Esophageal lichen planus

Abstract

Lichen planus is a chronic inflammatory disease that affects the skin, mucous membranes, nails and scalp. Esophageal lichen planus is a rarely reported manifestation of lichen planus, presenting itself commonly in middle-aged women, with symptoms such as dysphagia. We report a case of esophageal lichen planus in a 54-year-old woman associated with oral, cutaneous and ungual lichen planus. Although lichen planus is a disorder well known by dermatologists, reports of esophageal lichen planus are rare in dermatologic literature. The esophageal lichen planus is little known and underdiagnosed, with a significant delay between the onset of symptoms and diagnosis.

No lesion? No problem: case of oesophageal lichen planus in a patient without any cutaneous lesions

“…Due to its rare nature, there is a paucity of data investigating ELP, and our understanding of the disease is mainly derived from case reports and case series. The most common presenting symptom is dysphagia, though some patients may also experience odynophagia and many are asymptomatic 3 5–8. A review of 72 cases of ELP performed by Fox et al showed that 99% of this cohort had extraoesophageal manifestations of lichen planus, most often oral (89%), vulvovaginal/anogential (42%) and cutaneous (38%) 5.…”

“…Data show that the majority of ELP involves the proximal third of the oesophagus 5. Histopathology is very important in making a diagnosis, and the presence of Civatte bodies, necrotic keratinocytes that appear eosinophilic on light microscopy, is confirmatory for ELP 3–8. Direct immunofluorescence can be used if histology is inconclusive 9.…”

“…Lichen planus is a T-cell-mediated autoimmune disease that typically affects the scalp, skin, nails, and mucous membranes 1 2. The epidemiology of lichen planus is not well studied, but based on limited data, disease prevalence ranges between less than 1% of the population for cutaneous lichen planus and up to 3% of the population for mucosal lichen planus with a predilection for middle-aged and elderly females 2 3. While dermatologic cases of lichen planus are commonly diagnosed, identification of oesophageal lichen planus (ELP) is rare.…”

“…Oesophageal involvement in patients with cutaneous lichen planus has been reported to be as high as 50%, though most patients do not demonstrate any oesophageal symptoms 4. The most common presenting symptom of ELP is dysphagia 3. A review of the limited data of patients who have confirmed cases of symptomatic oesophageal involvement demonstrates that ELP more frequently affects patients who also have extra-ELP, most commonly oral or vulvar lichen planus.…”

Esophageal lichen planus: An unusual cause of dysphagia in the elderly

“…Preservation of gastroesophageal junction in ELP is an important resource that helps in the differentiation of ELP and gastroesophageal reflux disease. 3 Malignant transformation of ELP to squamous cell carcinoma has been reported in the literature; due to this fact, endoscopic surveillance is recommended. 4,5 Histological findings in the esophagus resemble those from oral mucosa and reflect chronic junctional inflammatory aggression mediated by mature T lymphocytes, which include a band-like lymphocytic infiltrate involving the superficial lamina propria and basal epithelium, besides basal layer degeneration with and apoptotic basal keratinocytes (Civatte bodies).…”