We report a case of mucous membrane pemphigoid and a case of ocular pemphigus vulgaris treated with tacrolimus ointment.
Case 1. The patient is a 74-year-old woman with a 5-year history of ocular irritation. Examination revealed bilateral blepharitis, entropion, symblepharon, and mild conjunctivitis. Conjunctival biopsy results showed no significant histopathologic abnormality, but direct immunofluorescence revealed strong linear to shaggy deposition of fibrinogen at the basement membrane zone. Indirect immunofluorescence demonstrated positive staining (IgG) of the basement membrane zone at a titer of 1:40. She was treated with dexamethasone-tobramycin (TobraDex) ophthalmic ointment twice daily. After 4 weeks she was started on a trial of 0.03% tacrolimus ointment daily. She discontinued the dexamethasone-tobramycin treatment after 5 weeks, 1 week after beginning treatment with tacrolimus. Three months later, she was asymptomatic with no signs of inflammation in the eyes. She experienced no irritation from the tacrolimus and has been applying the medication for 4 months.
Hall VC, Liesegang TJ, Kostick DA, Lookingbill DP. Ocular Mucous Membrane Pemphigoid and Ocular Pemphigus Vulgaris Treated Topically With Tacrolimus Ointment. Arch Dermatol. 2003;139(8):1083-1084. doi:10.1001/archderm.139.8.1083