A 53-year-old woman presented with generalized mucocutaneous lichen planus (LP) with progressive oral and retrosternal burning, accompanied by progressive dysphagia. She had a 9- and 5-year history of buccal and vulvar LP, respectively, both of which were partially controlled by short-term courses of corticosteroids, administered either topically or systemically. Skin examination revealed numerous papules of active LP and postinflammatory hyperpigmented macules on the flexural areas of the arms, axillae, and submammary and inguinal folds, as well as on the umbilical and lumbosacral areas. In the genital area, atrophic changes were evident on the labia minorum. White, reticulated, erosive lesions were observed on the jugal and gingival mucosae, and patchy whitish lesions were seen on the tongue and palate. Esophagoscopy demonstrated lesions consistent with LP spreading downward to the superior sphincter, with focal ulcerations and a moderate circumferential stenosis at the middle portion of the esophagus. Light microscopy of biopsy specimens of esophageal mucosa confirmed the diagnosis of LP, with no evidence of malignant transformation. Serologic tests were negative for hepatitis B and C. In an attempt to quickly alleviate the patient's discomfort, 3 consecutive intravenous pulses of methylprednisolone (500 mg/d) were administered along with a twice-daily topical application of a 0.03% solution of tacrolimus on the buccal and vulvar lesions. The dysphagia and mucocutaneous lesions dramatically improved in the following 2 weeks. Nevertheless, the patient had a relapse within the next 3 months. New lesions appeared on the lower back and inguinal areas, with involvement of the buccal mucosa and the vermilion of the lower lip (Figure 1A). The dysphagia reappeared, and new findings on esophagoscopy confirmed the presence of erosions and white plaques consistent with active LP (Figure 2A). Histologic examination showed a bandlike infiltrate together with an alteration of the dermoepidermal junction and a mild degree of keratinocyte necrosis. The vast majority of the infiltrate consisted of CD8+ T lymphocytes, with smaller numbers of CD4+ T lymphocytes and scarce CD20+ B cells (Figure 3). Direct immunofluorescence microscopy showed no specific deposits.