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Reekie IR, Simpson A, Erikitola O, Lyall D, Roberts F. Ocular Lichen Planus: A clinicopathologic review. Eur J Ophthalmol 2024:11206721241229128. [PMID: 38304934 DOI: 10.1177/11206721241229128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Lichen planus is a chronic inflammatory dermatosis that can affect the skin, mucous membranes and nails. Cutaneous lichen planus lesions are best described by the "six Ps" - purple pruritic polygonal planar papules and plaques. Mucous membrane lesions are commonly associated with cutaneous lichen planus. Ocular involvement with lichen planus is rare and conjunctival involvement usually predominates, it can however be visually devastating. Ocular lichen planus often progresses to extensive conjunctival scarring which can be impossible to distinguish clinically from other cicatrising conjunctivitis, requiring histopathological confirmation. Here we review the ocular pathology of this condition.
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Affiliation(s)
- Ian R Reekie
- Department of Ophthalmology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Alasdair Simpson
- Department of Ophthalmology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Ore Erikitola
- Department of Ophthalmology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Douglas Lyall
- Department of Ophthalmology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Fiona Roberts
- Department of Histopathology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
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2
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Feschuk AM, Green M, Kashetsky N, Maibach HI. Lichen planus following SARS-CoV-2 infection and vaccination? A systematic review. Int J Dermatol 2023; 62:e54-e56. [PMID: 36331066 PMCID: PMC9877567 DOI: 10.1111/ijd.16480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/25/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Aileen M. Feschuk
- Faculty of MedicineMemorial University of NewfoundlandSt. John'sNewfoundland & LabradorCanada
| | - Maxwell Green
- Tulane University School of MedicineNew OrleansLouisianaUSA
| | - Nadia Kashetsky
- Faculty of MedicineMemorial University of NewfoundlandSt. John'sNewfoundland & LabradorCanada
| | - Howard I. Maibach
- Department of DermatologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Young MK, Holder KG, Baker TE, Kauffman RP. Vulvovaginal erosive lichen planus refractory to topical therapies: What's next? A case report. Case Rep Womens Health 2023; 37:e00478. [PMID: 36636108 PMCID: PMC9829706 DOI: 10.1016/j.crwh.2023.e00478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/04/2023] Open
Abstract
A 60-year-old woman was referred for progressive and severe vulvovaginal pain characterized by erosions and Wickham's stria for the past 7 months. Her condition had not responded to oral fluconazole, topical estrogen cream, and topical clobetasol cream. Vulvar and vaginal biopsies were obtained under general anesthesia to verify the diagnosis of erosive lichen planus given the failed response to ultrapotent topical steroids. Tacrolimus cream was added but not tolerated. Oral and cutaneous lesions of lichen planus also developed. In the absence of evidence-based guidelines, three different systemic treatments were administered sequentially (hydroxychloroquine, mycophenolate, and finally cyclosporin) before a satisfactory, well-tolerated, and sustained clinical response was obtained. Topical betamethasone ointment in a taper was continued to assist in sustaining a vulvovaginal response after cyclosporin was discontinued.
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Musicante M, Goenaga-Vázquez Y, Klimas N. Lichenoid drug eruption induced by erenumab. JAAD Case Rep 2022; 32:26-28. [PMID: 36606202 PMCID: PMC9807817 DOI: 10.1016/j.jdcr.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Meryl Musicante
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Yamila Goenaga-Vázquez
- Department of Dermatology, McGovern Medical School at UT Health, Houston, Texas,Correspondence to: Yamila Goenaga-Vázquez, MD, Department of Dermatology, McGovern Medical School at UT Health, 6500 West Loop South, Suite 200-F, Bellaire, TX 77401.
