Lichen planus may involve the esophagus but the diagnosis is easily missed.
(1) The patient may show evidence of lichen planus elsewhere or have a past history of lichen planus.
(2) The patient may complain of odynophagia, retrosternal pain, and/or reflux-type symptoms.
(3) Endoscopy may show violaceous, flat papules and/or a network of white lines in the esophageal mucosa (Wickham's striae).
(4) Koebner's phenomenon (linear lesions developing along scratch marks or in scars)
(5) The patient typically improves with corticosteroid therapy.
(6) HLA typing may show DR1 or other associated antigens.
Histologic features of an esophageal biopsy:
(1) compact orthokeratosis
(2) Civatte bodies in the mucosa (necrotic keratinocytes)
(3) vacuolar degeneration of the basel layer
(4) a dense band-like lymphocytic infiltrate in the submucosa
(1) strictures which may be made worse by attempts at dilatation prior to medical management
(2) weight loss and dehydration secondary to decreased oral intake
(3) concomitant candidiasis, especially if the patient has diabetes mellitus
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