Peno-gingival lichen planus.
BACKGROUND
Lichen planus with simultaneous oral and genital involvement in males is a quite rare condition and often difficult to diagnose. The prevalence, treatment options, and management for this condition are far from being established, and research in this area primarily relies on anecdotes. We present the clinical features of eight cases of peno-gingival lichen planus and propose a management algorithm for this condition based on the best available published evidence.


METHODS
Personal medical history was collected for all cases. Following careful examination of the oral and genital mucosae, pathology was obtained, previous treatments and duration of mucosal lesions ascertained, treatment initiated, and response evaluated at 8 weeks on both oral and genital lesions. The first-line drug was topical clobetasol propionate 0.05% cream in all cases; in case of failure, topical cyclosporin was used. A review of the literature on treatment options for this rare condition was performed based upon standard literature review practices.


RESULTS
Five cases presented gingival lesions that clinically resembled lichen planus. Glans penis was involved in all patients. All patients responded to treatment except for one. Oral candidiasis was the only observed side effect.


CONCLUSIONS
Genital lichen planus may be suspected in males when atrophic-erosive gingival lichen planus is found. A thorough multidisciplinary medical management and active early treatment are necessary to improve symptoms and prevent genital sequelae and, given the risk of squamous cell carcinoma, as a preventative strategy, although this area still needs investigation. Therapeutic trials relating to the treatment of peno-gingival lichen planus may be undertaken considering that current management relies exclusively on observations of case reports.
Petruzzi
Massimo
M
Department of Odontostomatology and Surgery, University of Bari, Bari, Italy. petruzmf@tin.it
De Benedittis
Michele
M
Pastore
Luca
L
Grassi
Felice Roberto
FR
Serpico
Rosario
R
D000287:Administration, Topical; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002180:Candidiasis, Oral / Q000209:etiology; D002610:Cheek / Q000473:pathology; D002990:Clobetasol / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D015331:Cohort Studies; D005500:Follow-Up Studies; D005882:Gingival Diseases / Q000175:diagnosis / Q000188:drug therapy; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008010:Lichen Planus / Q000175:diagnosis* / Q000188:drug therapy; D017676:Lichen Planus, Oral / Q000175:diagnosis* / Q000188:drug therapy; D008047:Lip Diseases / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D010409:Penile Diseases / Q000175:diagnosis* / Q000188:drug therapy; D012074:Remission Induction; D014060:Tongue Diseases / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D002990:Clobetasol