| | - Natasha Klimas
- Department of Dermatology, McGovern Medical School at UT Health, Houston, Texas
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Oh SJ, Choi YH, Byun HJ, Oh SH, Park JH, Lee JH, Lee DY, Lee JH, Yang JM. A Case of Nivolumab-Induced Lichen Planus. Ann Dermatol 2019; 31:345-347. [PMID: 33911605 PMCID: PMC7992723 DOI: 10.5021/ad.2019.31.3.345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/04/2018] [Accepted: 05/15/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Se Jin Oh
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hwan Choi
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Jeong Byun
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hwan Oh
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Heung Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Mo Yang
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Affiliation(s)
- Brayden Forbes
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City
| | - Marta J Petersen
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City
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Oh SH, Byun HJ, Oh SJ, Jun JY, Park JH, Lee JH, Lee DY, Lee JH, Yang JM. Olmutinib Induced Lichen Planus Like Eruption. Ann Dermatol 2018; 30:451-453. [PMID: 30065585 PMCID: PMC6029972 DOI: 10.5021/ad.2018.30.4.451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 11/08/2022] Open
Abstract
Drug induced lichen planus like eruption is an uncommon cutaneous adverse effect of several drugs. This appears symmetric eruption of erythematous or violaceous plaques resembling lichen planus on the trunk and extremities. A 50-year-old male presented with scaly, violaceous plaques and dusky brown macules on whole body. For four months, the patient was treated with olmutinib, an oral, third-generation epidermal growth factor receptor-tyrosine kinase inhibitor. In May 2016, olmutinib received its first global approval in South Korea for the treatment of patients with locally advanced or metastatic epidermal growth factor receptor T790M mutation-positive non-small cell lung cancer. The biopsy specimen from the patient showed features of lichen planus. We diagnosed him with olmutinib-induced lichen planus like eruption. He was treated with oral methylprednisolone and topical desoxymethasone 0.25% ointment. At the same time, olmutinib dose was decreased to three-fourths of this patient's starting dose. After that, the cutaneous lesions improved.
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Affiliation(s)
- Seung Hwan Oh
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Jeong Byun
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Jin Oh
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Young Jun
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Heung Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Mo Yang
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ladhari C, Fathallah N, Mokni S, Sriha B, Ben Salem C. Lichenoid drug eruption associated with rifampicin. Presse Med 2018. [DOI: 10.1016/j.lpm.2018.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
Lichen planus (LP) is a mucocutaneous inflammatory dermatitis of idiopathic origin that can involve the skin, mucous membranes, hair, and nails. LP has an associated set of characteristic histopathologic findings which include hyperkeratosis, vacuolization of the basal layer, Civatte bodies, wedge-shaped hypergranulosis, band-like lymphocytic infiltrate at the dermal epidermal junction, eosinophilic colloid bodies in the papillary dermis, and pigment incontinence. The infiltrate is usually composed of lymphocytes with few histiocytes, mast cells, and macrophages. The presence of plasma cell predominant infiltrate in LP has only been reported in four previous cases and 2 other cases of lichen nitidus. The authors report another 2 cases of LP with predominate plasma cell infiltrate in 2 female patients on the legs. The differential includes a drug-induced lichenoid reaction with predominate plasma cell infiltrate. However, there have been no case reports of that type of reaction. Because plasma cells are seen commonly in certain infectious diseases, malignancy, and macroglobulinemia, it is prudent to rule out those entities. Our patients responded well with a class 1 topical steroid, with improvement of their lower leg lesions within 1 month of treatment.
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Kun J. Next step: functional studies on hypertension, lichen planus, and TRPA1 connections. Oral Dis 2017; 23:811-812. [PMID: 28130802 DOI: 10.1111/odi.12645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jozsef Kun
- Department of Pharmacology and Pharmacotherapy, University of Pecs Medical School, Pecs, Hungary.,MTA-PTE NAP-B Chronic Pain Research Group, University of Pecs Medical School, Pecs, Hungary.,Molecular Pharmacology Group, University of Pecs, Janos Szentagothai Research Center, Pecs, Hungary
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Bodmer M, Egger SS, Hohenstein E, Beltraminelli H, Krähenbühl S. Lichenoid Eruption Associated with the Use of Nebivolol. Ann Pharmacother 2016; 40:1688-90. [PMID: 16896017 DOI: 10.1345/aph.1h094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective: To report a case of lichenoid drug eruption (LDE) after starting antihypertensive treatment with nebivolol, a cardioselective β-blocker. Case Summary: Five weeks after starting treatment with nebivolol, a 62-year-old woman presented with erythematous papules on both extremities and skin lesions spreading over the back. She was not being treated with any other drugs. Because the administration of levocetirizine, topical methylprednisolone, and systemic prednisone was unsuccessful, the treatment was stopped and the lesions were biopsied. The histopathological features of the lesions were consistent with LDE. After withdrawal of nebivolol and subsequent readministration of topical methylprednisolone and systemic prednisone, the skin lesions resolved within 12 days. Assessment of the causality revealed a probable relationship between nebivolol and the lichenoid eruptions. Discussion: Although β-blockers can be associated with LDE, as of July 7, 2006, this has not been previously reported with nebivolol. T cells invading the dermis are considered to be responsible for epidermal destruction associated with LDE, as has been described for lichenoid forms of chronic graft versus host disease and idiopathic lichen ruber planus. Conclusions: Nebivolol can cause LDE, as has been reported with other β-blockers. The underlying mechanism appears to be T cell–mediated. Cross-reactivity with other β-blockers cannot be excluded; therefore, the risk of recurrent LDE should be weighed carefully against the clinical benefit before switching to another β-blocker.
