Cyclosporine in the Management of Esophageal Lichen Planus

Abstract

Lichen planus (LP) is an uncommon disorder of unknown etiology, mostly affecting patients in their fifth and sixth decade of life. It is believed to be an autoimmune process involving T cells directed against basal keratinocytes. It affects the skin, nails, oral pharynx and genitals. Esophageal involvement is quite rare and can cause strictures, ulcerations and squamous cell cancer. The present article describes the case of a 54-year-old woman who was referred for assessment of dysphagia that initially occurred with solids, which then progressed to soft foods but spared liquids. The patient reported a weight loss of 9.1 kg. An esophagogastroduodenoscopy was performed and she was subsequently diagnosed with pill esophagitis. At the same time, she was also diagnosed with oral LP, with no involvement of the esophagus. She was treated with a proton pump inhibitor that resolved her gastrointestinal symptoms. The symptoms returned one year later and a repeat esophagogastroduodenoscopy revealed white plaques due to LP. She was treated with intermittent glucocorticoids. Diagnosis of esophageal LP is crucial for the proper treatment. Some patients may require systemic immunosuppression and mechanical dilation to prevent weight loss. Surveillance endoscopies should be performed to monitor for squamous cell cancer. Cyclosporine has been used for genital and oral LP, but the present case is the first in which it has been used successfully to treat esophageal LP.

Oral, Esophageal and Cutaneous Lichen Ruber Planus Controlled with Alitretinoin: Case Report and Review of the Literature

“…Different systemic therapies are described. Systemic corticosteroids are supposed to be most effective as well as retinoids, cyclosporine, azathioprine, tacrolimus, rituximab and griseofulvin or intralesional corticosteroids [71,72,76,77,78,79,80,81,82,83,84,85,86]. …”

Swallowed fluticasone for the treatment of esophageal lichen planus

“…Reported treatment methods have included systemic steroids, cyclosporine, topical tacrolimus, and endoscopic dilation and steroid injection. [1][2][3]5,7 Treatment with systemic steroids has a reported response rate of up to 74%; however, relapse rates after steroid withdrawal may be as high as 85%. 1 Esophageal perforation was reported with endoscopic dilation in 1 of 5 patients with esophageal lichen planus in one case series.…”

Systemic Complications of Esophageal Lichen Planus

“…Furthermore, CsA represents a safe treatment option for autoimmune disease and concomitant chronic HCV infection, because it inhibits the viral calcineurin of HCV (7). CsA was previously used only in one case of ELP resistant to systemic corticosteroids (8) . Other treatment modalities include endoscopic intralesional injection of corticosteroids and endoscopic dilation of esophageal strictures, albeit carrying the risk of triggering an inflammatory flare via the Koebner phenomenon (9).…”