pulmicort and Lichen-Planus

Oesophageal lichen planus is an idiopathic inflammatory disorder characterized by significant oesophageal stricturing. Oesophageal lichen planus is a rare, difficult to diagnose, and likely an under recognized disease. As a result, there is no standardized approach to therapy and treatment strategies vary.. To examine the utility of topical steroid therapy (fluticasone or budesonide) in the management of oesophageal lichen planus.. A retrospective chart review was conducted of patients diagnosed with oesophageal lichen planus who underwent baseline and follow up endoscopy pre and post topical steroid therapy between 1995 and 2016 at Mayo Clinic, Rochester MN. Average time between upper GI endoscopy was 3.2 months (0.7-11.7). Swallowed steroid preparations included fluticasone 880 μg twice daily or budesonide 3 mg twice daily. Patients were reviewed for symptomatic response to therapy using the Dakkak-Bennett dysphagia score (0-4, no dysphagia to total aphagia). Pre- and post-endoscopic findings were assessed. Additional baseline demographic, endoscopic, and histologic data were also obtained.. We identified 40 patients who met the inclusion criteria. A significant reduction in median dysphagia score from 1 (0-4) to 0 (0-3) after steroid therapy (P < 0.001) was noted. 62% of patients reported resolution of their dysphagia after receiving topical corticosteroids. 72.5% had an endoscopic response to steroid therapy.. Topical swallowed budesonide or fluticasone appear to effective treatment for oesophageal lichen planus.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Budesonide; Deglutition Disorders; Esophageal Diseases; Female; Fluticasone; Glucocorticoids; Humans; Lichen Planus; Male; Middle Aged; Treatment Outcome

Lichen planus (LP) is a classic skin disease that can involve the skin, hair, and nails, as well as the oral and genital mucosa. Histopathology is characterized by a T-lymphocytic, lichenoid, and interface dermatitis. Multiple case reports and small case series have shown that LP can involve the esophagus. However, the diagnostic criteria, incidence, and best treatment options remain uncertain. This study aimed to refine the diagnostic criteria, estimate prevalence, and present an outlook on treatment options to prevent long-term sequelae.. Thirty-two consecutive patients with LP of the skin, hair, nails, oral mucosa, and/or genital mucosa underwent a comprehensive clinicopathologic assessment. Esophagogastroduodenoscopy was performed, and biopsies were evaluated histologically, immunohistochemically, and by direct immunofluorescence. Patients diagnosed with esophageal lichen planus (ELP) were followed up prospectively where possible.. In total, 20 of 32 patients had ELP. Ten of these 20 patients were classified as having proven ELP, with clear-cut endoscopically visible lesions; the other 10 were classified as having probable ELP. Eight of 10 patients with proven ELP were started on new or additional therapy because of esophageal findings. Treatment with a topical budesonide formulation or systemic corticosteroids was successful in most patients with proven ELP and reversed functional esophageal stenosis.. ELP can be found in more than 50% of patients with proven mucocutaneous LP when clinical and pathologic findings are correlated carefully. Topical or systemic corticosteroids are the first-line therapy for ELP. Timely medical therapy seems to prevent scarring stenosis of the esophagus.

Topics: Adult; Aged; Biopsy; Budesonide; Endoscopy, Digestive System; Esophageal Diseases; Female; Fluorescent Antibody Technique; Glucocorticoids; Humans; Immunohistochemistry; Lichen Planus; Male; Middle Aged; Prevalence

Here we describe the first case of symptomatic Lichen planus oesophagitis that was successfully treated with topical budesonide. Lichen planus is a chronic inflammatory disorder of the skin and mucous membranes which is in some cases associated with oesophageal involvement and dysphagia. So far, anecdotal treatment approaches consisted of systemic steroids, retinoids or immunosuppressives. Our patient received oral budesonide suspension 2×1 mg per day for 8 weeks, followed by 2 × 0.5  mg for 3 months. At the end of treatment we observed a complete symptomatic, endoscopic and histological remission, which lasted for at least further 6 months after termination of treatment.

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Esophagitis; Female; Humans; Lichen Planus; Middle Aged; Treatment Outcome