Esophageal Lichen Planus Research Articles

Management of Symptomatic Esophageal Involvement With Lichen Planus

To describe the clinical features and treatment schedules of a series of 5 patients with esophageal lichen planus (LP). To review the literature on esophageal LP. LP, a common papulosquamous dermatologic condition, can present to the gastroenterologist with esophageal involvement. This is rare and occurs in a distinct population of LP patients. Disease at this site is frequently refractory to conventional treatment. Between 2001 to 2007, 5 female patients were diagnosed with esophageal LP. They all had esophageal strictures which were treated with a combination of balloon dilatation and intralesional triamcinolone. Therapeutic intervention was covered with oral steroids before and after the procedure. Symptoms tended to recur, necessitating repeat procedures. The average interval between treatments was 8.3 months. Intralesional triamcinolone and balloon dilatation produced good symptomatic relief in these 5 patients with esophageal LP. This was generally maintained for several months. We reviewed 35 cases of symptomatic esophageal LP in the English literature. Esophageal LP seems to have a striking predilection for middle-aged women, particularly those with disease at other mucosal sites. A range of systemic immunosuppressants and esophageal-directed therapies has been tried.

Lichen planus

Lichen planus

High prevalence of esophageal involvement in lichen planus: a study using magnification chromoendoscopy

The first cases of squamous cell carcinoma in esophageal lichen planus were recently described. We performed a study to establish the prevalence of endoscopic and histopathologic abnormalities consistent with lichen planus and (pre-) malignancy in a cohort of patients with lichen planus. A total of 24 patients with lichen planus were prospectively studied using high-magnification chromoendoscopy. Focal esophageal abnormalities were mapped, classified, and biopsied. Biopsies were also taken from normal-appearing esophageal mucosa at three levels (proximal, middle, and distal). The presence of a lymphohistiocytic interface inflammatory infiltrate and Civatte bodies (i. e. apoptotic basal keratinocytes) at histopathologic examination was considered diagnostic for esophageal lichen planus. Symptoms were assessed using validated questionnaires. A total of 38 focal abnormalities were biopsied. These consisted of: layers of mucosa peeling off, hyperemic lesions, papular lesions, submucosal plaques/papules, a flat polypoid lesion, and segments of cylindrical epithelium. No endoscopic signs of dysplasia were present. Esophagitis consistent with gastroesophageal reflux disease was noted in 12 / 24 patients. Histopathology showed chronic inflammation of the esophageal mucosa in the majority (18 / 24) of patients. In 50 % (12 / 24), the diagnosis of esophageal lichen planus was made. Dysplasia was not present. There were no differences in symptoms between patients with and without esophageal lichen planus. At screening endoscopy a high prevalence (50 %) of esophageal lichen planus was found in patients with orocutaneous lichen planus. No dysplasia was found.

Cyclosporine in the Management of Esophageal Lichen Planus

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.

Cyclosporin in the Management of Esophageal Lichen Planus

Purpose: The first report of cyclosporin in the management of esophageal Lichen Planus. Methods: A 54 yr woman with oral lichen planus was referred for assessment of dysphagia. Esophageal lichen planus was diagnosed. She became steroid dependent. She was then placed on cyclosporin. Results: Lichen planus (LP) is an uncommon disorder of unknown etiology mostly affecting patients in their 5th and 6th decade. It is thought to be an autoimmune process involving the T cells against basal keratinocytes. It mostly affects skin, nails, mucous membranes (especially oral pharynx), vulva and penis. Esophageal involvement is quite rare and can cause strictures, ulcerations and squamous cell cancer. Initially, dysphagia occurred with solid foods and then progressed to soft foods but sparing liquids. She had lost 20 lbs. She did not complain of epigastric pain or reflux symptoms. She has no other significant past medical history. She drinks socially and is a non- smoker. An esophagogastroduodenoscopy (EGD) was performed and she was diagnosed with pill esophagitis. At the same time, she was also diagnosed with lichen planus in her oral pharynx with no involvement of the esophagus. She was treated with a PPI and her GI symptoms resolved. However, the symptoms returned after a year and a repeat EGD revealed white plaques in the esophagus and the biopsy showed dense lichenoid inflammatory infiltrate underneath the lamina propria. She was subsequently treated with dilatations and intermittent glucocorticoids. However, as soon as the steroids were tapered she flared, therefore, she was tried on cyclosporine and she responded well. Diagnosis of LP of the esophagus is crucial for the proper treatment. Symptomatic patients should have EGD and biopsies taken. Some of these patients may require systemic immunosuppression as well as mechanical treatment to prevent weight loss. Surveillance endoscopies should be carried out to monitor for the development of squamous cell carcinoma. Conclusion: Cyclosporine has been used in the past for genital and oral LP, but our case is the first where it has been used successfully for esophageal LP.Figure

Esophageal Lichen Planus: Case Report and Literature Review

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.

