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SummaryBackgroundOesophageal lichen planus is an idiopathic inflammatory disorder characterized by significant oesophageal stricturing. Oesophageal lichen planus is a rare, difficult to diagnose, and likely an under recognized disease. As a result, there is no standardized approach to therapy and treatment strategies vary.AimTo examine the utility of topical steroid therapy (fluticasone or budesonide) in the management of oesophageal lichen planus.MethodsA retrospective chart review was conducted of patients diagnosed with oesophageal lichen planus who underwent baseline and follow up endoscopy pre and post topical steroid therapy between 1995 and 2016 at Mayo Clinic, Rochester MN. Average time between upper GI endoscopy was 3.2 months (0.7–11.7). Swallowed steroid preparations included fluticasone 880 μg twice daily or budesonide 3 mg twice daily. Patients were reviewed for symptomatic response to therapy using the Dakkak‐Bennett dysphagia score (0–4, no dysphagia to total aphagia). Pre‐ and post‐endoscopic findings were assessed. Additional baseline demographic, endoscopic, and histologic data were also obtained.ResultsWe identified 40 patients who met the inclusion criteria. A significant reduction in median dysphagia score from 1 (0–4) to 0 (0–3) after steroid therapy (P < 0.001) was noted. 62% of patients reported resolution of their dysphagia after receiving topical corticosteroids. 72.5% had an endoscopic response to steroid therapy.ConclusionTopical swallowed budesonide or fluticasone appear to effective treatment for oesophageal lichen planus.

Background Periodic acid Schiff‐diastase ( PAS ‐D) staining is used routinely in dermatopathology. Conventionally, parakeratosis or intracorneal neutrophils justify use of PAS ‐D stain to identify dermatophytosis. We aimed to investigate the histopathological features of superficial dermatophytosis. Methods Skin biopsies with PAS ‐D stain were retrospectively reviewed by a blinded dermatopathologist. Histopathologic findings in cases with dermatophytosis were compared with those without. Results We studied 110 cases, of which 63 were PAS ‐D positive for dermatophytes. Dermatophytes were identified on hematoxylin and eosin (H&E) staining in 49 (77.8%) of the PAS ‐D‐positive cases. Diffuse compact orthokeratosis (79.37%, p < 0.001) and focal parakeratosis (65.08%, p = 0.03) were significantly more frequent in dermatophytosis. Intracorneal neutrophils and spongiosis were not significant findings. Fungal elements were frequently observed within compact orthokeratosis (62.0%) and parakeratosis (31.8%) but rarely within intracorneal pustules (12.7%). In some dermatophyte cases, intracorneal neutrophils (47.6%) or parakeratosis (17.5%) were absent. Conclusions Compact orthokeratosis or focal parakeratosis justifies PAS ‐D staining, whereas the absence of intracorneal neutrophils or parakeratosis is insufficient to exclude dermatophytosis. Results indicate that having a low threshold to perform PAS‐D stain is justified. PAS‐D stain may be deferred until H&E slides have been evaluated.