Clinical behaviour and long-term therapeutic response in orofacial granulomatosis patients treated with intralesional triamcinolone acetonide injections alone or in combination with topical pimecrolimus 1%.

Background: Orofacial granulomatosis (OFG) is a relapsing inflammatory disorder of unknown aetiology and non-standardized treatment protocols. The aim of this study was to assess the clinical behaviour and long-term therapeutic response in OFG patients treated with intralesional triamcinolone acetonide (TA) injections alone or in combination with topical pimecrolimus 1%, as adjuvant, in those patients partially responders to TA. Methods: We analysed data from 19 OFG patients followed-up for 7 years. Demographic characteristics, clinical behaviour and long-term therapeutic response were investigated. Results: Eleven (57.9%) OFG patients treated with intralesional TA injections therapy reached first complete clinical remission in a mean time of 10 +/- 2.2 (95% CI, 8.511.5) weeks, while eight (42.1%) patients, partially responders to intralesional TA injections, were treated with TA injections plus topical pimecrolimus 1%, as adjuvant, achieving complete clinical remission in a mean time of 29.8 +/- 7.8 (95% CI, 23.236.3) weeks. Relapses occurred in four TA responder patients with a disease-free time of 35.8 +/- 8.7 (95% CI, 21.946.4) weeks and in five patients treated with TA and topical pimecrolimus 1% with a disease-free time of 55.8 +/- 18.5 (95% CI, 32.878.8) weeks. Patients were followed-up for a mean time of 56.3 +/- 18.2 (95% CI, 47.665.1) months. At last control, all 19 patients were in complete clinical remission. Conclusion: These preliminary data suggest that intralesional TA injections still represent a mainstay in the treatment of OFG. It is unclear the role of topical pimecrolimus, as adjuvant, in leading OFG patients, partly responders to intralesional TA injections, to a complete clinical remission.