Esophageal lichen planus: a series of eight cases including a patient with esophageal verrucous carcinoma. A case series

Esophageal lichen planus is a rare condition. Its risk of malignant transformation is unknown. We report a series of eight patients with esophageal lichen planus referred to our unit between 1990 and 2005. Clinical, endoscopic, radiological and histological data of these patients were retrospectively reviewed. Seven patients were women. All patients had oral lichen planus. Endoscopic lesions were located in the upper third of the esophagus in seven patients and in the mid third in two patients. Five patients had esophageal stricture. Seven patients had peeling, friable esophageal mucosa. Histological examination of esophageal biopsies found characteristic features of lichen planus in two patients and nonspecific changes in five patients. All patients received corticosteroids. Patients with stricture underwent esophageal dilation. Esophageal perforation after dilation occurred in one patient. Corticosteroids improved dysphagia in all patients; steroid dependence occurred in two patients with stricture. One patient had an esophageal verrucous carcinoma, which was treated with radiotherapy and chemotherapy. Upper endoscopy should be performed in patients with mucosal lichen planus presenting with dysphagia to assess esophageal involvement. Esophageal strictures are frequent and require dilation. Corticosteroids are the first-line treatment, but steroid dependence may occur. Cancer can arise on esophageal lichen planus and justifies endoscopic follow-up.

Esophageal Lichen Planus

Abstract Esophageal lichen planus is an underrecognized condition, with fewer than 50 cases reported to date. Unlike cutaneous lichen planus, esophageal lichen planus occurs almost exclusively in middle-aged or older women who also have oral involvement. It commonly involves the proximal esophagus and manifests as progressive dysphagia and odynophagia. Endoscopic findings can include lacy white papules, pinpoint erosions, desquamation, pseudomembranes, and stenosis. Histologic features of esophageal lichen planus have only rarely been illustrated. They differ from those of cutaneous disease in several respects, including the presence of parakeratosis, epithelial atrophy, and lack of hypergranulosis. Correct diagnosis of esophageal lichen planus is difficult but bears important therapeutic implications. It is typically a chronic and relapsing condition that can require systemic or local immunosuppressive therapy and repeated endoscopic dilatations for esophageal strictures. Esophageal lichen planus may hav...

Esophageal Lichen Planus

Abstract Esophageal lichen planus is an underrecognized condition, with fewer than 50 cases reported to date. Unlike cutaneous lichen planus, esophageal lichen planus occurs almost exclusively in middle-aged or older women who also have oral involvement. It commonly involves the proximal esophagus and manifests as progressive dysphagia and odynophagia. Endoscopic findings can include lacy white papules, pinpoint erosions, desquamation, pseudomembranes, and stenosis. Histologic features of esophageal lichen planus have only rarely been illustrated. They differ from those of cutaneous disease in several respects, including the presence of parakeratosis, epithelial atrophy, and lack of hypergranulosis. Correct diagnosis of esophageal lichen planus is difficult but bears important therapeutic implications. It is typically a chronic and relapsing condition that can require systemic or local immunosuppressive therapy and repeated endoscopic dilatations for esophageal strictures. Esophageal lichen planus may have malignant potential, as evidenced by 3 patients who developed squamous carcinoma of the esophagus after longstanding disease.

Esophageal lichen planus: A case report and review of literature

Lichen planus is a rare cause of esophagitis and esophageal stricture. It is invariably associated with oral mucosal involvement and the diagnosis has to be considered in these patients who present with dysphagia. We present a case of esophageal stricture secondary to lichen planus.

