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Lichenoid drug eruption in Adult
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Lichenoid drug eruption in Adult

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Contributors: Susan Burgin MD, Belinda Tan MD, PhD, Lowell A. Goldsmith MD, MPH
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Synopsis

Lichenoid drug eruptions are distinctive eruptions characterized by violaceous, scaling papules and plaques that are typically symmetrical and widespread. Pruritus is a common concomitant. The classic sites of involvement in lichen planus, such as the wrists, may be spared. Other clinical features that may suggest that a drug is causative include the presence of larger plaques, secondary eczematization, and significant post-inflammatory hyperpigmentation. Lichenoid drug eruption may progress to exfoliative erythroderma. Photo-lichenoid eruptions favor photo-exposed areas. Oral involvement from a drug is uncommon and may occur with skin involvement or may be isolated.

A number of medications have been reported to cause lichenoid eruptions including nonsteroidal anti-inflammatory drugs (NSAIDs), angiotensin-converting enzyme (ACE) inhibitors, beta adrenergic blockers, phenothiazines, gold, antimalarials, chlorpropamide, d-penicillamine, phenytoin, carbamazepine, and isoniazid. Newer offenders include imatinib mesylate, anti-PDI (programmed death 1) chemotherapy, statins, and anti-tumor necrosis factor (TNF)-alpha antagonists. Drugs that commonly cause photosensitive lichenoid drug eruptions are thiazide diuretics, tetracycline, quinine, and quinidine. Furosemide, sparfloxacin, ethambutol, and clopidogrel have also been implicated.

Common offending agents in oral lichenoid drug eruptions include NSAIDs, antihypertensive medication (beta blockers, thiazides, ACE inhibitors), antirheumatics (antimalarials, gold salts, penicillamine), and antiretroviral therapies.

Typically, the eruption occurs 2-3 months after initiation of the culprit medication, although onset may be as short as a few weeks or as long as 2 years. Resolution may take months or up to a year after its discontinuation. Oral lichenoid drug eruptions occur predominantly in adults, although pediatric cases have been reported.

Related topics: Lichen planus, Oral lichen planus, Lichen planopilaris

Codes

ICD10CM:
L27.1 – Localized skin eruption due to drugs and medicaments taken internally

SNOMEDCT:
109254000 – Lichenoid drug eruption

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Oral lichenoid drug eruption:

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 03/08/2018
Last Updated: 03/08/2018
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Lichenoid drug eruption in Adult
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Lichenoid drug eruption : Erythema, Fine scaly plaque, Widespread, Pruritus
Clinical image of Lichenoid drug eruption
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