Clinical Challenge: Blistering of the Lower Lip - MPR

Clinical Challenge: Blistering of the Lower Lip

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A 54-year-old man presents with blistering of his lower lip. The condition has waxed and waned in severity over the past several months. He describes an ongoing cycle in which delicate water blisters form on his lip, burst, develop a slight crust, and resolve without scarring. Subjectively, he complains of itching and mild burning at the site of the blisters. His medical history includes a complaint of recurrent itchy lesions on his wrists and ankles for the past 10 years.

This patient was diagnosed with bullous lichen planus affecting his oral mucosa based on the presence of classic lesions of lichen planus on his extremities, as well as subsequent biopsy findings. Bullous lichen planus is an uncommon variant of lichen...

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This patient was diagnosed with bullous lichen planus affecting his oral mucosa based on the presence of classic lesions of lichen planus on his extremities, as well as subsequent biopsy findings. Bullous lichen planus is an uncommon variant of lichen planus, a cell-mediated inflammatory disorder that may affect the skin, nails, and mucous membranes. The bullous subtype is characterized by vesicular and/or bullous lesions that may occur on pre-existing lichen planus lesions or perilesional skin.1

The condition often presents with erosive or crusted lesions that are fragile and easily ruptured.2 Nonbullous lichen planus within the oral cavity tends to be chronic and may undergo spontaneous remission.3 Lip lesions that do not heal should undergo biopsy to rule out malignant transformation.4

Currently, no established treatment protocol for lichen planus exists. The primary focus of therapy is to improve symptoms and monitor the oral mucosa for suspicious changes. As this condition is inflammatory in nature, topical glucocorticoids, oral steroids, immunomodulating drugs including cyclosporine, and topical tacrolimus are commonly used, as are retinoids that also modify cell differentiation.3,5

Nelson Maniscalco, DPM, is a joint podiatry/dermatology fellow under the aegis of St. Luke’s Medical Center in Allentown, Pennsylvania, and the DermDox Center for Dermatology. Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, associate professor of medicine at Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Liakopoulou A, Rallis E. Bullous lichen planus – a reviewJ Dermatol Case Rep. 2017;11(1):1-4.

2. Babu A, Chellaswamy S, Muthukumar S, Pandey B, Jayaraj M, Francis S. Bullous lichen planus: case report and review. J Pharm Bioallied Sci. 2019;11(Suppl 2):S499-S506.  

3. Hasan S. Lichen planus of lip – report of a rare case with review of literatureJ Family Med Prim Care. 2019;8(3):1269-1275.  

4. Chintagunta SR, Sana SN, Gopidi PJ. Ulcerative lichen planus of lower lip – case series. J Dr NTR Univ Health Sci. 2018;7(4):288-291.  

5. Rallis E, Liakopoulou A, Christodoulopoulos C, Katoulis A. Successful treatment of bullous lichen planus with acitretin monotherapy.Review of treatment options for bullous lichen planus and case reportJ Dermatol Case Rep. 2016;10(4):62-64.