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Affiliation(s)
- Michael Bodmer
- Clinical Pharmacology & Toxicology, University Hospital, Basel, Switzerland.
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Kun J, Perkecz A, Knie L, Sétáló G, Tornóczki T, Pintér E, Bán Á. TRPA1 receptor is upregulated in human oral lichen planus. Oral Dis 2016; 23:189-198. [PMID: 27718297 DOI: 10.1111/odi.12593] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/14/2016] [Accepted: 10/04/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Oral lichen planus (OLP) is a chronic inflammatory disease of unknown etiology with antigen-specific and non-specific mechanisms. Transient receptor potential ankyrin 1 (TRPA1) is a non-selective cation channel activated by noxious stimuli such as oxidative stress products evoking pain and release of proinflammatory mediators from sensory nerve endings culminating in neurogenic inflammation. Extraneuronal TRPA1s, for example, on immune cells possess yet unknown functions. SUBJECTS AND METHODS We studied the buccal mRNA expression (qPCR) and protein localization (immunohistochemistry) of TRPA1 receptors and key OLP mediator transcripts in oral mucosa samples of healthy volunteers (n = 9), OLP patients (n = 43), and OLP-like hyperkeratotic patients (n = 12). RESULTS We measured 27.7- and 25.5-fold TRPA1 mRNA increase in OLP and OLP-like hyperkeratotic patients compared to healthy controls. TRPA1 transcripts elevated 2.4-fold in hypertensive OLP but not in hyperkeratotic patients compared to counterparts, reduced by 1.6-fold by angiotensin-convertase inhibitor intake. TRPA1 messenger RNA was more coexpressed with transcripts of tumor necrosis factor α than with interferon γ. Keratinocytes, macrophages but not T cells expressed TRPA1. CONCLUSIONS We provided evidence for the extraneuronal presence and upregulation of the proinflammatory TRPA1 receptor in buccal samples of patients with OLP. This may implicate the ion channel in the pathomechanism of OLP.
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Affiliation(s)
- J Kun
- Department of Pharmacology and Pharmacotherapy, University of Pécs Medical School, Pécs, Hungary.,Molecular Pharmacology Group, Szentágothai Research Center, University of Pecs, Pécs, Hungary.,MTA-PTE NAP B Chronic Pain Research Group, University of Pécs, Pécs, Hungary
| | - A Perkecz
- Department of Pharmacology and Pharmacotherapy, University of Pécs Medical School, Pécs, Hungary
| | - L Knie
- Department of Dentistry, Oral and Maxillofacial Surgery, University of Pécs Medical School, Pécs, Hungary
| | - G Sétáló
- Department of Medical Biology, University of Pécs Medical School, Pécs, Hungary
| | - T Tornóczki
- Oral Pathology Unit, Department of Pathology, University of Pécs Medical School, Hungary
| | - E Pintér
- Department of Pharmacology and Pharmacotherapy, University of Pécs Medical School, Pécs, Hungary.,Molecular Pharmacology Group, Szentágothai Research Center, University of Pecs, Pécs, Hungary
| | - Á Bán
- Department of Dentistry, Oral and Maxillofacial Surgery, University of Pécs Medical School, Pécs, Hungary
