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Maul JT, Guillet C, Oschmann A, Maul LV, Meier-Schiesser B, Stadler PC, French LE, Kerl K. Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications. J Eur Acad Dermatol Venereol 2023; 37:965-975. [PMID: 36652271 DOI: 10.1111/jdv.18879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
Cutaneous lichenoid drug eruptions (LDE) are adverse drug reactions (ADR) characterized by symmetric, erythematous, violaceous papules reminiscent but rarely fully characteristic of lichen planus (LP). We aimed to analyse the literature describing cases of LDE within the last 20 years to provide additional insight into culprit drugs, typical latency to onset of the eruption, the spectrum of clinical presentations, severity and management. A literature search was conducted in MEDLINE between January 2000 and 27 January 2021. The keywords 'lichenoid drug rash' and 'lichenoid drug eruption' were used. Cases were included if LDE diagnosis was made, and culprit drugs were identified. A total of 323 cases with LDE were identified from 163 published case reports and studies. The mean patient age was 58.5 years (1 month to 92 years), and 135 patients (41.8%) were female. Checkpoint inhibitors (CKI) were the most frequently reported culprit drugs (136 cases; 42.1%), followed by tyrosine kinase inhibitors (TKI) (39 cases; 12.0%) and anti-TNF-α-monoclonal antibodies (13 cases; 4.0%). The latency between initiation of the drug and manifestation was 15.7 weeks (range: 0.1-208 weeks). After discontinuing the culprit drug, the median time to resolution was 14.2 weeks (range: 0.71-416 weeks). One hundred thirty-six patients (42.1%) were treated with topical, and 54 patients (16.7%) with systemic glucocorticoids. Overall, we conclude that, albeit rare, LDE is challenging to diagnose ADR induced by mostly CKI, TKI, and biologics. Treatment modalities resemble that of lichen planus, and the culprit drugs had to be discontinued in only 26%, which is low compared with other types of adverse drug reactions. This is probably due to the low risk of aggravation (e.g. toxic epidermal necrolysis) if the drug is continued and the benefit/risk ratio favouring the drug, as is often the case in cancer therapy.
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Affiliation(s)
- Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Carole Guillet
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Anna Oschmann
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
| | - Lara Valeska Maul
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Barbara Meier-Schiesser
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Pia-Charlotte Stadler
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
| | - Lars E French
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany.,Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Katrin Kerl
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
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Sidikov A, Zaslavsky D, Sadykov A, Megna M, Garcia T, Aristizabal M, Chuprov I, Olisova О, Grekova Е, Ibragimova N, Kozlova D, Nasyrov R, Shalaeva EV. The new differential diagnostic test for the lichenoid drug eruption. Dermatol Ther 2020; 33:e13784. [PMID: 32510667 DOI: 10.1111/dth.13784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/28/2020] [Accepted: 05/31/2020] [Indexed: 12/23/2022]
Abstract
The differential diagnosis between lichenoid drug eruption (LDE) and lichen planus (LP) is difficult due to similar clinical and histological signs but important for treatment and prognosis. The purpose of this study was to propose the new diagnosis method for differentiate LDE from LP. During 2015-2018, 20 patients with confirmed LDE, 13 patients with LP and 134 controls were examined and treated at the Lenoblcenter. All enrolled patients were underwent the injection of 0.5 mL of the 2% lidocaine solution by insulin syringe into the papule with following histological examination. The formation of a blister (bulla) at the site of injection was considered a positive test result. Among LDE, 18 of 20 patients were found positive for developing blister (bulla) and two results were questionable. In 12 of 13 LP patents, bulla on the site of injection was not identified and the result of one patient was nonspecific. All control patients were negative for the proposed test. The histological sections showed that the bulla has corresponded to the separation of the epidermis from the dermis. Intracutaneous injection of 0.5 mL of lidocaine into the papule is an easy highly specific and sensitive method to differentiate LDE from LP.
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Affiliation(s)
- Akmal Sidikov
- Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, 2A, Litovskaya, Saint Petersburg, 194100, Russian Federation
| | - Denis Zaslavsky
- Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, 2A, Litovskaya, Saint Petersburg, 194100, Russian Federation
| | - Aslan Sadykov
- Department of dermatovenereology, Medical Center XXI century, 45, Bol'shoy Sampsonievsky prospect, Saint-Petersburg, 194044, Russian Federation
| | - Matteo Megna
- Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, 2A, Litovskaya, Saint Petersburg, 194100, Russian Federation
| | - Torres Garcia
- Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, 2A, Litovskaya, Saint Petersburg, 194100, Russian Federation
| | - Mikhea Aristizabal
- Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, 2A, Litovskaya, Saint Petersburg, 194100, Russian Federation
| | - Igor Chuprov
- Department of Pathomorphology, I.I. Mechnikov North-Western State Medical University, 47, Piskarevsky prospect, St. Petersburg, 195067, Russian Federation
| | - Оlga Olisova
- V.A. Rakhmanov Department of Skin and Venereal Diseases, I.M. Sechenov First Moscow State Medical University, 19c1, Bol'shaya Pirogovskaya, Moscow, 119146, Russian Federation
| | - Еkaterina Grekova
- V.A. Rakhmanov Department of Skin and Venereal Diseases, I.M. Sechenov First Moscow State Medical University, 19c1, Bol'shaya Pirogovskaya, Moscow, 119146, Russian Federation
| | - Nargiza Ibragimova
- Department of dermatovenereology, Republican Scientific and Practical Center of Sports Medicine, 6, Almazar street, Tashkent, 100003, Uzbekistan
| | - Darya Kozlova
- Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, 2A, Litovskaya, Saint Petersburg, 194100, Russian Federation
| | - Ruslan Nasyrov
- Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, 2A, Litovskaya, Saint Petersburg, 194100, Russian Federation
| | - Evgeniya V Shalaeva
- Department of dermatovenereology, Tashkent Medical Academy, 2, Ferobiy, Tashkent, 100109, Uzbekistan
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Katare A, Arora P, Sardana K, Malhotra P. Lichenoid drug reaction due to anti-tubercular therapy presenting as erythroderma. Dermatol Ther 2019; 33:e13169. [PMID: 31747108 DOI: 10.1111/dth.13169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/10/2019] [Accepted: 11/18/2019] [Indexed: 11/30/2022]
Abstract
First-line anti-tubercular therapy (ATT) is very effective in management of tuberculosis and is usually well tolerated. Varied spectrum of cutaneous adverse drug reactions is associated with ATT, of which lichenoid drug eruption (LDR) constitutes approximately 10% of the cases. However, LDR presenting as erythroderma is very rare. Here, we report a case of exfoliative dermatitis secondary to LDR which developed after 5 months of ATT.
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Affiliation(s)
- Anusha Katare
- Department of Dermatology, PGIMER Dr RML Hospital, New Delhi, India
| | - Pooja Arora
- Department of Dermatology, PGIMER Dr RML Hospital, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, PGIMER Dr RML Hospital, New Delhi, India
| | - Purnima Malhotra
- Department of Pathology, PGIMER Dr RML Hospital, New Delhi, India
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