Esophageal Lichen Planus: Highlighting Diagnostic Challenges and Therapeutic Limitations

Esophageal lichen planus (ELP) is a rare inflammatory disorder frequently misdiagnosed due to its nonspecific symptoms and overlapping features with other esophageal conditions. We present 3 cases of ELP characterized by delayed diagnosis and variable response to conventional therapies. All patients exhibited dysphagia and odynophagia with limited response to proton pump inhibitors, and endoscopic findings including mucosal sloughing, ulcerations, and strictures. Histopathologic findings were nondiagnostic but demonstrated features consistent with a lichenoid pattern of injury. While all patients trialed swallowed topical corticosteroids, 2 demonstrated minimal clinical response, and 1 required serial esophageal dilations and enteral nutritional support. These cases highlight the diagnostic and therapeutic challenges of ELP, emphasizing the need for increased awareness and development of standard treatment protocols.