mucosal diseases; Pimecrolimus; Topical steroids; Non-melanoma skin cancers; Oral mucosa; Atopic dermatitis