title: Esophageal involvement is frequent in lichen planus: study in 32 patients with suggestion of clinicopathologic diagnostic criteria and therapeutic implications.
abstract: OBJECTIVE
  Lichen planus (LP) is a classic skin disease that can involve the skin, hair, and nails, as well as the oral and genital mucosa. Histopathology is characterized by a T-lymphocytic, lichenoid, and interface dermatitis. Multiple case reports and small case series have shown that LP can involve the esophagus. However, the diagnostic criteria, incidence, and best treatment options remain uncertain. This study aimed to refine the diagnostic criteria, estimate prevalence, and present an outlook on treatment options to prevent long-term sequelae.
  
  
  METHODS
  Thirty-two consecutive patients with LP of the skin, hair, nails, oral mucosa, and/or genital mucosa underwent a comprehensive clinicopathologic assessment. Esophagogastroduodenoscopy was performed, and biopsies were evaluated histologically, immunohistochemically, and by direct immunofluorescence. Patients diagnosed with esophageal lichen planus (ELP) were followed up prospectively where possible.
  
  
  RESULTS
  In total, 20 of 32 patients had ELP. Ten of these 20 patients were classified as having proven ELP, with clear-cut endoscopically visible lesions; the other 10 were classified as having probable ELP. Eight of 10 patients with proven ELP were started on new or additional therapy because of esophageal findings. Treatment with a topical budesonide formulation or systemic corticosteroids was successful in most patients with proven ELP and reversed functional esophageal stenosis.
  
  
  CONCLUSIONS
  ELP can be found in more than 50% of patients with proven mucocutaneous LP when clinical and pathologic findings are correlated carefully. Topical or systemic corticosteroids are the first-line therapy for ELP. Timely medical therapy seems to prevent scarring stenosis of the esophagus.
authors: Departments of aDermatology bInternal Medicine, Gastroenterology, Hepatology, Endocrinology and Infectiology cInternal Medicine, Institute for Exercise and Occupational Medicine dInstitute of Pathology, Medical Center, Faculty of Medicine, University of Freiburg eDepartment of Medicine, RKK St. Josef's Hospital, Freiburg, Germany fSkin & Cancer Foundation Inc., Carlton gDepartment of Dermatology, Royal Melbourne Hospital, Parkville hDepartment of Dermatology, Box Hill Hospital-Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia.
authors: Johannes S
authors: JS
authors: Kern
authors: Kristin
authors: K
authors: Technau-Hafsi
authors: Henning
authors: H
authors: Schwacha
authors: Jan
authors: J
authors: Kuhlmann
authors: Gunther
authors: G
authors: Hirsch
authors: Volker
authors: V
authors: Brass
authors: Peter
authors: P
authors: Deibert
authors: Anette
authors: A
authors: Schmitt-Graeff
authors: Wolfgang
authors: W
authors: Kreisel
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D019819:Budesonide / Q000627:therapeutic use; D016145:Endoscopy, Digestive System; D004935:Esophageal Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D005260:Female; D005455:Fluorescent Antibody Technique; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007150:Immunohistochemistry; D008010:Lichen Planus / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence
chemical_list: D005938:Glucocorticoids; D019819:Budesonide