Liquen plano con afectación esofágica

Lichen planus is an inflammatory disease of unknown etiology which may affect the esophagus. Patients with esophageal lichen planus are usually elderly women. The most frequent symptoms are dysphagia and odynophagia. There is usually concomitant oral involvement in cases of esophageal lichen planus. Endoscopic findings include erosions, exudates and stenosis. Systemic steroids are the most effective therapy for these patients. We report a 68-year-old woman with oral, genital and submammary lesions of lichen planus of nine months duration, that referred dysphagia and odynophagia. The endoscopic study revealed white plaques and areas of friable mucosa without stenosis. Histological findings were not conclusive but excluded changes due to fungal or reflux esophagitis. Biopsy of oral and cutaneous lesions showed typical features of lichen planus. Treatment with systemic steroids significantly improved the symptoms.

Lichen Planus With Esophageal Involvement

Lichen planus is an inflammatory disease of unknown etiology which may affect the esophagus. Patients with esophageal lichen planus are usually elderly women. The most frequent symptoms are dysphagia and odynophagia. There is usually concomitant oral involvement in cases of esophageal lichen planus. Endoscopic findings include erosions, exudates and stenosis. Systemic steroids are the most effective therapy for these patients. We report a 68-year-old woman with oral, genital and submammary lesions of lichen planus of nine months duration, that referred dysphagia and odynophagia. The endoscopic study revealed white plaques and areas of friable mucosa without stenosis. Histological findings were not conclusive but excluded changes due to fungal or reflux esophagitis. Biopsy of oral and cutaneous lesions showed typical features of lichen planus. Treatment with systemic steroids significantly improved the symptoms.

Lichen planus in the oesophagus: are we missing something?

Lichen planus of the oesophagus is rare with a predilection for middle-aged to elderly women. There is a potential risk of malignant transformation to squamous cell carcinoma. Squamous cell carcinoma of the oesophagus still accounts for 30-40% of oesophageal cancer cases in the west and is almost exclusively the disease still encountered in the rest of the world. An increased awareness of oesophageal lichen planus is suggested in patients with cutaneous, oral or vulval disease. Endoscopic investigation of patients with lichen planus, possibly initially limited to those with oesophageal symptoms, and consideration of surveillance in patients with proven oesophageal lichen planus, will aid understanding of natural history of lesions and may help detect early stage tumours. Squamous cell carcinoma still accounts for 30-40% of oesophageal cancer cases in the west and is almost exclusively the disease still encountered elsewhere. Lichen planus of the oesophagus is potentially a premalignant condition for squamous cell carcinoma that could be surveilled in order to detect early-stage tumours with a consequent greater chance of cure. Oesophageal lichen planus is, however, rare, frequently asymptomatic and although the majority of cases occur in conjunction with lichen planus in other sites, the oesophageal features may be subtle and easily missed by endoscopic assessment. Furthermore, the histological changes are difficult to interpret and there may be significant underreporting. As a consequence, the true prevalence of these lesions is hard to determine. The difficulties in detection may mean that we are underestimating the frequency of oesophageal lichen planus. Endoscopic detection may be aided by the use of magnification indigo carmine chromoendoscopy and this warrants further evaluation. The risk of malignant transformation is currently unknown but may parallel that of oral lesions at approximately 1-3%. An increased awareness of the condition can only help to identify more cases and increase our understanding of this interesting condition.

Two siblings with lichen planus and squamous cell carcinoma of the oesophagus

Lichen planus is a mucocutaneous disease which can also affect the oesophagus. Unlike in oral lichen planus an increased risk for the development of squamous cell carcinoma in the oesophagus has not been established. We describe two sisters with a history of long-standing cutaneous lichen planus who developed oesophageal squamous cell carcinoma, diagnosed at the ages of 68 and 70 years, respectively. In one of the cases, dysplastic areas were identified by high-magnification chromoendoscopy. In both cases, oesophageal resection was carried out with a curative intent. For the first time these sibling case reports suggest an increased precancerous potential of oesophageal lichen planus.

Oesophageal Lichen Planus: A Missed Diagnosis

Oesophageal Lichen Planus: A Missed Diagnosis

Oesophageal lichen planus: a missed diagnosis

Lichen planus is a chronic inflammatory mucocutaneous disease of unknown aetiology with no racial predisposition, although there is a considerable variation in its incidence. Involvement of oesophagus is considered to be extremely rare; the diagnosis is often not made until complications occur. An epidemiological study of 584 patients with oral lichen planus showed oesophageal involvement in only six patients, clearly showing a rare prevalence. The incidence of this disease in dermatology clinics is 1.4%, compared to 3% in oral medicine clinics. We describe a 69-year-old woman who presented with a 2-year history of odynophagia due to oesophageal lichen planus. This case is very unusual in that she had skin involvement 28 years before and had no recurrence.

