Lichen planus with Oesophageal Involvement

Abstract

Background: Lichen planus is a common mucocutaneous disease of unknown aetiology. Oral disease affecting the mouth and the pharynx occurs in 30–70% of the cases. Oesophageal disease is considered to be extremely rare. The diagnosis of oesophageal involvement is often not made until complications occur. Case Report: A 56-year-old woman with oral and genital erosive lichen planus for more than 4 years complained of odynophagia and dysphagia. Episodes of oesophageal bolus obstruction started 2 months earlier. Upper endoscopy revealed a high-grade concentric stenosis at 21–24 cm from the incisors. Biopsy specimens taken after bougienage showed a squamous epithelium with dense leukocyte infiltration and Civatte bodies. The bougienage led to complete relief, but due to recurrent symptomatic stenosis, endoscopic dilatation had to be performed another four times within 5 years of follow-up. Immunosuppressive therapy with systemic and local steroid application did not prevent recurrent stenosis. Conclusions: Patients with lichen planus should be evaluated for gastrointestinal symptoms because oesophageal involvement is a rare but severe complication leading to inflammatory stenosis. The benefit of immunosuppressive therapy in the prevention of recurrent stenosis is not established. A review of all reported cases is done with particular regard to therapy.

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

“…One case of esophageal LP also showed laryngeal and conjunctival involvement, but also a facial and abducens nerve paralysis which could be coincidental; an immunological explanation via mast cell activation was suggested [88,89]. Esophageal LP may also lead to malignant transformation and cause squamous cell carcinoma ( [76,90,91] and unpublished data).…”

“…In oral LP a higher risk has been proven and the WHO defines oral LP as a ‘premalignant condition' [96,97]. Malignant transformation in oral LP is about 0.8-10% [59,89] respectively 1-3% [98,99,100,101]. It has been discussed that the chronic inflammation plays a role in the malignant transformation of LP by analogy to ulcerative colitis and colorectal carcinoma [102].…”

Esophageal lichen planus

“…1 The true prevalence of esophageal lichen planus in the general population is almost impossible to determine for several reasons, such as: lack of clinical and pathological knowledge of this condition, high rates of asymptomatic or subtle disease, and the possibility that esophageal involvement may be the only manifestation of lichen planus. 3 , 6 - 9 …”

Lichenoide Ösophagitis ohne Haut-, Genital- oder Mundschleimhautbeteiligung

“…Die Hepatitis-Serologie war unauffällig. Die meisten Patienten mit ösophagealem Lichen ruber sind asymptomatisch, einige fallen durch eine Dysphagie auf [7]. Wir können über einen 68-jährigen Patienten berichten, welcher mit Verschlechterung des Allgemeinzustands, schmerzhafter Dysphagie und Gewichtsverlust stationär aufgenommen wurde und keinerlei Haut-oder Schleimhautveränderungen aktuell und in der Vorgeschichte aufwies.…”