Successful Treatment of Erosive Lichen Planus With Topical Tacrolimus

Abstract

A 69-year-old woman with a history of colon carcinoma, cirrhosis of the liver secondary to hepatitis C, and erosive oral lichen planus presented to the dermatology clinic for therapeutic options regarding a growing ulceration on her lower lip. In the past year, the ulceration had enlarged and she had begun to develop new, painful, shallow ulcerations in the oral mucosa. In addition, she complained of intermittently pruritic papules involving the distal volar surfaces of her forearms. Biopsies and direct immunofluorescence were performed to evaluate histopathological features. The patient was diagnosed with erosive oral and cutaneous lichen planus. The cutaneous lesions resolved on treatment with fluocinonide cream. However, the lip and oral ulcerations persisted despite topical application of fluocinonide and clobetasol propionate gel once or twice daily for 1 year. Physical examination showed a 2.031.0-cm shallow ulceration involving the central lower lip (Figure1). The oral mucosa revealed extensive superficial ulcerations involving the buccal, gingival, and lingual mucosal surfaces. In addition, there were ulcerations on the dorsum of the tongue and a superficial ulceration on the hard palate, with a fine, reticulated grayish-white plaque surrounding the area (Figure 2). The volar aspect of the forearms revealed violaceous, lichenoid papules. There were no nail changes detected. Histopathological examination revealed an interface dermatitis with a dense bandlike infiltrate along the dermoepidermal junction. An occasional civette body was noted. Direct immunofluorescence showed a continuous, strong, shaggy deposition of fibrinogen along the basement membrane, with many scattered and clumped cystoids that tested positive for IgM and C3.