MIAMI BEACH -- The autoimmune disease lichen planus may affect the ear more commonly than previously thought, researchers reported here.
In a review of records from the Mayo Clinic in Rochester, Minn., 19 patients over a 10-year period were diagnosed with otic lichen planus, reported Julio Sartori Valinotti, MD, of the Mayo Clinic, during a poster session at the American Academy of Dermatology meeting.
"Otic lichen planus has a nonspecific presentation, because pruritus, otorrhea, and hearing loss are not necessarily complaints that will make people think about lichen planus," Sartori Valinotti told MedPage Today. "That's the reason we think people need to be aware that these common complaints could lead you to this uncommon disease."
Lichen planus is an autoimmune, inflammatory disease of unknown origin that typically affects the skin, nails, and hair, and can also involve the mucosal surfaces of the mouth, nose, and esophagus.
However, the epithelium of the external auditory canal can also be affected, leading to otorrhea, external auditory canal stenosis, tympanic membrane thickening, and conductive hearing loss, Sartori Valinotti said.
However, the prevalence of ear manifestations with the disease is difficult to estimate because of a lack of data.
So he and colleagues reviewed the electronic medical records of their patients seen between Jan. 1, 2001 and May 31, 2011.
Overall, they identified 19 cases of otic lichen planus, which mostly occurred in females (15).
The most common symptoms were otorrhea and hearing loss, occurring in 15 patients; 11 had both conditions simultaneously. There was also external auditory canal plugging in six patients and pruritus in five patients.
A total of 11 patients had bilateral disease, while eight had unilateral disease.
The most common exam findings were erythema, external canal stenosis, and thickening of tympanic membranes.
The mean duration of symptoms before diagnosis was 4 years in 13 patients, they reported.
Just five patients had only otic lichen planus; other patients had multiple sites involved. Most had other forms of lichen planus diagnosed for several years before noticing the otic disease, Sartori Valinotti said.
Indeed, one patient had otic involvement for 27 years before the diagnosis of lichen planus was confirmed, he added.
The majority of patients were treated with topical tacrolimus, although one was given systemic treatment with rituximab (Rituxan) because of severe esophageal stenosis.
Sartori Valinotti emphasized that clinicians should think about lichen planus, particularly in patients who complain of these symptoms and have other areas affected by the disease.
"We think it's underdiagnosed," Sartori Valinotti said to MedPage Today. "Only 19 patients in 10 years is underrepresented because people don't think about this. "Not all patients are seen by dermatologists, so sometimes they're seen by a primary care physician for common otic complaints or by an ENT who may not be aware of this entity."
He noted that early detection may lead to better outcomes, and that a biopsy isn't needed because patients have usually had them at another site.
The researchers reported no conflicts of interest.
- Reviewed by F. Perry Wilson, MD, MSCE Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania
American Academy of DermatologySource Reference: Sartori Valinotti JC, et al "The Mayo Clinic experience with otic lichen planus: A 10-year review" AAD 2013.