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Leggio L, Ferrulli A, Mirijello A, Abenavoli L, Di Giuda D, Funiciello S, Rotoli M, Gasbarrini G, Addolorato G. Penicillamine-Related Lichenoid Dermatitis and Utility of Zinc Acetate in a Wilson Disease Patient with Hepatic Presentation, Anxiety and Spect Abnormalities. Int J Immunopathol Pharmacol 2016; 20:185-90. [PMID: 17346443 DOI: 10.1177/039463200702000122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Wilson disease is an autosomal recessive disorder of hepatic copper metabolism with consequent copper accumulation and toxicity in many tissues and consequent hepatic, neurologic and psychiatric disorders. We report a case of Wilson disease with chronic liver disease; moreover, in our patient, presenting also with high levels of state anxiety without depression 99mTc-ECD-SPECT showed cortical hypoperfusion in frontal lobes, more marked on the left frontal lobe. During the follow-up of our patient, penicillamine was interrupted after the appearance of a lichenoid dermatitis, and zinc acetate permitted to continue the successful treatment of the patient without side-effects. In our case the therapy with zinc acetate represented an effective treatment for a Wilson disease patient in which penicillamine-related side effects appeared. The safety of the zinc acetate allowed us to avoid other potentially toxic chelating drugs; this observation is in line with the growing evidence on the efficacy of the drug in the treatment of Wilson disease. Since most of Wilson disease penicillamine-treated patients do not seem to develop this skin lesion, it could be conceivable that a specific genetic factor is involved in drug response. Further studies are needed for a better clarification of Wilson disease therapy, and in particular to differentiate specific therapies for different Wilson disease phenotypes.
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15
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Xue Y, Cohen JM, Wright NA, Merola JF. Skin Signs of Rheumatoid Arthritis and its Therapy-Induced Cutaneous Side Effects. Am J Clin Dermatol 2016; 17:147-62. [PMID: 26649439 DOI: 10.1007/s40257-015-0167-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disorder that primarily affects the joints, but may exhibit extra-articular, including cutaneous, manifestations such as rheumatoid nodules, rheumatoid vasculitis, granulomatous skin disorders, and neutrophilic dermatoses. A large burden of cutaneous disease may be an indication of RA disease activity and the need for more aggressive treatment. Many of the therapeutic agents used to treat RA can also result in cutaneous adverse effects, which pose their own diagnostic and therapeutic challenges. Anti-TNFα agents, in particular, have a wide variety of adverse effects including psoraisiform eruptions, granulomatous conditions, and cutaneous connective tissue disorders. Herein we provide an update on the clinical presentations and management of RA-associated cutaneous findings as well as drug-induced cutaneous effects, with particular attention to the adverse effects of biologic disease-modifying agents.
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Lukács J, Schliemann S, Elsner P. Lichen planus and lichenoid reactions as a systemic disease. Clin Dermatol 2015; 33:512-9. [DOI: 10.1016/j.clindermatol.2015.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Zaïem A, Sahnoun R, Badri T, Lakhoua G, Koubaa W, Kastalli S, Daghfous R, Lakhal M, El Aidli S. Lichen associated with metformin. Therapie 2014; 69:253-4. [PMID: 24927507 DOI: 10.2515/therapie/2014025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/20/2014] [Indexed: 11/20/2022]
Abstract
We report an exceptional case of bullous lichen induced by metformin in a patient with diabetes mellitus.
