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Objective: Lichen planus is a chronic mucocutaneous disease characterized by oral ulcerations with or without cutaneous lesions. Erosive lichen planus is a rare form of lichen planus characterized by painful oral ulcers, and often associated with ulcers in the genital area. Erosive lichen planus is considered a pre-malignant condition. The objective of this paper is to report a case of Erosive lichen planus (vulvovaginal gingival syndrome) in a 67-year-old female with oral and genital lesions; to highlight the nature of a severe variant of lichen planus, its clinical presentation and management.
Case report: A 67-year-old female presented with a one- year history of recurrent mouth ulcers. This was associated with itchy cutaneous lesions around the navel and genital region. Patient had been placed on steroid therapy alongside antibiotics by general practitioners. This gave her temporary relief. Intra-oral examination revealed wide spread erosions and erythema, worse on both buccal mucosae and the tongue. Some areas were covered with pseudomembrane which could not be scrapped off. There was also marked desquamative gingivitis. An impression of Erosive lichen planus-vulvovaginal gingival syndrome, was made based on a history and clinical assessment and patient was commenced on prednisolone 50mg daily, dapsone 50mg 12hourly, and dexamethasone oral rinse 12hourly. Subsequent reviews showed healing oral and cutaneous lesions. Patient is currently on maintenance dose of prednisolone 10mg, dapsone 100mg daily, and oral steroid rinse.
Conclusion: This study reports a case of Erosive lichen planus ‘vulvovaginal- gingival syndrome’ in an elderly female, with refractory oral and genital ulcers. Early and accurate diagnosis with appropriate treatment is very important for alleviation of symptoms and improvement of patient’s wellbeing.