Esophageal Lichen Planus: Case Report and Literature Review

Abstract

Lichen planus is an inflammatory mucocutaneous disorder that typically affects the flexor skin surfaces, mucous membranes, and genitalia. We describe a case of severe esophageal lichen planus associated with typical mucocutaneous manifestations and discuss the presentation, diagnosis, and difficulties encountered in treatment. The published literature is reviewed and treatment strategies described.

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.…”

“…[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. 5 We advocate consideration of swallowed topical steroids for treatment of esophageal lichen planus.…”

“…1 A case series of esophageal lichen planus reported the esophagus as the presenting location of disease in 48% of patients. 2 The endoscopic appearances of esophageal lichen planus and eosinophilic esophagitis are similar, with rings, friable mucosa, and strictures of the middle esophagus.…”

“…[1][2] Clinical presentation and endoscopic findings may mimic those of eosinophilic esophagitis, although they are histologically distinct. We report a case of complete clinical and endoscopic improvement of a 53-year-old woman with esophageal lichen planus treated with swallowed fluticasone.…”

A 50-year-old woman with a recurrent oesophageal stricture

“…This presentation is typical with strictures usually misdiagnosed as peptic with multiple subsequent dilations 1. Differential diagnoses include eosinophilic oesophagitis, caustic injury, viral infections or drugs.…”