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. Drug induced oral lichenoid reactions were first mentioned in 1929, and were later cited in 1971 by alme yda and levantine 3. Which of the current drugs most commonly cause drug eruptions e. It is responsible for about 10% of all adverse drug reactions. This drug eruption can mimic features of idiopathic lichen planus in clinical presentation and pathology. Druginduced skin reaction or drug eruption is a general term for eruptions in the skin and mucosa induced by a drug or its metabolites. 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. Practice cutaneous lichenoid drug eruptions ldes and. 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. The lichenoid eruptions are a challenge diagnostically, to both the clinician and the histopathologist, especially in dermatoses which have a lichenoid phase. Drugs acting on the central nervous system have been frequently reported to cause oral lichenoid drug eruption. In addition, the patients skin eruption only began to definitively clear when use of the kenkay body wash was ceased. 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.
A lichenoid drug eruption is a reaction to a medication. Litts drug eruption and reaction manual, 21st edition drug. 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. 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. David weedon ao md frcpa fcaphon, in weedons skin pathology third edition, 2010. Design skin biopsies from 40 patients demonstrating a. Fixed drug eruptions fdes are a localized response to medications that typically appear as welldemarcated erythematous dusky patches or plaques. Diagnosis of this drug reaction is straightforward, but occasionally recognition of the causative drug is not possible. Drug intolerances account for 90% of adverse drug reactions. Some of the types of drugs that may trigger this condition include. A lichenoid eruption is a skin disease characterized by damage and infiltration between the epidermis and dermis. Common adverse drug reactions of rifampicin are hepatotoxicity, flulike syndrome, gastrointestinal symptoms and thrombocytopenia.
Lichenoid eruption an overview sciencedirect topics. Clear identification of the culprit drug is not always possible in the. Although hiv infection causes profound anergy to other immune stimuli, the frequency of drug hypersensitivity reactions, including severe reactions eg, ten, is markedly increased in hivpositive individuals. Histologically, lichenoid drug reactions resemble lichen planus at lowpower magnification. We report a case of severe lichenoid drug eruption with multiple possible causative agents. 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. 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. Pdf lichenoid drug eruption induced by olanzapine omar.
Drug eruptions and reactions dermatologic disorders. Lde from ace inhibitors typically takes 3 to 6 months to appear. The degree of eosinophilia is predictive of the severity of the drug eruption. Pdf lichenoid drug eruption with proton pump inhibitors. Lichenoid drug reactions are induced by a medication or another exogenous source which can mimic other lichenoid dermatoses clinically and histologically. Multiple medications have been implicated in lichenoid drug eruptions. It appears the same as idiopathic oral lichen planus clinically and under the microscope, but an oral lichenoid drug eruption resolves if the triggering drug is ceased. We describe the case of a 73yearold man who developed a lichenoid drug eruption secondary to atorvastatin.
A condition called acute generalised exanthematous pustulosis agep is an example of a pustular drug eruption. Rifampicininduced lichenoid drug eruption postgraduate. Was any drug introduced a few days or weeks before the eruption appeared. The dental clinician is in a prime position to identify these lesions and liaise with medical colleagues regarding their management.
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. Lichen nitidus is a rare, usually asymptomatic chronic eruption characterized by the presence of multiple, small fleshcolored papules, 12 mm in diameter. You may find the drug allergy article more useful, or one of our other health articles. Multiple fixed drug eruption due to piroxicam longdom. Lichenoid drug eruptions lde are rarely seen in children. Clinical images uncommon side effect of a common medication case 1 presentation. 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. Does the eruption fit with a wellrecognized pattern caused by one of the current drugs e. The most common types of cutaneous drug reactions are the maculopapular rash 35%, fixed drug eruption 30% and urticaria 14%. Lichenoid drug reaction differential diagnosis lichen planus. Case report a 61yearold man presented with a history of alkpositive nsclc with lungtolung metastasis and pleural. When a drug induces lichenoid eruption it can be called more specifically a lichenoid drug eruption. Acute drug eruption with numerous red, raised lesions.
