Recurrent Oral and Genital Ulcers and Hemorrhagic Crusting of Lips

Objectives: Lichen planus is a T-cell-medicated immunological disorder causing inflammatory lesions on the skin and oral mucosa. This study reported a patient with very rare manifestation in oral mucosa and skin.
Methods: A 34-year-old man was referred for recurrent multiple oral and skin lesions. Hemorrhagic crusting of the lips highly indicated erythema multiforme, while genital ulcers suggested Bechcet’s diseases. No eye symptoms or joint pain were found. Pathery test was negative. Patient was treated as Bechcet’s diseases in a Rheumatology Clinic for over 6 months time without improvement. Biopsy was conducted and subject to histopathology and direct immunofluorescence examinations.
Results: Biopsy findings confirmed lichen planus although clinically no manifestation indicated this disease.
Conclusions: Clinically, lichen planus is white lesion that manifest as reticular, popular, plaque-like, erythemaous, erosive or bullous subtypes. This is a very rare case of lichen planus in which no white component was found in oral cavity and skin. All the clinical manifestation indicated erythema multiforme or Bechcet’s diseases. Further understanding of the rare clinical presentation of lichen planus will benefit not only the specialist in Oral Medicine but general dental practitioners, who may serve as the first line clinician seeing the patients.