The challenges of managing refractory oesphageal lichen planus

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.

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.

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.