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Gastrointestinal Manifestations of Dermatologic Disorders
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2008;6:601
LETTERS TO THE EDITOR Readers are encouraged to write letters to the editor concerning articles that have been published in CLINICAL GASTROENTEROLOGY AND HEPATOLOGY. Short, general comments are also considered, but use of the Letters to the Editor section for publication of original data in preliminary form is not encouraged. Letters should be typewritten and submitted electronically to http://www.editorialmanager.com/cgh. Please be sure to send 2 hard copies of any figures to the editorial office.
Gastrointestinal Manifestations of Dermatologic Disorders Dear Editor: We compliment Shields et al1 on their initiative to increase gastroenterologists’ awareness of gastrointestinal manifestations of dermatologic disorders. In their article, epidermolysis bullosa, mastocytosis, hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease), and melanoma were highlighted as examples of related dermatologic and gastrointestinal pathology. Based on its prevalence, however, we think lichen planus (LP) should have been mentioned as well. Similar to epidermolysis bullosa, LP is a mucocutaneous disorder in which mucosal lesions can occur in the oral cavity, which has the same epithelial lining as the esophagus. Esophageal manifestations of LP are known to cause symptomatic strictures of the proximal esophagus, mimicking malignancy. To date, 36 cases have been described. Recently, we described proximal squamous esophageal carcinoma occurring in 2 sisters, both with esophageal manifestations of LP.2 One prospective endoscopic study that aimed to determine the prevalence of esophageal LP has been published.3 In 19 patients Dickens et al3 found 5 patients to have esophageal LP based on endoscopic and histopathologic criteria. We recently completed an endoscopic study using high magnification and chromoendoscopy in 24 LP patients, 12 of whom had esophageal manifestations, which we intend to publish soon. We believe that awareness of gastrointestinal manifestations of dermatologic disorders in general and esophageal manifestations of LP more specifically might benefit patients with these disorders. RUTGER QUISPEL MATTHIJS P. SCHWARTZ ANDRÉ J. SMOUT Department of Gastroenterology University Medical Center Utrecht Utrecht, The Netherlands 1. Shields HM, Shaffer K, O’Farrell RP, et al. Gastrointestinal manifestations of dermatologic disorders. Clin Gastroenterol Hepatol 2007;5:1010 –1017. 2. Schwartz MP, Sigurdsson V, Vreuls W, et al. Two siblings with lichen planus and squamous cell carcinoma of the oesophagus. Eur J Gastroenterol Hepatol 2006;18:1111–1115.
3. Dickens CM, Hesseltine D, Walton S, et al. The oesophagus in lichen planus: an endoscopic study. BMJ 1990;300:84. doi:10.1016/j.cgh.2007.12.016
Reply. Thank you for your compliment regarding our taking the initiative to increase a gastroenterologist’s awareness of the gastrointestinal manifestations of certain skin diseases in our recently published article entitled “Gastrointestinal Manifestations of Dermatologic Disorders.”1 We appreciate your questioning us as to why lichen planus, a common and fascinating mucocutaneous disorder, associated with both esophageal abnormalities and chronic liver diseases such as hepatitis C, was not included in our review.2,3 Lichen planus was one of the dermatologic disorders that we seriously considered for inclusion. In the end, we did not choose it because of space constraints and the fact that we did not have a recent case of cutaneous lichen planus with excellent endoscopic pictures and pathology of the esophageal manifestations. We recognize the importance of your 2006 publication in which you described 2 sisters with a long history of lichen planus who both developed squamous cell carcinoma of the esophagus.2 Your recent endoscopic study using high magnification and chromoendoscopy, in which esophageal manifestations of lichen planus were found in half the lichen planus patients studied, is extremely interesting. We look forward to reading the published study, which will increase clinicians’ recognition of lichen planus in the esophagus. HELEN SHIELDS, MD, AGAF Harvard Medical School Beth Israel Deaconess Medical Center Boston, Massachusetts 1. Shields HM, Shaffer K, O’Farrell RP, et al. Gastrointestinal manifestations of dermatologic disorders. Clin Gastroenterol Hepatol 2007;5:1010 –1017. 2. Schwartz MP, Sigurdsson V, Vreuls W, et al. Two siblings with lichen planus and squamous cell carcinoma of the oesophagus. Eur J Gastroenterol Hepatol 2006;18:1111–1115. 3. Berk DR, Mallory SB, Keefe EB, et al. Dermatologic disorders associated with chronic hepatitis C: effect of interferon. 2007; 5:142–151. doi:10.1016/j.cgh.2008.02.046
LETTERS TO THE EDITOR Readers are encouraged to write letters to the editor concerning articles that have been published in CLINICAL GASTROENTEROLOGY AND HEPATOLOGY. Short, general comments are also considered, but use of the Letters to the Editor section for publication of original data in preliminary form is not encouraged. Letters should be typewritten and submitted electronically to http://www.editorialmanager.com/cgh. Please be sure to send 2 hard copies of any figures to the editorial office.