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Affiliation(s)
- Ahmed Zaïem
- National Center of Pharmacovigilance, Tunis, Tunisia - Tunis El Manar University, Medicine Faculty, Tunis, Tunisia
| | - Rym Sahnoun
- National Center of Pharmacovigilance, Tunis, Tunisia - Tunis El Manar University, Medicine Faculty, Tunis, Tunisia
| | - Talel Badri
- Tunis El Manar University, Medicine Faculty, Tunis, Tunisia - Dermatology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Ghozlane Lakhoua
- National Center of Pharmacovigilance, Tunis, Tunisia - Tunis El Manar University, Medicine Faculty, Tunis, Tunisia
| | - Wafa Koubaa
- Pathological Anatomy Laboratory, Habib Thameur Hospital, Tunis, Tunisia
| | - Sarrah Kastalli
- National Center of Pharmacovigilance, Tunis, Tunisia - Tunis El Manar University, Medicine Faculty, Tunis, Tunisia
| | - Riadh Daghfous
- National Center of Pharmacovigilance, Tunis, Tunisia - Tunis El Manar University, Medicine Faculty, Tunis, Tunisia
| | - Mohamed Lakhal
- National Center of Pharmacovigilance, Tunis, Tunisia - Tunis El Manar University, Medicine Faculty, Tunis, Tunisia
| | - Sihem El Aidli
- National Center of Pharmacovigilance, Tunis, Tunisia - Tunis El Manar University, Medicine Faculty, Tunis, Tunisia
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Abstract
Cutaneous drug eruptions can range from an asymptomatic rash to a life-threatening emergency. Because of the high frequency, morbidity, and potential mortality associated with drug eruptions, patients with possible drug reactions should promptly be recognized, worked up, and treated. Drug reactions are common in the elderly population due to age-related alterations in metabolism, excretion of medications, and polypharmacy. This review discusses the epidemiology, pathogenesis, clinical presentation, diagnosis, and management of drug eruptions that providers commonly encounter in the care of the geriatric population. An algorithm for an approach to patients with a suspected drug eruption is presented.
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Affiliation(s)
- Ammar M Ahmed
- Department of Dermatology, University of Texas-Southwestern Medical Center-Austin Campus, University Medical Center Brackenridge, Seton Healthcare Family, 601 East 15th Street, CEC C2.443, Austin, TX 78701, USA.
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Fessa C, Lim P, Kossard S, Richards S, Peñas PF. Lichen planus-like drug eruptions due to β-blockers: a case report and literature review. Am J Clin Dermatol 2012; 13:417-21. [PMID: 22809321 DOI: 10.2165/11634590-000000000-00000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Lichen planus-like drug eruptions (LDE) can appear similar or identical to idiopathic lichen planus. We present a 45-year-old man with a widespread, violaceous, papular, generalized exanthema with histologic features of a lichenoid reaction, which subsequently resolved with the cessation of labetatol. We found 29 cases of previously reported β-adrenoceptor antagonist (β-blocker)-associated LDE. This is a relatively rare complication that may present as classic lichenoid papules indistinguishable from lichen planus and has a predilection for the limbs, chest, back, and oral mucosa. Histologically, there is a lichenoid infiltrate often with eosinophils. LDE may be due to drug cross-reactivity or as a result of a suppressed skin adrenergic system. Multiple potential medications in case studies and the inability to differentiate LDE from idiopathic lichen planus in cross-sectional association studies make any conclusive analysis difficult.
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Affiliation(s)
- Chris Fessa
- Department of Dermatology, Westmead Hospital, Westmead, NSW, Australia.
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Hogan J, Radhakrishnan J. The assessment and importance of hypertension in the dental setting. Dent Clin North Am 2012; 56:731-45. [PMID: 23017548 DOI: 10.1016/j.cden.2012.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many patients with hypertension have uncontrolled disease. The dental visit presents a unique opportunity to screen patients for undiagnosed and undertreated hypertension, which may lead to improved monitoring and treatment. Although there are no clinical studies, it is generally recommended that nonemergent procedures be avoided in patients with a blood pressure of greater than 180/110 mm Hg. Because of the high prevalence of disease and medication use for hypertension, dentists should be aware of the oral side effects of antihypertensive medications as well as the cardiovascular effects of medications commonly used during dental visits.
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Affiliation(s)
- Jonathan Hogan
- Division of Nephrology, Department of Medicine, Columbia University College of Physician and Surgeons, New York, NY 10032, USA
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Lehloenya RJ, Todd G, Mogotlane L, Gantsho N, Hlela C, Dheda K. Lichenoid drug reaction to antituberculosis drugs treated through with topical steroids and phototherapy. J Antimicrob Chemother 2012; 67:2535-7. [PMID: 22687890 DOI: 10.1093/jac/dks225] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nguyen DL, Wittich CM. Metoprolol-induced lichenoid dermatitis. J Gen Intern Med 2011; 26:1379-80. [PMID: 21614631 PMCID: PMC3208471 DOI: 10.1007/s11606-011-1742-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 04/18/2011] [Accepted: 04/27/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Douglas L. Nguyen
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN USA
| | - Christopher M. Wittich
- Division of General Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905 USA
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Rudikoff D. Differential diagnosis of round or discoid lesions. Clin Dermatol 2011; 29:489-97. [PMID: 21855723 DOI: 10.1016/j.clindermatol.2010.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Dermatologists are called on to diagnose a variety of skin conditions in diverse age groups. Dermatologic diagnosis, based on identification of a primary lesion, uses morphologic clues to categorize the pathologic process causing the eruption. In addition, distribution and grouping of lesions helps support a specific diagnosis. Dermatologists consciously or unconsciously use pattern recognition to arrive at their differential diagnosis based on clinical experience and their having previously viewed similarly appearing skin lesions in lectures, texts, and journals. Round and discoid patches and plaques are extremely common in the clinical practice of dermatology. This contribution reviews the dermatologic conditions that present as round or discoid lesions and presents an approach to diagnosis.
