Lichen planus of the esophagus: What dermatologists need to know

BackgroundEsophageal lichen planus (ELP) is a rare manifestation of mucocutaneous lichen planus (LP).ObjectivesWe aimed to report our experience and review all cases of ELP reported in the English-language literature.MethodsWe 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.ResultsA 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.LimitationsThis is a review of our cases and others reported in the literature.ConclusionsELP 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.