Drug eruption pediatric condition, treatments, and pictures. 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. Fixed drug eruptions with intraoral presentation ncbi. The fixed drug eruption is a common adverse drug reaction. 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. Drug eruption definition at, a free online dictionary with pronunciation, synonyms and translation. Phenytoin induced oral lichenoid eruption and melasma. 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. They are written by uk doctors and based on research evidence, uk and european guidelines. 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. Clinical features and drug characteristics of patients with. Nov 24, 2014 professional reference articles are designed for health professionals to use. Cutaneous reactions to im have been reported to occur in varying number of patients in different case series.
Uncommon side effect of a common medication case 1 presentation. Feb 15, 2019 treatment of a drug eruption depends on the specific type of reaction. In lichenoid drug reactions the pathology is nearly identical to lichen planus. Interestingly, all four reported cases of capecitabineinduced lichenoid drug eruption occurred in elderly women. Generalized bullous fixed drug eruption is distinct from stevensjohnson syndrometoxic epidermal necrolysis by immunohistopathological features. Although positive patch test reactions can be more easily obtained with the drug diluted to 50%, this should not be done because. We describe a novel form of lichenoid dermatitis with a granulomatous component. The onset may be within weeks of drug initiation, but lde is atypical in that it can take up to 12 months to evolve. 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. Au brauer j, votava hj, meehan s, soter na so dermatol online j. 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. A drug eruption can appear in many ways, and any medication can cause a drug eruption. Inverse lichenoid drug eruption associated with nivolumab. Angiotensinconverting enzyme inhibitors, amlodipine, and beta blockers are among several reported causes of lichenoid drug eruptions.
Feb 26, 2019 drug eruptions are adverse skin reactions to drugs that occur in about 3% of hospitalized people. 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. Lichenoid drug eruptions are a potential cutaneous side effect of medications including antibiotics, antimalarials, and statins. Non lichenoid cutaneous reactions due to im are the commonest nonhematologic adverse.
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. Also in contrast with lichen planus, there is a middermal and. Lichenoid mucocutaneous eruptions with antipd1 and anti. A rare culprit article pdf available in case reports in dermatology 93. A latent period of 3 years has been reported with penicillamine. Feb 15, 2019 immunocompromised persons have a 10fold higher risk of developing a drug eruption than the general population. Lichen planus lp is a common, benign condition of generally unknown cause affecting the skin and mucus membranes. Abstract background fixed drug eruption is designated as a typical allergic reaction occurring due to exposure to a medicine.
Cureus atorvastatininduced lichenoid drug eruption. 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. Drugs can cause multiple skin eruptions and reactions. It can also be associated with abrasion or drug use. Oral lichenoid drug eruption is an uncommon medicationinduced chronic change inside the mouth. 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. Lichenoid drug eruption doesnt always happen right after you start taking a new drug. Drug rashes can appear on people of all ages, all races, and of both sexes. 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. Sensitivity to nonsteroidal antiinflammatory drugs. A diagnosis of lichenoid drug eruption secondary to a protonpump inhibitor was made. Lichenoid drug eruptions are not mentioned in the smpcs of metoprolol, bisoprolol or atenolol. Lichenoid eruption associated with antituberculous drug. Drug eruptions can appear on people of all ages, all races, and of both sexes. It is characterized by recurrent lesion in the same anatomical area.
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. 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. 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. They may resemble skin diseases very closely but generally fade away when the drug is withdrawn.
Fixed drug eruption fde is a common cutaneous adverse drug reaction. Betaadrenergic blockers and lichenoid drug eruption. Dec 22, 2016 an inverse lichenoid drug eruption related to treatment with nivolumab was diagnosed. This rash can sometimes become difficult to distinguish from idiopathic. 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.
In contrast to idiopathic lichen planus, lichenoid drug eruptions, where practicable, may be managed by substitution of the offending drug. He was started on a new medication by his cardiologist 2 months prior to the onset of the rash. Role of t cells in nonimmediate allergic drug reactions inserm. Lichenoid dermatologic toxicity from immune checkpoint. 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. Drug eruption definition of drug eruption by medical dictionary. Sixteen patients 80% were concurrently taking medications that have been previously reported to cause lichenoid drug eruptions. 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. Examples include lichen planus, lichen sclerosus and lichen nitidus. Findings suggestive of lichenoid drug eruption lde. An adverse drug reaction may be either immunologic i.
