Variations in presentations of esophageal involvement in lichen planus.
OBJECTIVE
Lichen planus is a relatively uncommon, presumed autoimmune disease that affects middle-aged patients and is manifested in the skin, nails, and mucous membranes. Reports of esophageal involvement have been rare, despite the classification of the esophagus as a mucous membrane.


METHODS
Assuming esophageal involvement might not be as rare as expected, we reviewed the Mayo Clinic Pathology Database for all cases from 2000 to the present.


RESULTS
Twenty-seven cases were identified, with a mean age of 64 years; 25 were women. Patients presenting with esophageal lichen planus as the initial manifestation and those with a diagnosis of lichen planus involving other sites were equal in number. Many patients had received multiple dilations and reflux treatments before diagnosis. All patients presented with dysphagia. Endoscopy and radiology studies demonstrated a wide range of abnormalities, including strictures of varying length and location, small-caliber esophagus, and a mucosal appearance of sloughing, white discoloration, erythema, thickening, and superficial ulceration. Treatment regimens varied markedly, with some patients responding to topical or systemic corticosteroids.


CONCLUSIONS
Esophageal lichen planus is rare but probably more common than previously suspected. It presents with a wide range of endoscopic signs and is commonly the presenting sign of lichen planus. In evaluating middle-aged patients with strictures, particularly proximal esophageal strictures in women, physicians should consider a diagnosis of lichen planus even in the absence of extraesophageal manifestations.
Katzka
David A
DA
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA. katzka.david@mayo.edu
Smyrk
Thomas C
TC
Bruce
Alison J
AJ
Romero
Yvonne
Y
Alexander
Jeffrey A
JA
Murray
Joseph A
JA
D000368:Aged; D016145:Endoscopy, Digestive System; D004935:Esophageal Diseases / Q000453:epidemiology* / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D008010:Lichen Planus / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies