Vesicular lesion of gingiva diagnosed as bullous lichen planus: Management with combination therapy

Introduction: Oral lichen planus is a T cell mediated autoimmune disease which often affects middle-aged adults. Amongst the reticular, atrophic and erosive types, bullous form of lichen planus is rarely observed. Case Report: A case of 60-year-old male complaining of discomfort in lower front gingiva with occasional fluid filled vesicles in same area and buccal mucosa. Based on clinical and histopathological findings the case was diagnosed as bullous lichen planus. Management of bullous form of oral lichen planus is challenging and there is no reliable effective treatment. The mainstay of therapy remains topical and oral corticosteroids but there are limited data on the potential efficacy of newer agents. Here we report a case which was managed Khushboo Goel1, Ashish Shrestha2, Vinay Marla3, Iccha Maharjan4 Affiliations: 1MDS, Assistant Professor, Department of Periodontology and Oral Implantology, College of Dental Surgery, B.P Koirala Institute of Health and Sciences, Dharan, Sunsari, Nepal; 2MDS, Associate Professor, Dr. Ashish Shrestha, Department of Oral Histology and Pathology, College of Dental Surgery, B.P Koirala Institute of Health and Sciences, Dharan, Sunsari, Nepal; 3MDS, Assistant Professor, Dr.Vinay Marla, Department of Oral Histology and Pathology, College of Dental Surgery, B.P Koirala Institute of Health and Sciences, Dharan, Sunsari, Nepal; 4MDS, Assistant Professor, Dr. Iccha Maharjan, Department of Oral medicine and radiology, College of Dental Surgery, B.P Koirala Institute of Health and Sciences, Dharan, Sunsari, Nepal. Corresponding Author: Dr. Khushboo Goel, MDS, Periodontology and Oral Implantology, College of Dental Surgery, B.P Koirala Institute of Health and Sciences, Dharan 56700, Nepal, E-mail: [email protected] Received: 24 November 2016 Accepted: 10 January 2017 Published: 27 January 2017 with low dose corticosteroids (betamethasone) combined with an immunomodulator (pentoxifylline) which achieved clinical success with no recurrence and minimal side effects during one year follow-up. Conclusion: This case provides evidence that low dose corticosteroids combined with immunomodulator improved clinical outcome in bullous form of disease. Early diagnosis and treatment can help prevent the complication and reduce morbidity in this rare entity.