Diagnosis and treatment of an oesophageal stricture due to lichen planus

Abstract

Involvement of the oral mucous membranes occurs commonly in lichen planus. Oesophageal involvement is less common and may result in pain, dysphagia and strictures. We present a case of an oesophageal stricture in a patient with lichen planus. A 44-year-old woman with a 24 year history of oral lichen planus and a 9 year history of anogenital involvement gave a 2 year history of dysphagia. An endoscopy performed when she first noticed dysphagia showed oropharyngeal ulceration and the pharynx was narrowed with a friable mucosa. A further endoscopy in December 1990 showed an ulcerated nasopharynx but no abnormality in the oesophagus.

Lichen planus esophagitis: report of three patients treated with oral tacrolimus or intraesophageal corticosteroid injections or both*

“…All of our patients had oral and mucous membrane disease, however, their oral lesions did not flare after esophageal dilation. In contrast with oral lichen planus, no known progression of esophageal lichen planus to esophageal malignancy has been described 12 . One author suggested that surveillance of the esophagus for development of squamous cell carcinoma may be indicated 13 …”

“…Dilation is commonly used despite concerns about worsening esophageal stenosis or oral lesions due to Koebner phenomenon. Other regimens described include adrenocorticotropic hormone injections, oral corticosteroids, etretinate, and topical corticosteroids 1,11–23 . Topical tacrolimus, a potent inactivator of T‐lymphocytes used initially in patients with transplants, was successful for oral lichen planus in six patients 24–26 Table 3.…”

“…Endoscopic findings in esophageal lichen planus include elevated lacy, white papules, esophageal webs, pseudomembranes, desquamation, and superficial pinpoint erosions with and without stenosis. [9][10][11][12][13][14][15][16] Poor distensibility of the esophagus also has been described. 16 Simultaneous oral and mucous membrane involvement is common.…”

“…Other regimens described include adrenocorticotropic hormone injections, oral corticosteroids, etretinate, and topical corticosteroids. 1,[11][12][13][14][15][16][17][18][19][20][21][22][23] Topical tacrolimus, a potent inactivator of T-lymphocytes used initially in patients with transplants, was successful for oral lichen planus in six patients. [24][25][26] Table 3 summarizes data for 24 patients with esophageal lichen planus (including our three patients).…”

Lichen planus with Oesophageal Involvement

“…Oesophageal involvement in lichen planus is very rare, only 17 cases [7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22]and a series of 6 patients in 15 years from the Mayo Clinic [23]have been reported in the literature so far. This complication is probably underestimated, since a small study in 1990 on 19 patients with OLP demonstrated that a quarter of those had oesophageal involvement [24](table 1).…”