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Keywords

Bullous lichen planus, direct immunofluorescence, oral lichen planus

Abstract

Lichen planus (LP)is a common immune-mediated chronic mucocutaneous disorder with a worldwide distribution. It mainly affects the skin, nails, hair, and the genital area. Initial presentation of these lesions may occur in the oral mucosa without any other cutaneous manifestations. Hence, it is necessary for the dental professionals to be both familiar with its varied clinical presentations, course of this condition, and their management. Here, we report a case of bullous LP in a 23-year-old male patient, discussing clinical features, etiopathogenesis, and management.

Introduction

Oral lichen planus (OLP) is a well-recognized potentially malignant disorder which affects epithelium of skin, oral mucosa, and genitalia. Clinically, the lesion looks like lace-like pattern produced by symbolic algae and fungal colonies on the surface of rocks (lichens) and "planus" stands for flat. It is most commonly seen in females in the age group of the third to sixth decades of life.[1] Malignant transformation is reported to be 0.4-5% in a duration of 0.5-20 years.

Although LP is considered as an autoimmune disease, its exact cause is not clear. Few researchers have suggested that LP is a chronic, cell-mediated immune disorder involving activated lymphocytes and upregulated cytokine production.[2] OLP has varied clinical presentations such as reticular, erosive, atrophic, papular, plaque-like, and bullous subtypes of which bullous is considered to be the rarest.[3] The signs and symptoms can vary according to the clinical subtypes. Reticular OLP usually presents as asymptomatic while the erosive and atrophic forms will be associated with pain or burning sensation.[3]

Bullous lichen planus (BLP) is rare and may be confused with other sub-epidermal bullous dermatoses. Here, we present a case report of bullous OLP in a young male patient with initial involvement of oral mucosa alone.

Case Report

A 23-year-old male patient (Figure 1) presented with a history of burning sensation and recurrent fluid-filled blisters in the buccal mucosa since 2 weeks. The boils would subsequently burst. The patient also noticed white colored patches on the buccal mucosa bilaterally. Medical history was negative and he was not under any medications.

Cutaneous examination...

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