The presence of eosinophils within the infiltrate, involvement of the deep vascular plexus, and the presence of parakeratosis and focal dyskeratotic cells within the stratum corneum are all clues to a lichenoid drug eruption. Common adverse drug reactions of rifampicin are hepatotoxicity, flulike syndrome, gastrointestinal symptoms and thrombocytopenia. Oral involvement from a drug is uncommon and may occur with skin involvement or may be isolated. Background the prototypic lichenoid eruptions, lichen planus lp, lichenoid drug eruptions, secondary syphilis, and collagen vascular disease, are defined histologically by a band. Imatinib mesylateinduced lichenoid drug eruption mdedge. Design skin biopsies from 40 patients demonstrating a. A rare culprit article pdf available in case reports in dermatology 93. Findings suggestive of lichenoid drug eruption lde. The pathological features of a lichenoid drug eruption may be difficult to distinguish from idiopathic lichen planus, but the diagnosis of lichenoid drug eruptions may be suggested by the types and distribution of inflammatory cells as well as other changes. Introduction drug induced pigmentation represents 10 to 20% of all cases of acquired hyper pigmentation and usually occurs on photo exposed part of the skin. Acute generalized exanthematous pustulosis agep is a distinct drug eruption that typically presents with sudden onset erythroderma full body erythema, fever, and tiny 1 to 2mm sterile. The fixed drug eruption is a common adverse drug reaction. Drug eruption definition of drug eruption by medical dictionary.
Lichenoid dermatologic toxicity from immune checkpoint. Many cases were documented among united states military personnel during the. Lichenoid drug eruptions are a potential cutaneous side effect of medications including antibiotics, antimalarials, and statins. Conclusions and relevance papular and nodular eruptions with scale, as well as mucosal erosions, with lichenoid features on histologic analysis were a distinct finding seen with antipd1pdl1 therapies and were. Drugs can cause multiple skin eruptions and reactions. A diagnosis of lichenoid drug eruption secondary to a protonpump inhibitor was made. Drug induced oral lichenoid reactions were first mentioned in 1929, and were later cited in 1971 by alme yda and levantine 3.
We describe the case of a 73yearold man who developed a lichenoid drug eruption secondary to atorvastatin. In addition, the patients skin eruption only began to definitively clear when use of the kenkay body wash was ceased. Drug rashes can appear on people of all ages, all races, and of both sexes. Clear identification of the culprit drug is not always possible in the. Lichenoid mucocutaneous eruptions with antipd1 and anti.
Pdf lichenoid drug eruption induced by olanzapine omar. She was able to continue nivolumab without any recurrences of the eruption for the following 4 months after treatment. The lichenoid drug eruption, in which a lymphocytic infiltrate is observed within a fairly dense, bandlike configuration in superficial dermal tissues and involving overlying epidermis, is common and may raise suspicion for lymphoma. Lde from ace inhibitors typically takes 3 to 6 months to appear. In lichenoid drug reactions the pathology is nearly identical to lichen planus. Multiple medications have been implicated in lichenoid drug eruptions. Litts drug eruption and reaction manual, 21st edition drug. The rash of a lichenoid drug eruption can sometimes be difficult to distinguish from idiopathic lichen planus because of similarities in the clinical appearance and the pathology seen on skin biopsy. Eruptions can occur frequently with a certain drug for example, with phenytoin 8, or be very rare for example, sweets syndrome following the administration of colonystimulating factors 9. There were lymphocytes extending to the dermoepidermal junction with vacuolar changes. David weedon ao md frcpa fcaphon, in weedons skin pathology third edition, 2010. Therapy for exanthematous drug eruptions is supportive in nature.
Diagnosis of this drug reaction is straightforward, but occasionally recognition of the causative drug is not possible. Lichen planus lp is a common, benign condition of generally unknown cause affecting the skin and mucus membranes. This clinical uncertainty is usually the result of similar changes in the gross histopathologic. It can also be associated with abrasion or drug use. Drug eruptions can appear on people of all ages, all races, and of both sexes. Au brauer j, votava hj, meehan s, soter na so dermatol online j. Drug eruption pediatric condition, treatments, and pictures. Pdf lichenoid drug eruption with proton pump inhibitors. He was started on a new medication by his cardiologist 2 months prior to the onset of the rash. It is responsible for about 10% of all adverse drug reactions.
