title: Topical tacrolimus with custom trays in the treatment of severe oral chronic graft-versus-host disease refractory to a potent topical steroid therapy: a case report.
abstract: BACKGROUND
  The authors present a case demonstrating the success of topical tacrolimus (TAC) therapy with custom trays in the treatment of oral chronic graft-versus-host disease (cGVHD). The 41-year-old male patient initially responded to topical steroid therapy (clobetasol propionate 0.05% ointment) applied both topically and with flexible carrier trays, but later became refractory to this potent topical agent. Topical TAC therapy with flexible carrier trays and systemic prednisone therapy was initiated.
  
  
  RESULTS
  The patient responded favorably with the change to topical TAC therapy with custom trays (and oral prednisone). His oral cGVHD lesions resolved within a period of 4 weeks. The improvement has remained stable at 14 months of follow-up.
  
  
  CONCLUSIONS
  This is the first case reported with regard to the successful resolution of steroid recalcitrant cGVHD successfully treated with topical TAC with custom trays.
authors.affiliation: Department of Oral Diagnostic Services, Howard University College of Dentistry, Washington, DC 20059, USA. rbrown@howard.edu
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Brown
authors.forename: Dean
authors.initials: D
authors.lastname: Edwards
authors.forename: Tracey
authors.initials: T
authors.lastname: Walsh-Chocolaad
authors.forename: Richard W
authors.initials: RW
authors.lastname: Childs
mesh_terms: D000287:Administration, Topical; D000328:Adult; D002990:Clobetasol / Q000008:administration & dosage*; D004337:Drug Carriers; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006086:Graft vs Host Disease / Q000188:drug therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D009059:Mouth Diseases / Q000188:drug therapy*; D009190:Myelodysplastic Syndromes / Q000601:surgery; D012008:Recurrence; D016559:Tacrolimus / Q000008:administration & dosage*
chemical_list: D004337:Drug Carriers; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D002990:Clobetasol; D016559:Tacrolimus