Successful treatment of mucous membrane pemphigoid with tacrolimus

Mucous membrane pemphigold (MMP) is a heterogeneous group of autoimmune, chronic inflammatory subepithelial vesiculobullous disorders. It predominantly affects the mucous membranes of the oral cavity and eyes of the elderly population. Oral manifestations of pemphigoid include desquamative gingivitis, ulcers, erythematous patches, erosions, vesicles and bullae located on the attached gingiva, palate, buccal mucosa, labial mucosa, and tongue. Diagnosis is based on history, clinical features and a biopsy stained with hematoxylin and eosin (H&E), and also direct and indirect immunofluorescence. Topical and systemic corticosteroids are the most commonly used medications for managing pemphigoid. Recently, topical tacrolimus has been successfully used in the treatment of ocular and skin pemphigoid. In this report we present a patient with long-term recalcitrant MMP that did not respond to conventional treatment but was treated successfully with tacrolimus ointment.