Lichen planus of the esophagus: What dermatologists need to know

Fox, Lindy Peta MD
Lightdale, Charles J. MD
Grossman, Marc E. MD

^aDepartment of Dermatology, University of California, San Francisco, California
^bDepartment of Medicine, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York
^cDepartment of Dermatology, Columbia University Medical Center, New York, New York

Correspondence to: Lindy Peta Fox, MD, Department of Dermatology, University of California, San Francisco, 1701 Divisadero St, Third Floor, Box 0316, San Francisco, CA 94115. E-mail: [email protected].

Supported in part by a Medical Dermatology Career Development Award given by the Dermatology Foundation (Dr Fox).

Conflicts of interest: None declared.

Reprints not available from the authors.

Presented at the Intersociety Liaison Committee Abstract-based Concurrent Sessions Participants, 63rd American Academy of Dermatology Annual Meeting, New Orleans, LA, February 20, 2005, and published in abstract form in J Am Acad Dermatol 2005;52:SAB7. Since that time, additional cases from the literature have been included in this analysis; thus, reported results differ slightly from those presented in 2005.

Journal of the American Academy of Dermatology 65(1):p 175-183, July 2011.

Background:

Esophageal lichen planus (ELP) is a rare manifestation of mucocutaneous lichen planus (LP).

Objectives:

We aimed to report our experience and review all cases of ELP reported in the English-language literature.

Methods:

We report our experience with 4 cases and reviewed PubMed for reports of ELP. Cases were evaluated for age of onset, sex, location of LP, relationship of the onset of ELP to extra-ELP, endoscopic findings, whether biopsy was performed, histopathology of esophageal biopsy specimens, medical history (including gastrointestinal history), development of esophageal squamous cell carcinoma, therapies tried, and response to treatment.

Results:

A total of 72 cases of ELP were studied. In all, 87% of patients were female, with a median age of 61.9 years at time of diagnosis. Dysphagia was present in 81% and odynophagia was present in 24%. Oral LP was present in 89%, anogenital/vulvar LP in 42%, and cutaneous LP in 38%. Fourteen patients developed ELP as the sole or first manifestation of LP. Proximal esophageal lesions were present in 64%, distal in 11%, and both proximal and distal in 26%. Histology was “consistent with” LP in 71%. Four patients developed squamous cell carcinoma in association with ELP.

Limitations:

This is a review of our cases and others reported in the literature.

Conclusions:

ELP is underrecognized and underreported. There is often a significant delay between the onset of symptoms and the diagnosis. Malignant transformation of ELP to squamous cell carcinoma has been reported.