title: Lichen planus and cicatrizing conjunctivitis: characterization of five cases.
abstract: OBJECTIVE
  To report the clinical and immunopathologic features and the response to therapy in a series of six patients with cicatrizing conjunctivitis due to lichen planus.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  All six patients were seen in an ocular pemphigoid clinic. Clinical, immunopathologic, and serologic features were evaluated and therapeutic response in each patient was monitored.
  
  
  RESULTS
  All six patients had evidence of conjunctival scarring. Five patients had lichen planus of the oral mucosa and gingiva; one patient had involvement of the skin. Histologic findings consisted of thickened epithelium and an interface lymphocytic infiltrate along the lamina propria. In three patients, electron microscopy of the conjunctiva revealed thickening, fragmentation, and duplication of the basement membrane zone. Direct immunofluorescence examination of the conjunctiva and oral mucosa demonstrated linear and shaggy fibrinogen deposition along the basement membrane zone, confirming the diagnosis of lichen planus. All six patients were placed on immunosuppressive therapy with control of the disease. However, only one patient was able to discontinue the anti-inflammatory medication and have the lichen planus remain in remission.
  
  
  CONCLUSIONS
  Lichen planus should be included in the differential diagnosis of cicatrizing conjunctivitis. Performing appropriate investigations to distinguish conjunctival lichen planus from other autoimmune diseases such as mucous membrane pemphigoid is critical to managing the patient with cicatrizing conjunctivitis appropriately. Oral cyclosporine effectively controlled the conjunctival lichen planus in four of the six cases.
authors.affiliation: Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA. jthorne@jhmi.edu
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.forename: Olga V
authors.initials: OV
authors.lastname: Nikolskaia
authors.forename: Daniel
authors.initials: D
authors.lastname: Mimouni
authors.forename: Grant J
authors.initials: GJ
authors.lastname: Anhalt
authors.forename: H Carlos
authors.initials: HC
authors.lastname: Nousari
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000378:metabolism; D002921:Cicatrix / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D003231:Conjunctivitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008010:Lichen Planus / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D005340:Fibrinogen