Diffuse esophageal stricture secondary to esophageal lichen planus

There are many well-known causes of diffuse esophageal stricture, including lye burns, reflux, radiation, and several mucocutaneous diseases. We report a case of esophageal stricture secondary to lichen planus. Esophageal lichen planus is rare and frequently mistaken for other more common disorders such as gastroesophageal reflux disease, which delays diagnosis and appropriate treatment, but it should be considered in female patients with cutaneous and oral lichen planus.

Squamous cell carcinoma arising in esophageal lichen planus

Carlo Calabrese, MD, PhD, Anna Fabbri, MD, Marco Benni, MD, Alessandra Areni, MD, Carlo Scialpi, MD, Mario Miglioli, MD, Giulio Di Febo, MD Lichen planus (LP) is a chronic disease of skin and other squamous epithelium of unknown etiology. The estimated prevalence ranges from 0.02% to 2%. 13 An association has been suggested with acute alopecia and chronic hepatitis, especially hepatitus C virus-induced, and autoimmune disorders. 4-6 Although LP of the skin affects both genders with equal frequency and can appear at any age, mucosal LP is mainly a disease of middle-aged women.7, 8 It can involve the oral cavity, pharynx, esophagus, geni- talia, and anus. 3 Coexistent skin lesions are present in approximately 30% to 50% of patients.9,10 Skin lesions are tiny, flat-topped, violaceus papulae, ofter~ with a network of delicate white lines on the surface. Mucosal IJP has a different pattern: it is more com- monly found within the oral cavity and it appears in at least 6 forms that can occur separately or simulta- neously: reticular, papular, plaque-like, atrophic, ero- sive, and bullous. 11 Esophageal involvement in LP is rare, but its prevalence is probably underestimated. 12 Only 35 cases have been reported in French and English language publications to date. 1-3,7,8-10,12-33 At endoscopy, the most common features include peeling mucosae and plaque-like lesions and/or benign stric- tures in the proximal and middle thirds of the esoph- agus. It can involve the entire length of the esopha- gus, but the gastroesophageal junction is always spared. Histopathol0gic features are nonspecific and resemble those of chronic mucosal inflammation. In particular, the band-like infiltrate with a predomi- nance of mature T-cells and basal layer degeneration, including characteristic Civatte bodies, typical of skin involvement may not be present.7,19, 22 Mucosal LP has a recognized risk of malignant transformation to squamous cell carcinoma (SCC) of approximately 0.5% to 1%. 34-36 However, no case of malignant evolu- tion of esophageal LP has been described to date. CASE REPORT A 49-year-old white woman was referred to our endo- scopic unit because of recurrent epigastric pain, regurgita-

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

Clinically significant involvement of the esophagus is uncommon in patients who have lichen planus, a common disorder of squamous epithelium. In three patients who had oral, cutaneous, and esophageal lichen planus, endoscopic intralesional esophageal injection of corticosteroids (in all three patients) and oral tacrolimus (FH506) (in two patients) resulted in improvement in dysphagia, a less frequent need for dilation, and improvement in esophageal inflammation.

Esophageal lichen planus: the Mayo Clinic experience.

Lichen planus (LP) is an inflammatory papulosquamous disease which may affect the squamous epithelium of the esophagus. We reviewed six patients with esophageal lichen planus (ELP) seen at Mayo Clinic Rochester between 1984 and 1998. The presenting symptoms were dysphagia (in all six patients) and odynophagia (two patients). Cervical esophageal strictures were seen in four patients; average number of esophageal dilatations required was 15 (range, 10-18). Esophageal biopsies demonstrated the classical histologic findings of ELP in two patients, and a lymphocytic infiltrate in the other four. Concomitant lichen planus (LP) was seen at other sites in five patients: all five had oral LP preceeded by ELP symptoms in all five; three had genital LP preceeded by ELP symptoms in all three; two had dermal LP, preceeded by ELP symptoms in one. Proton pump inhibitors were tried unsuccessfully in all patients. Four patients were started on systemic steroid medication; three had resolution of symptoms within 1 month.