Lichenoid drug eruption

    Article Contributors: 
    Sean Klepper M.D.
    Artur Zembowicz M.D....

    Clinical Features:

    • Clinically similar to lichen planus, but often larger, and with a predilection for the trunk and extremities
    • Sometimes photodistributed
    • May occur months to years ofter the patient is started on the offending drug, in contrast to the typically shorter latencies seen with other types of drug reactions
    • Occasionally, lesions may become eczematous, psoriasiform, bullous or ulcerative.
    • Complications include postinflammatory hyperpigmentation, scarring alopecia and anhidrosis.
    • Among the most commonly involved drugs are:
      • Gold salts
      • Penicillamine
      • β-blockers
      • Lithium
      • Furosemide
      • Spironolactone
      • Antimalarials
      • Captopril
      • Ethambutol
    • Lichenoid drug eruptions may also be caused by cutaneous contact with such agents as p-phenylenediamine, nickel, gold and dental restorative agents.

    Histologic Features:

    • The findings are very similar to those of lichen planus, and lichenoid drug eruption is often histologically indistinguishable from that entity.
    • Features that may help distinguish lichenoid drug eruption in some case are:
      • Focal parakeratosis
      • Spongiosis
      • A frequently thinner epidermis
      • Less pronounced hypergranulosis
      • Eosinophils and occasional plasma cells
      • Cytoid bodies in the upper stratum granulosum or even the stratum corneum
      • Focal interruption of the granular layer
      • Exocytosis of lymphocytes into the upper epidermis
      • Deep dermal perivascular infiltrate
    External Links:

    Cases associated with this book:

  • Lichenoid drug eruption
    Author: Artur Zembowicz M.D. Ph.D.

    Conference: Teaching Collection