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Canadian Journal of Gastroenterology
Volume 23 (2009), Issue 10, Pages 686-688
http://dx.doi.org/10.1155/2009/802075
Brief Communication

Cyclosporine in the Management of Esophageal Lichen Planus

M Chaklader,1 C Morris-Larkin,2 W Gulliver,3 and J McGrath4

1Department of Medicine, Memorial University of Newfoundland, St John’s, Newfoundland, Canada
2Division of Pathology, Memorial University of Newfoundland, St John’s, Newfoundland, Canada
3Division of Dermatology, Memorial University of Newfoundland, St John’s, Newfoundland, Canada
4Division of Gastroenterology, Memorial University of Newfoundland, St John’s, Newfoundland, Canada

Received 24 July 2008; Accepted 28 July 2008

Copyright © 2009 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lichen planus (LP) is an uncommon disorder of unknown etiology, mostly affecting patients in their fifth and sixth decade of life. It is believed to be an autoimmune process involving T cells directed against basal keratinocytes. It affects the skin, nails, oral pharynx and genitals. Esophageal involvement is quite rare and can cause strictures, ulcerations and squamous cell cancer. The present article describes the case of a 54-year-old woman who was referred for assessment of dysphagia that initially occurred with solids, which then progressed to soft foods but spared liquids. The patient reported a weight loss of 9.1 kg. An esophagogastroduodenoscopy was performed and she was subsequently diagnosed with pill esophagitis. At the same time, she was also diagnosed with oral LP, with no involvement of the esophagus. She was treated with a proton pump inhibitor that resolved her gastrointestinal symptoms. The symptoms returned one year later and a repeat esophagogastroduodenoscopy revealed white plaques due to LP. She was treated with intermittent glucocorticoids. Diagnosis of esophageal LP is crucial for the proper treatment. Some patients may require systemic immunosuppression and mechanical dilation to prevent weight loss. Surveillance endoscopies should be performed to monitor for squamous cell cancer. Cyclosporine has been used for genital and oral LP, but the present case is the first in which it has been used successfully to treat esophageal LP.