HPI: The patient is an otherwise healthy and alert 92 year old woman with painful erosions of tongue and vulva for six years. She has marked pain with eating and urination. Mouth lesions preceded genital lesions by a few years. She has been followed for erosive lichen planus but it is unclear if any biopsies were positive. She has lost weight because her painful tongue causes her to avoid eating. She has been treated with clobetasol ointment, Viscous Lidocaine was not effective.
O/E: Erosive lesions of tongue and labia. No bullae noted. Remainder of cutaneous exam unremarkable.
Clinical Photos:
Pathology: Biopsy of genital labial skin shows papillary dermal fiborsis and a mild superficial perivascular mixed inflammatory cell infiltrate. No lichenoid infiltrate. Direct immunofluorescence from perilesional skin was negative. PASD negative for fungi.
Diagnosis: Painful erosions mouth and genitalia. At present no support for lichen planus or bullous process histologically.
Questions: What are your thoughts? Her oral pain makes eating difficult and negatively affects her quality of life. Are there other therapies that we could consider?
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