Gastrointestinal Manifestations of Dermatologic Disorders Dear Editor: We compliment Shields et al1 on their initiative to increase gastroenterologists’ awareness of gastrointestinal manifestations of dermatologic disorders. In their article, epidermolysis bullosa, mastocytosis, hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease), and melanoma were highlighted as examples of related dermatologic and gastrointestinal pathology. Based on its prevalence, however, we think lichen planus (LP) should have been mentioned as well. Similar to epidermolysis bullosa, LP is a mucocutaneous disorder in which mucosal lesions can occur in the oral cavity, which has the same epithelial lining as the esophagus. Esophageal manifestations of LP are known to cause symptomatic strictures of the proximal esophagus, mimicking malignancy. To date, 36 cases have been described. Recently, we described proximal squamous esophageal carcinoma occurring in 2 sisters, both with esophageal manifestations of LP.2 One prospective endoscopic study that aimed to determine the prevalence of esophageal LP has been published.3 In 19 patients Dickens et al3 found 5 patients to have esophageal LP based on endoscopic and histopathologic criteria. We recently completed an endoscopic study using high magnification and chromoendoscopy in 24 LP patients, 12 of whom had esophageal manifestations, which we intend to publish soon. We believe that awareness of gastrointestinal manifestations of dermatologic disorders in general and esophageal manifestations of LP more specifically might benefit patients with these disorders. RUTGER QUISPEL MATTHIJS P. SCHWARTZ ANDRÉ J. SMOUT Department of Gastroenterology University Medical Center Utrecht Utrecht, The Netherlands 1. Shields HM, Shaffer K, O’Farrell RP, et al. Gastrointestinal manifestations of dermatologic disorders. Clin Gastroenterol Hepatol 2007;5:1010 –1017. 2. Schwartz MP, Sigurdsson V, Vreuls W, et al. Two siblings with lichen planus and squamous cell carcinoma of the oesophagus. Eur J Gastroenterol Hepatol 2006;18:1111–1115.
3. Dickens CM, Hesseltine D, Walton S, et al. The oesophagus in lichen planus: an endoscopic study. BMJ 1990;300:84. doi:10.1016/j.cgh.2007.12.016
Reply. Thank you for your compliment regarding our taking the initiative to increase a gastroenterologist’s awareness of the gastrointestinal manifestations of certain skin diseases in our recently published article entitled “Gastrointestinal Manifestations of Dermatologic Disorders.”1 We appreciate your questioning us as to why lichen planus, a common and fascinating mucocutaneous disorder, associated with both esophageal abnormalities and chronic liver diseases such as hepatitis C, was not included in our review.2,3 Lichen planus was one of the dermatologic disorders that we seriously considered for inclusion. In the end, we did not choose it because of space constraints and the fact that we did not have a recent case of cutaneous lichen planus with excellent endoscopic pictures and pathology of the esophageal manifestations. We recognize the importance of your 2006 publication in which you described 2 sisters with a long history of lichen planus who both developed squamous cell carcinoma of the esophagus.2 Your recent endoscopic study using high magnification and chromoendoscopy, in which esophageal manifestations of lichen planus were found in half the lichen planus patients studied, is extremely interesting. We look forward to reading the published study, which will increase clinicians’ recognition of lichen planus in the esophagus. HELEN SHIELDS, MD, AGAF Harvard Medical School Beth Israel Deaconess Medical Center Boston, Massachusetts 1. Shields HM, Shaffer K, O’Farrell RP, et al. Gastrointestinal manifestations of dermatologic disorders. Clin Gastroenterol Hepatol 2007;5:1010 –1017. 2. Schwartz MP, Sigurdsson V, Vreuls W, et al. Two siblings with lichen planus and squamous cell carcinoma of the oesophagus. Eur J Gastroenterol Hepatol 2006;18:1111–1115. 3. Berk DR, Mallory SB, Keefe EB, et al. Dermatologic disorders associated with chronic hepatitis C: effect of interferon. 2007; 5:142–151. doi:10.1016/j.cgh.2008.02.046