Repeated courses of potent topical
corticosteroids and maintenance
therapy with moderately potent topical
corticosteroids are frequently needed to treat various forms of vulvar
dermatoses, which are often characterized by an abnormal proliferation or activation of T lymphocytes. Because such therapeutic regimen is associated with an increased risk of potential side effects, particularly skin
atrophy, an anti-inflammatory alternative to topical
corticosteroids is desirable. The two non-
steroid topical
calcineurin inhibitors pimecrolimus and
tacrolimus are
immunomodulators that block the release of inflammatory
cytokines from T lymphocytes in the skin while promoting cutaneous innate host defences. They are currently approved in Europe and in the United States of America as second-line
anti-inflammatory agents for the treatment of
atopic dermatitis. We provide a comprehensive summary of existing case reports, series of cases, and open-label prospective studies concerning the use of topical
pimecrolimus and
tacrolimus for the treatment of anogenital
lichen sclerosus, genital
lichen planus, vulvar
lichen simplex chronicus and related pruritic vulvar
dermatoses (chronic vulvar
pruritus and
allergic contact dermatitis of the vulva). The available data suggest that both topical
calcineurin inhibitors may be effective and well tolerated in these vulvar
dermatoses, although topical
pimecrolimus may exhibit a better long-term tolerability profile. Being devoid of
steroid-related side effects, they may represent a useful second-line therapeutic option for patients who are intolerant of, or resistant to topical
corticosteroids. Controlled clinical trials and comparative studies are warranted to substantiate the promising findings summarized in this review.