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. Lichenoid drug eruption lde is a common cutaneous side effect of drugs including antimalarials, antihypertensives, nonsteroids, antiinflammatory drugs and diuretics. Imatinib mesylateinduced lichenoid drug eruption mdedge. Lichenoid drug eruption associated with bendamustine. Lichenoid drug eruption may progress to exfoliative erythroderma. There were lymphocytes extending to the dermoepidermal junction with vacuolar changes. In most cases, patch tests should be performed with the drug mixed in petrolatum to 1020% or diluted in water at the same concentration. The new edition has been comprehensively revised and updated, featuring an enlarged section of. 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. Adalimumab induced lichenoid drug eruption article pdf available in le journal medical libanais. This study was aimed at evaluating the clinical features and culprit drugs in generalized fixed drug eruptions in the west of iran. A drug rash drug eruption, also known as a drug reaction, is a skin condition caused by a medication.
Bullous drug eruptions refer to drug induced blister formation. 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. This clinical uncertainty is usually the result of similar changes in the gross histopathologic. A drug rash can appear in many forms, and any medication can cause a drug rash. Lichenoid eruption is an uncommon skin lesion which can be induced by many environmental agents, medications or industrial byproducts such as inhaled particles. Generalized fixed drug eruption is a specific variant of fixed drug eruption with multifocal lesions. Some drug eruptions, although trivial, may cause cosmetic embarrassment and fixed drug eruption fde is one of them. 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. Mild topical steroids eg, hydrocortisone, desonide and moisturizing lotions are also used, especially during the late desquamative phase. Fde commonly occurs on the genitals, lips, trunk, and hands. Examples of bullous drug eruptions include pseudoporphyria, drug induced bullous pemphigoid, stevensjohnson syndrome sjs and toxic epidermal necrolysis ten.
Lichenoid drug eruptions may also be caused by cutaneous contact with such agents as pphenylenediamine, nickel, gold and dental restorative agents. Drug eruptions and reactions merck manuals professional edition. Literature lichenoid drug eruptions as a class effect of betablockers have been described. Many cases were documented among united states military personnel during the.
An adverse reaction to a drug is an undesirable and usually unanticipated response independent of the intended therapeutic purpose of the medication. A drug eruption, also known as drug reaction or drug rash, is a skin condition caused by taking a medication. It is characterized by a symmetric eruption of flattopped, erythematous or violaceous papules resembling lichen planus on the trunk and extremities. She was able to continue nivolumab without any recurrences of the eruption for the following 4 months after treatment. Although uncommon in flexural or mucosal sites, lichenoid drug eruptions may be histologically indistinguishable from lp.
Therapy for exanthematous drug eruptions is supportive in nature. Lichenoid drug eruption, also called drug induced lichen planus, is an uncommon cutaneous adverse effect of several drugs. 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. Morbilliform simple drug eruption per the drug chart, the most likely culprit is. Lichenoid drug eruption caused by imatinib mesylate in a chinese patient with gastrointestinal stromal tumor. Lichen planus lp is a chronic inflammatory and immune mediated disease that affects the skin, nails, hair, and mucous membranes. To the best of our knowledge, only one other case of lichenoid drug eruption secondary to a protonpump inhibitor has been reported. Oral lichenoid drug eruptions oral lichenoid drug eruptions mccartan, be. The diagnosis may be suspected from the unusual clinical features and a skin biopsy then taken. Rifampicin is a bactericidal drug extensively used for tuberculosis and leprosy. Any drug can cause a skin reaction but some classes of drugs are characteristically. Fixed drug eruption fde is a form of presentation of recurrent cutaneous drug reaction characterized by appearance of single or multiple erythematous annular. The findings are very similar to those of lichen planus, and lichenoid drug eruption is.
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