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Affiliation(s)
- Donald Rudikoff
- Division of Dermatology, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Bronx, NY 10457, USA.
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Abstract
Drugs may elicit a considerable variety of clinical signs, often affecting the skin and the mucous membranes. The most common are maculopapular exanthemas and urticaria, more rarely pustules, bullae vasculitic lesions, and lichenoid lesions may also be observed. Apart from the morphology, the chronology of the occurrence and the evolution of single skin lesions and exanthema are also paramount in the clinical diagnosis of cutaneous drug hypersensitivity. Often, the skin represents the only organ manifestation; however, it may be the herald for a systemic involvement of internal organs, such as in severe drug-induced hypersensitivity syndromes or anaphylaxis.
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Affiliation(s)
- Andreas J Bircher
- Allergy Unit, Department of Dermatology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
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Woo V, Bonks J, Borukhova L, Zegarelli D. Oral lichenoid drug eruption: a report of a pediatric case and review of the literature. Pediatr Dermatol 2009; 26:458-64. [PMID: 19689525 DOI: 10.1111/j.1525-1470.2009.00953.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Lichenoid drug eruptions are seen most frequently on the skin and seldomly affect the mucosal surfaces. Oral involvement-known as oral lichenoid drug eruption-is more common in the adult population and has been associated with numerous medications. Pediatric-onset oral lichenoid drug eruption is an exceptionally rare finding with only isolated cases published in the literature. The nonspecific appearance and latent presentation of pediatric oral lichenoid drug eruption can cause confusion in diagnosis and treatment. We report a case of oral lichenoid drug eruption occurring in a 15-year-old and explore challenges in the clinical and histologic recognition of this condition.
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Affiliation(s)
- Victoria Woo
- School of Dental Medicine, University of Nevada, Las Vegas, Nevada, USA
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Seeborg FO, Rihal PS, Czelusta A, Sanchez R, Hanson IC. Lichen planus associated with omalizumab administration in an adult with allergic asthma. Ann Allergy Asthma Immunol 2009; 102:349-51. [PMID: 19445051 DOI: 10.1016/s1081-1206(10)60343-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Eichbaum MHR, Harms W, Bolz S, Gebauer G, Schneeweiss A, Sohn C. Extensive genital and gluteal epitheliolyses caused by locoregional lichen ruber two years after primary treatment of vulvar cancer. ACTA ACUST UNITED AC 2008; 31:332-4. [PMID: 18547976 DOI: 10.1159/000127401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lichen ruber is a rare inflammatory mucocutaneous dermatosis with unknown etiology. Paraneoplastic manifestations of the disease are rare. Eruptions of lichen ruber subsequent to traumas such as surgery or radiotherapy are described as Köbner's phenomenon. PATIENTS AND METHODS A 72-year-old woman presented at our institution because of increasing, extensive erosive epitheliolyses of the genital and gluteal area two years after surgery and radiotherapy because of vulvar cancer. RESULTS Thorough clinical as well as histological examination revealed a localized lichen ruber reaction. All epitheliolyses healed well within weeks under topic treatment with steroids. CONCLUSION Lichen ruber is a rare dermatologic reaction that can occur several months after surgery and radiotherapy and has to be taken into account on examination of patients with late-onset skin reactions after local cancer treatment.
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Affiliation(s)
- Michael H R Eichbaum
- Department of Gynecology and Obstetrics, University of Heidelberg Medical School, Heidelberg, Germany.
