Esophageal lichen planus: A prospective interdisciplinary, monocentric cohort study

Summary Background and objectives Lichen planus (LP) is an inflammatory condition that affects skin, hair follicles, nails and mucous membranes with esophageal involvement being an underrecognized manifestation. Patients and Methods In this prospective cohort study (2020–2023), we screened 562 patients for symptomatic and clinically relevant esophageal lichen planus (ELP), using dysphagia as the primary screening criterion. The study included patients from the Department of Dermatology with either newly diagnosed or existing LP who reported esophageal symptoms, as well as patients referred from the Department of Gastroenterology who underwent endoscopy for unexplained esophageal symptoms potentially associated with ELP. The diagnosis of ELP was based on endoscopic, histopathological, and immunofluorescence findings. Results Through this approach, 77 patients with dysphagia and potential ELP were identified, of whom 21 were diagnosed with ELP. A more detailed evaluation of their symptoms revealed that ELP patients exhibited significantly higher rates of esophageal dysphagia, food bolus obstruction, and retrosternal pain compared to LP patients without esophageal involvement. Two ELP patients were diagnosed with esophageal squamous cell carcinoma. Multilocular LP manifestation emerged as a strong indicator of esophageal involvement. Conclusions This study underscores the importance of recognizing ELP, recommending comprehensive endoscopic evaluation and dermatological assessments when esophageal symptoms are present.