Tacrolimus in Solution as an Option to Inflammatory Conditions of the Scalp

Introduction: Several dermatological diseases lead to inflammatory conditions of the scalp. Most of these afflictions are recalcitrant and require long term maintenance treatment. Objectives: We present a case series where topical tacrolimus was used in a solution vehicle for these conditions. Methods: A total of 22 patients (aged 24-90 years) with confirmed diagnosis of lichen planus pilaris (LPP), discoid lupus (DL), frontal fibrosing alopecia (FFA), erosive pustulosis of the scalp (EPS) or folliculitis decalvans (FD) were evaluated and treated with tacrolimus solution (0.1%) applied twice daily for 1 month, then once daily for another month and alternate days for 4 months. Efficacy was evaluated by an investigator global assessment, clinical and dermoscopic evaluation at weeks 4, 8 and 24. The safety assessment included monitoring of all adverse events. Results: The study included 13 patients with LPP, 2 with DL, 2 with FD, 2 with EPS and 3 with AFF. After 1 month, 14 patients (63.6%) had a good response and 7 (31.8%) had excellent response. After 2 months, 16 patients (72.7%) had excellent response, and this response was persistent after 6 months of treatment. Conclusions: Tacrolimus in solution, even if not yet commercially available, was an effective and well tolerated alternative for the maintenance treatment of inflammatory conditions of the scalp.