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Summey BT, Bowen SE, Allen HB. Lichen planus-like atopic dermatitis: expanding the differential diagnosis of spongiotic dermatitis. J Cutan Pathol 2008; 35:311-4. [DOI: 10.1111/j.1600-0560.2007.00806.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Clinical and histopathological differential diagnosis is usually impossible in drug-induced lichen planus (LP) and idiopathic LP. Naproxen is a nonsteroidal anti-inflammatory drug, which is widely used for its analgesic, antipyretic and anti-inflammatory effects. To the best of our knowledge, two case reports on naproxen-induced LP have been reported. METHODS Fifty-five patients with LP, and a history of naproxen intake before their eruption, were investigated. RESULTS Twenty-five patients (45.5%) had a history of naproxen intake prior to their eruption without any other medication. Twelve patients (21.8%) had a history of simultaneous use of naproxen with other drugs that were reported as inducers of LP. Eighteen patients (32.7%) had given a history of using naproxen together with drugs that had not been previously reported as inducers of LP. Moreover, in 42 patients, eruptive-type LP development after naproxen intake, is an interesting observation. New lesions were not observed after the cessation of naproxen intake in any of the patients. CONCLUSION Naproxen might be accepted as an important inducer for LP, especially for the eruptive form.
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Affiliation(s)
- Ali Tahsin Güneş
- Department of Dermatology, Faculty of Medicine, University of Dokuz Eylül, Izmir, Turkey
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Abstract
SUMMARY A 64-year-old woman presented with diffuse and numerous pigmented macules on her face and upper back. Histopathological examination of a skin punch biopsy of the rash showed a lichenoid dermatitis. The most likely offending drug was pravastatin. Cessation of pravastatin resulted in gradual fading of the pigmentation. 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors have previously been reported to cause lichenoid drug eruptions.
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Affiliation(s)
- Vernon Sc Pua
- Department of Dermatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Büyükgebiz B, Arslan N, Oztürk Y, Soyal C, Lebe B. Drug reaction to ursodeoxycholic acid: lichenoid drug eruption in an infant using ursodeoxycholic acid for neonatal hepatitis. J Pediatr Gastroenterol Nutr 2002; 35:384-6. [PMID: 12352534 DOI: 10.1097/00005176-200209000-00030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Lichenoid drug eruptions are skin reactions associated with a number of drugs and chemicals. They are rare in infants. We report here an infant who presented with neonatal hepatitis and who was being treated with ursodeoxycholic acid. The infant developed lichenoid skin eruptions in the third week of the therapy. The lesions have resolved two months after the discontinuation of the drug. To our knowledge, this is the first infant case of lichenoid drug eruption associated with ursodeoxycholic acid.
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Affiliation(s)
- Benal Büyükgebiz
- Dokuz Eylül University Medical Faculty, Department of Pediatrics, Izmir, Turkey
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Affiliation(s)
- D Krasowska
- Department of Dermatology, Medical University of Lublin, Lublin, Poland
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Abstract
Cutaneous lichenoid eruptions can arise as a result of exogenous compound exposures. Pharmaceutical drugs, industrial compounds, and inhaled particles have been implicated as causative agents. To date, there have been no recorded cases of lichenoid drug eruptions (LDEs) caused by clinical use of the nonsteroidal anti-inflammatory drug salsalate. We describe a patient who experienced a lichenoid eruption after the initiation of salsalate for relief of arthritic pain. This eruption emerged after 1 month of therapy with salsalate, persisted for as long as salsalate was administered, and cleared within 3 weeks of discontinuing the medication. LDEs can clinically and histologically resemble idiopathic or classic lichen planus. Integrating drug history, clinical morphology, clinical distribution, and histopathology can aid in the differentiation. As in our patient's case, curative treatment for LDE requires discontinuation of the drug.
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Affiliation(s)
- M L Powell
- Division of Dermatology, University of Kansas Medical Center, Kansas City 66160-7319, USA
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Cather JC, Menter MA. Purplish, Pruritic Papules on the Limbs. Proc (Bayl Univ Med Cent) 2001; 14:449-51. [PMID: 16369657 PMCID: PMC1305910 DOI: 10.1080/08998280.2001.11927799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- J C Cather
- Division of Dermatology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA
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