A lichenoid drug eruption is a reaction to a medication. Lichenoid drug eruptions are not mentioned in the smpcs of metoprolol, bisoprolol or atenolol. Fixed drug eruption fde is a distinctive type of cutaneous drug reaction that characteristically recurs in the same locations upon re exposure to the offending drug. Rifampicininduced lichenoid drug eruption postgraduate. Examples include lichen planus, lichen sclerosus and lichen nitidus.
This rash can sometimes become difficult to distinguish from idiopathic. We describe a novel form of lichenoid dermatitis with a granulomatous component. Abstract background fixed drug eruption is designated as a typical allergic reaction occurring due to exposure to a medicine. Druginduced skin reaction or drug eruption is a general term for eruptions in the skin and mucosa induced by a drug or its metabolites. The onset may be within weeks of drug initiation, but lde is atypical in that it can take up to 12 months to evolve.
Does the eruption fit with a wellrecognized pattern caused by one of the current drugs e. In most cases, patch tests should be performed with the drug mixed in petrolatum to 1020% or diluted in water at the same concentration. Mild topical steroids eg, hydrocortisone, desonide and moisturizing lotions are also used, especially during the late desquamative phase. Lichen nitidus is a rare, usually asymptomatic chronic eruption characterized by the presence of multiple, small fleshcolored papules, 12 mm in diameter. Lichenoid eruption associated with antituberculous drug.
Lichenoid eruption an overview sciencedirect topics. Sixteen patients 80% were concurrently taking medications that have been previously reported to cause lichenoid drug eruptions. The lichenoid eruptions are a challenge diagnostically, to both the clinician and the histopathologist, especially in dermatoses which have a lichenoid phase. Acute drug eruption with numerous red, raised lesions. A lichenoid eruption is a skin disease characterized by damage and infiltration between the epidermis and dermis examples include lichen planus, lichen sclerosus and lichen nitidus. Lichen planus lp is a chronic inflammatory and immune mediated disease that affects the skin, nails, hair, and mucous membranes. Although positive patch test reactions can be more easily obtained with the drug diluted to 50%, this should not be done because.
They may resemble skin diseases very closely but generally fade away when the drug is withdrawn. Some drug eruptions, although trivial, may cause cosmetic embarrassment and fixed drug eruption fde is one of them. Some of the types of drugs that may trigger this condition include. Drug eruption definition at, a free online dictionary with pronunciation, synonyms and translation. It is characterized by a symmetric eruption of flattopped, erythematous or violaceous papules resembling lichen planus on the trunk and extremities. Fde commonly occurs on the genitals, lips, trunk, and hands. Lichenoid drug eruption, also known as drug induced lichen planus, is an uncommon cutaneous adverse effect of several drugs. Psoriasis, aggravation of psoriasis or psoriatiform skin reactions are described as very rare to uncommon adverse drug reactions 1. The topic lichenoid drug eruption lde you are seeking is a synonym, or alternative name, or is closely related to the medical condition druginduced lichen planus. The most common histopathologic pattern of drug eruptions is a vacuolar interface dermatitis. Lichenoid drug reactions are induced by a medication or another exogenous source which can mimic other lichenoid dermatoses clinically and histologically. Lichenoid drug eruptions may also be caused by cutaneous contact with such agents as pphenylenediamine, nickel, gold and dental restorative agents. Uncommon side effect of a common medication case 1 presentation. Rifampicin is a bactericidal drug extensively used for tuberculosis and leprosy.
Lichenoid drug eruption associated with bendamustine. Phenytoin induced oral lichenoid eruption and melasma. The diagnosis may be suspected from the unusual clinical features and a skin biopsy then taken. M 1989 concluded that a relevant drug history is obtained when the certain histopathological signs lde related criteria are present in more than 50% of lichenoid drug eruption lde. Oral lichenoid drug eruptions oral lichenoid drug eruptions mccartan, be. The initial eruption of a fde appears 1 week post drug exposure, whereas subsequent exposures to the same drug lead to development of lesions within. Interestingly, all four reported cases of capecitabineinduced lichenoid drug eruption occurred in elderly women. Lichenoid contact dermatitis has been reported with color developers, such as paraphenylenediamine and its derivatives, nickel, epoxy resins, aminoglycoside antibiotics, and methacrylic acid esters for industrial use. Lichenoid drug eruption, also called drug induced lichen planus, is an uncommon cutaneous adverse effect of several drugs.
