Purpose of Review <p>Esophageal lichen planus is an underrecognized manifestation of lichen planus that is frequently overlooked in clinical practice. Though it is associated with substantial morbidity, there is a lack of strong data to guide management. This review summarizes evidence on the pathophysiology, presentation, and treatment of esophageal lichen planus, to improve recognition and care in community practice.</p> Recent Findings <p>Esophageal lichen planus has variable clinical presentation, high rates of asymptomatic disease, and significant diagnostic overlap with other esophagitis disorders. Endoscopic findings may be subtle or absent, and histopathology alone is often insufficient for definitive diagnosis, necessitating a multimodal approach. Proposed frameworks and severity grading systems may help standardize evaluation and guide clinical decision-making. Management approach is largely extrapolated from other lichen planus manifestations and rely on expert consensus given limited data. Topical corticosteroids remain first-line therapy and are associated with symptomatic and endoscopic improvement in most patients, while immunomodulators like Janus Kinase inhibitors and tacrolimus have shown promise in refractory disease. Endoscopic dilation is frequently required for stenotic complications, and surveillance remains recommended given concerns for malignant squamous cell transformation.</p> Summary <p>Esophageal lichen planus is a diagnostically challenging condition with limited evidence-based therapies. Increased clinical awareness and structured diagnostic approaches are essential to reducing delays in diagnosis and preventing complications. Further prospective studies and randomized controlled trials are needed to refine diagnostic criteria, evaluate emerging treatments, and define long-term management strategies.</p>