The challenges of managing refractory oesphageal lichen planus.

INTRODUCTION: Lichen planus is an inflammatory mucocutaneous disorder, often idiopathic. It is postulated that the characteristic skin lesions arise from a T cell mediated autoimmune response against basal keratinocytes. Oral mucosal involvement can occur in up to 70 % of cases of cutaneous disease however, oesphageal involvement is rare. RESULT: We report the case of a 60 year old female with ulcerative oesphagitis and concomitant cutaneous lesions suggestive of lichen planus. Multiple immunosuppressant therapies were administered but with little success, except for pulses of oral steroids.
CONCLUSION: Oesphageal lichen planus is rare, often unrecognised and can be resistant to treatment. However, diagnosis is crucial as malignant transformation of longstanding ulcerative lichen planus may occur.