Practice cutaneous lichenoid drug eruptions ldes and. Fixed drug eruptions with intraoral presentation ncbi. Jun 16, 2017 findings vary, with a range of symptoms that usually begin 1 to 8 weeks after the initial exposure, may worsen after the drug is stopped, and may be fatal if not promptly treated. Clinical images uncommon side effect of a common medication case 1 presentation. Lichenoid drug reaction differential diagnosis lichen planus. Feb 26, 2019 drug eruptions are adverse skin reactions to drugs that occur in about 3% of hospitalized people. Feb 15, 2019 immunocompromised persons have a 10fold higher risk of developing a drug eruption than the general population. Fixed drug eruption fde is a common cutaneous adverse drug reaction. Drug eruptions and reactions merck manuals professional edition. The most serious of these are discussed elsewhere in t he m anual and include stevensjohnson syndrome and toxic epidermal necrolysis, hypersensitivity syndrome, serum sickness, exfoliative dermatitis, angioedema, anaphylaxis, and drug induced vasculitis.
When a drug induces lichenoid eruption it can be called more specifically a lichenoid drug eruption. You may find the drug allergy article more useful, or one of our other health articles. Sensitivity to nonsteroidal antiinflammatory drugs. Generalized fixed drug eruption is a specific variant of fixed drug eruption with multifocal lesions. Lichenoid drug eruption caused by imatinib mesylate in a chinese patient with gastrointestinal stromal tumor.
A condition called acute generalised exanthematous pustulosis agep is an example of a pustular drug eruption. Morbilliform simple drug eruption per the drug chart, the most likely culprit is. Generalized bullous fixed drug eruption is distinct from stevensjohnson syndrometoxic epidermal necrolysis by immunohistopathological features. Adalimumab induced lichenoid drug eruption article pdf available in le journal medical libanais. Fixed drug eruptions fdes are a localized response to medications that typically appear as welldemarcated erythematous dusky patches or plaques. In contrast to idiopathic lichen planus, lichenoid drug eruptions, where practicable, may be managed by substitution of the offending drug. It is characterized by recurrent lesion in the same anatomical area.
Feb 15, 2019 treatment of a drug eruption depends on the specific type of reaction. A drug rash drug eruption, also known as a drug reaction, is a skin condition caused by a medication. Fixed drug eruption fde is a form of presentation of recurrent cutaneous drug reaction characterized by appearance of single or multiple erythematous annular. A drug eruption, also known as drug reaction or drug rash, is a skin condition caused by taking a medication. Bullous drug eruptions refer to drug induced blister formation. Cureus atorvastatininduced lichenoid drug eruption. A lichenoid eruption is a skin disease characterized by damage and infiltration between the epidermis and dermis. A drug eruption can appear in many ways, and any medication can cause a drug eruption. It has been observed in conjunction with the use of proton pump inhibitors, and might be a sign andor symptom of lupus such as subacute cutaneous lupus. An adverse reaction to a drug is an undesirable and usually unanticipated response independent of the intended therapeutic purpose of the medication. A detailed examination of the clinicopathologic features, abstract immunotherapy targeting the programmed cell death 1 pd1 receptor has demonstrated tremendous promise in the treatment of advanced solid tumors.
Also in contrast with lichen planus, there is a middermal and. Cutaneous reactions to im have been reported to occur in varying number of patients in different case series. Lichen planus lp is a chronic inflammatory dermatosis of unknown origin that involves the skin and mucous membranes, and lichenoid drug eruption lde is an uncommon cutaneous adverse reaction to a medication. Lichenoid drug eruption doesnt always happen right after you start taking a new drug. The most common types of cutaneous drug reactions are the maculopapular rash 35%, fixed drug eruption 30% and urticaria 14%. The dental clinician is in a prime position to identify these lesions and liaise with medical colleagues regarding their management. Which of the current drugs most commonly cause drug eruptions e.
