ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferencesView all Images (36)
Lichenoid drug eruption in Adult
Print Captions OFF
Other Resources UpToDate PubMed

Lichenoid drug eruption in Adult

Print Images (36)
Contributors: Jeffrey M. Cohen MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Lichenoid drug eruptions are distinctive eruptions characterized by violaceous, scaling papules and plaques that are typically symmetrical and widespread. Pruritus is a common feature. 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, significant post-inflammatory hyperpigmentation, and lack of Wickham striae. Lichenoid drug eruption may progress to exfoliative erythroderma. Photolichenoid eruptions favor photoexposed areas. Oral involvement from a drug is uncommon and may occur with skin involvement or may be isolated.

Multiple medications have been implicated in lichenoid drug eruptions. Classic cutaneous lichenoid drug eruptions may be caused by angiotensin-converting enzyme (ACE) inhibitors, antimalarials, beta blockers, gold, lithium, mercury amalgam, methyldopa, penicillamine, quinidine, sulfonylureas, thiazide diuretics, tumor necrosis factor (TNF)-α inhibitors, and tyrosine kinase inhibitors. Cutaneous and oral lichenoid reactions may be caused by ACE inhibitors, allopurinol, anticonvulsants, antiretrovirals, gold, ketoconazole, and NSAIDs. Photodistributed lichenoid drug eruptions may be caused by carbamazepine, chlorpromazine, diltiazem, ethambutol, quinidine, quinine, tetracyclines, and thiazide diuretics.

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 several years. Resolution may take months or up to a year after its discontinuation; however, there are reports of resolution while an individual remains on the medication. 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:
L43.2 – Lichenoid drug reaction

SNOMEDCT:
109254000 – Lichenoid drug eruption

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Oral lichenoid drug eruption:

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

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.

Subscription Required

References

Subscription Required

Last Reviewed: 07/26/2019
Last Updated: 07/31/2019
Copyright © 2019 VisualDx®. All rights reserved.
Lichenoid drug eruption in Adult
Captions OFF Print 36 Images Filter Images
View all Images (36)
(with subscription)
 Reset
Lichenoid drug eruption : Erythema, Widespread, Pruritus, Fine scaly plaques, Fine scaly papules, Violaceous
Clinical image of Lichenoid drug eruption
Scaly, violaceous papules and plaques on the arm and dorsal hand.
Copyright © 2019 VisualDx®. All rights reserved.