In a 12-week randomized clinical trial, topical Tacrolimus patch exhibited better and initial rapid clinical response with greater patient compliance compared to Tacrolimus and Triamcinolone acetonide gel for oral lichen planus management. Suzan S. Ibrahim et al. investigated the clinical efficacy of topical Tacrolimus or Triamcinolone acetonide gel for atrophic/erosive oral lichen planus and determined how these treatments affected the expression of Caspase-3 as an indicator of apoptosis.

For eight weeks, 30 patients were divided into 3 equal groups and randomly allocated to get either topical Tacrolimus 0.1% patch two times daily, topical Tacrolimus 0.1% gel, or topical Triamcinolone acetonide 0.1% gel 4 times a day. At baseline, 2, 4, and 8 weeks of therapy, as well as after 4 weeks of a treatment-free interval, an assessment of each subject's visual analogue scale (VAS), clinical score, and total atrophic area of the marker lesion was done.

In pre- and post-treatment biopsied stained sections, lymphocytic counts and expression of caspase-3 were evaluated. Within the first 2 weeks, the Tacrolimus patch led to greatest decrease in VAS (- 70.21 [15.82%]) and clinical score (-14.00 [15.54%]), followed by Tacrolimus gel and Triamcinolone acetonide gel. The decrease in VAS and total atrophic area was considerably larger in Tacrolimus groups compared to Triamcinolone acetonide gel. But, this difference between Tacrolimus therapies (gel and patch) was not significant, which was found throughout the treatment and follow-up periods.

In all groups, Caspase-3 expression in connective tissue elevated. In both the Tacrolimus groups, Caspase-3 expression dropped considerably within the epithelium but elevated in Triamcinolone acetonide gel group. Lymphocytic counts decreased considerably with the Tacrolimus patch contrasted to other groups. Significant correlations were found between percentage alteration in Caspase-3 epithelial expression and the clinical score, total atrophic area, and lymphocytic counts.

Hence, when compared to Triamcinolone acetonide gel, both Tacrolimus patch and gel considerably minimized pain, lesion size, and exhibited a much lower level of Caspase-3 expression in the epithelium.