Baylor University Medical Center Proceedings July 2017 - 361

Figure 3. Linear IgA deposition along dermal-epidermal junction.

inﬁltrate. A few prior cases of oral LABD with a lichenoid
histology mimicking lichen planus have been reported (1).
Two types of LABD have been identiﬁed, drug-induced
and spontaneous (2). In drug-induced LABD, lesions tend to
be more severe than in the spontaneous form. Various case
reports have described drug-induced LABD presenting as toxic
epidermal necrolysis (3). Commonly implicated drugs include
vancomycin (4), beta-lactam antibiotics, captopril, and nonsteroidal antiinﬂammatory drugs.
The diﬀerential diagnosis for reticular changes of the buccal mucosa includes primarily lichen planus, lichenoid drug
reaction, and contact allergy. Biopsy in our patient revealed a
lichenoid inﬂammatory inﬁltrate, compatible with lichen planus. She was not taking any medications. Furthermore, she
denied any recent dental work, minimizing the possibility of
a contact allergy to components of her ﬁllings in nearby teeth.

July 2017

Establishing the correct diagnosis can guide appropriate
treatment. In recent years, indirect and direct immunoﬂuorescence have emerged as tools that can be used in conjunction
with histopathology in making these diﬃcult diagnoses (5). It
is important to consider oral LABD as a diﬀerential in cases
of clinically suspected oral lichen planus, especially those that
fail to respond to initial therapies. Thus, direct immunoﬂuorescence studies should be pursued to distinguish between the
two entities and guide appropriate treatment. Dapsone has been
reported as a successful treatment option for management of
oral LABD in cases refractory to topical and systemic steroids.
Early diagnosis and management of LABD can induce rapid
improvement and may decrease the incidence of relapse after
treatment withdrawal (6).
1.
2.
3.

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Linear IgA bullous dermatosis mimicking oral lichen planus

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