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, 8.5–11.5) 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, 23.2–36.3) weeks. Relapses occurred in four TA responder patients with a disease‐free time of 35.8 ± 8.7 (95% CI, 21.9–46.4) weeks and in five patients treated with TA and topical pimecrolimus 1% with a disease‐free time of 55.8 ± 18.5 (95% CI, 32.8–78.8) weeks. Patients were followed‐up for a mean time of 56.3 ± 18.2 (95% CI, 47.6–65.1) 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.