Ulcerative Lichen Planus in Childhood

Lichen planus (LP) is a chronic inflammatory mucocutaneous condition which is relatively common in adults but rarely affects children. The present study is a report on an unusual case of ulcerative oral LP involving the dorsum of tongue in a 12-year-old boy. Patient complained of painful oral lesion on the tongue which was burning in nature and obstructing talking and eating spicy foods. On intraoral examination, a white ulcerative lesion on the dorsum of tongue was observed. Diagnosis was made based on clinical examination and histopathological features. We instituted local treatment and patient responded well to the treatment. Although rarely reported in childhood, lichen planus should be considered in a differential diagnosis of hyperkeratotic, reticular, and ulcerative lesions of the oral mucosa in children. 1. Introduction Lichen planus (LP) is an autoimmune, chronic, inflammatory disease that affects mucosal and cutaneous tissues. The exact etiology of LP is unknown, but it is believed to result from an abnormal T cell-mediated immune response in which basal epithelial cells are recognized as foreign because of changes in the antigenicity of their cell surface [1]. Oral lichen planus (OLP) is a common disease in the middle aged and elderly population and has a prevalence of about 0.5% to 2%. By contrast, oral lichen planus in childhood (OLP) is rare and it was first reported in the 1920s. Oral mucosal involvement in adults itself accounts for 0.5% to 19%, while in children, it is very uncommon [2]. The oral lesions are more pleomorphic than those of their cutaneous forms and subtypes are categorized as reticular, papular, plaque-like, atrophic, erosive, and bullous [3]. The erosive form is extremely rare in children and few reports on this subject have been published in the literature. Herewith, we are presenting a case of a 12-year-old boy having erosive lichen planus without cutaneous involvement, who responded very well to the treatment. This paper also reviews ulcerative oral lichen planus in children and emphasizes its diagnosis from other oral white and red lesions in children. 2. Case Report A 12-year-old boy reported to the Department of Pedodontics and Preventive Dentistry, with the chief complaint of ulcer on his dorsum of the tongue which is causing burning sensation on consuming spicy foods from past 1 year (Figure 5). There is no significant medical history observed. On extra oral examination, patient was normal. On intraoral examination, a single irregular red and white ulcerative lesion measuring approximately 2.5 × 1.0？cm in size