Permalink : http://hdl.handle.net/2115/57101

KEYWORDS : Oral lichen planus;Chronic oral inflammation;Tacrolimus;Oral management;口腔扁平苔癬;慢性歯性炎症巣;タクロリムス軟膏;口腔管理

We report a case of intractable lichen planus that was temporarily responsive to 0.1% Tacrolimus but flared up again, and that was ultimately improved by long-term complete oral care.　A 66-year-old female presented with haphalgesia on the palate since about two years. She was diagnosed with lichen planus by her dental practitioner and treated with a local application of a steroid ointment for several months without obvious improvement. She then consulted a dermatologist at our hospital and was prescribed with 0.1% Tacrolimus ointment. Soon after its application, the lesion showed significant improvement. However, the condition recurred, and different treatments were repeatedly attempted for almost 2 years after cessation of Tacrolimus treatment. Meanwhile, we employed all possible techniques to keep the oral cavity clean to eradicate the chronic inflammation. Finally, the lesion resolved completely, with no recurrence even 4 years after the last application of Tacrolimus. Our results indicate that chronic oral lesions play a potential role in the pathogenesis of oral lichen planus.
今回著者らは，0.1％タクロリムス軟膏が一時的に有効であったが再燃を繰り返した難治性の口腔扁平苔癬（Oral lichen planus: OLP）症例に対し，長期に亘り全顎的な歯科治療を行うことで，良好な経過をたどった症例を経験したので報告する． 　患者は66歳女性，初診の約２年前より口蓋部の摂食痛を自覚し，近医歯科で数か月間ステロイド軟膏による治療が行われたが症状の改善を認めなかった．そのため当院皮膚科で，0.1％タクロリムス軟膏による治療が行われた．OLPはタクロリムス軟膏塗布後に一旦消失したが，塗布中止により再燃し以後，１年10か月に亘り再燃と寛解を繰り返した．その間，全顎的な歯科治療を行い慢性歯性炎症巣を除去したところ，タクロリムス軟膏中止後４年以上経過したが，OLPの再燃は認めていない．これは，慢性歯性炎症巣がOLPの発症に何らかの関与をしていた可能性があると思われる．