Although uncommon in flexural or mucosal sites, lichenoid drug eruptions may be histologically indistinguishable from lp. Lichenoid drug eruptions lde are rarely seen in children. Literature lichenoid drug eruptions as a class effect of betablockers have been described. Betaadrenergic blockers and lichenoid drug eruption. Clues that a lichenoid tissue reaction represents a lichenoid drug eruption include parakeratosis, diminished granular cell layer, and a mixed inflammatory infiltrate, including plasma cells, eosinophils, and neutrophils fig. Histologically, lichenoid drug reactions resemble lichen planus at lowpower magnification. Drugs acting on the central nervous system have been frequently reported to cause oral lichenoid drug eruption. This drug eruption can mimic features of idiopathic lichen planus in clinical presentation and pathology. This study was aimed at evaluating the clinical features and culprit drugs in generalized fixed drug eruptions in the west of iran. Role of t cells in nonimmediate allergic drug reactions inserm.
Lichenoid eruption is an uncommon skin lesion which can be induced by many environmental agents, medications or industrial byproducts such as inhaled particles. We report a case of severe lichenoid drug eruption with multiple possible causative agents. Dec 22, 2016 an inverse lichenoid drug eruption related to treatment with nivolumab was diagnosed. Lichenoid drug eruption lde is a common cutaneous side effect of drugs including antimalarials, antihypertensives, nonsteroids, antiinflammatory drugs and diuretics. Drug intolerances account for 90% of adverse drug reactions. Non lichenoid cutaneous reactions due to im are the commonest nonhematologic adverse. A fixed drug eruption is the term for a drug eruption that occurs in the same skin area every time the person is exposed to the drug. Multiple fixed drug eruption due to piroxicam longdom. Any drug can cause a skin reaction but some classes of drugs are characteristically. The extent of interface changes varies greatly, from extensive vacuolar alteration at the dermoepidermal junction and many necrotic keratocytes at all levels of the epidermis, as in most cases of fixed drug eruption and toxic epidermal necrolysis, to focal and very. Statins and lichenoid drug eruption introduction statins inhibit the enzyme hmgcoa 3hydroxymethylglutarylcoenzyme areductase, which plays an important role in the synthesis of cholesterol by catalysing the conversion from hmgcoa to mevalonate. To the best of our knowledge, only one other case of lichenoid drug eruption secondary to a protonpump inhibitor has been reported.
Clinical features and drug characteristics of patients with. They are written by uk doctors and based on research evidence, uk and european guidelines. The new edition has been comprehensively revised and updated, featuring an enlarged section of. Inverse lichenoid drug eruption associated with nivolumab. Unlike idiopathic lichen planus, which typically involves flexural surfaces, lichenoid drug eruption is characterized by an extensive symmetric eruption of flattopped violaceous plaques involving the trunk and extremities.
Lichenoid drug eruption may progress to exfoliative erythroderma. Lichenoid drug eruption also referred to as drug induced lichen planus lp is characterized by symmetrically distributed flattopped erythematous to violaceous papules that often reach confluence on the trunk and extremities, resembling lp, but without the characteristic fine lacelike patterns known as wickham striae seen in classic lp. A 78yearold man presented with an eightmonth history of folliculocentric, pink, hyperkeratotic papules and plaques with thick white scale that involved the entire body, with confluence on the buttocks and genitalia. The findings are very similar to those of lichen planus, and lichenoid drug eruption is. Nov 24, 2014 professional reference articles are designed for health professionals to use.
The extent of interface changes varies greatly, from extensive vacuolar alteration at the dermoepidermal junction and many necrotic keratocytes at all levels of the epidermis, as in most cases of fixed drug eruption and toxic epidermal necrolysis, to focal and. Fixed drug eruption fde is a welldefined, circular, hyperpigmenting plaque that recurs as one or a few lesions always in fixed locations upon ingestion of a drug. Angiotensinconverting enzyme inhibitors, amlodipine, and beta blockers are among several reported causes of lichenoid drug eruptions. It is characterized by polygonal, flattopped, violaceous papules and plaques with overlying, reticulated, fine white scale wickhams striae, commonly affecting dorsal hands, flexural wrists and forearms, trunk, anterior lower legs and oral mucosa. A drug rash can appear in many forms, and any medication can cause a drug rash. Was any drug introduced a few days or weeks before the eruption appeared. Case report a 61yearold man presented with a history of alkpositive nsclc with lungtolung metastasis and pleural. What is a lichenoid drug eruption lichenoid eruptions are uncommon skin rashes that can be induced by many environmental agents, medications or industrial byproducts such as inhaled particles.
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