15 July 2024

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Oral Chronic Mucositis in a Known Lichen Planus Pigmentosus Patient

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Oral manifestations of mucocutaneous inflammatory diseases such as lichenoid dermatoses often affect the patient’s quality of life through the symptoms of pain and burning sensation. In this case report, a patient with known lichen planus pigmentosus (LPP), a variant of lichenoid dermatoses that rarely affect oral mucosa, presented with chronic pain in the oral cavity for 2 months. Her intraoral examination revealed multiple pseudomembranous ulcers with erythematous areas and white striae similar to erosive lichen planus.

The histological assessment revealed chronic mucositis, while the direct immunofluorescent examination showed negative results, contradicting the diagnosis of both lichen planus and LPP. Thus, the diagnosis was given as chronic mucositis, and the topical steroid was given. After 6 weeks of steroid application, the lesion resolved. To the best of our knowledge, this is the first report of chronic mucositis in LPP patients. This report could raise the awareness of clinicians to carefully take history as the patient with LPP may suffer from chronic mucositis in the oral cavity as well.

Introduction

Lichen planus pigmentosus (LPP), a rare subvariant of lichenoid dermatoses, is a group of mucocutaneous inflammatory diseases of unknown etiology consisting of lichen planus (LP), which is the most common, and lichen planopilaris. This idiopathic inflammatory condition of the skin is characterized by chronic-acquired dark brown to gray macular pigmentation at sun-exposed areas of the face and neck and sun-protected flexural skin in dark-skinned middle-aged patients which rarely involves oral mucosa. Although the etiology and pathogenesis are still unclear, it has been discovered that some of them are associated with the hepatitis C virus and other variants of LP. Affected patients may suffer from emotional stress due to the manifestation of the lesion in an aesthetic area and the chronic nature of the disease, which impact their quality of life.

This case report details the presentation of a 70-year-old female patient initially diagnosed with oral lichen planus (OLP), alongside LPP as her known underlying condition. However, an incisional biopsy yielded findings indicative of chronic mucositis instead. One week later, without any treatment, the lesions improved, and then, with the aid of a topical steroid supplement, the lesions eventually resolved.

Authors: Dalad Pinchaleaw, Pirawish Limlawan

Source: https://onlinelibrary.wiley.com/