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While topical steroids have been accepted as the first\u2010line treatment, they fail to achieve symptomatic control in approximately 40% of patients. Second\u2010line therapies include other topical treatments such as calcineurin inhibitors, systemic therapies including oral steroids, methotrexate, mycophenolate mofetil, biologics, and tacrolimus, and procedural options including surgery and dilation, photodynamic therapy, and ultrasound. 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