Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Lichenoid drug eruption (drug-induced lichen planus)

INTRODUCTION

Lichenoid drug eruption, also called drug-induced lichen planus, is an uncommon cutaneous adverse effect of several drugs [1-4]. It is characterized by a symmetric eruption of flat-topped, erythematous or violaceous papules resembling lichen planus on the trunk and extremities. The time interval between the initiation of the offending drug and the appearance of the cutaneous lesions varies from months to a year or more and depends upon the class of drug, dose, host reaction, and concurrent medications [3]. Histologic examination reveals lichenoid interface dermatitis [5].

This topic will discuss the pathogenesis, clinical manifestations, diagnosis, and treatment of lichenoid drug eruptions. Lichen planus and other types of cutaneous adverse reactions to drugs are discussed separately.

(See "Lichen planus".)

(See "Exanthematous (morbilliform) drug eruption", section on 'Patient education'.)

(See "Fixed drug eruption".)

                     

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2014. | This topic last updated: May 15, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Fox GN, Harrell CC, Mehregan DR. Extensive lichenoid drug eruption due to glyburide: a case report and review of the literature. Cutis 2005; 76:41.
  2. Antiga E, Melani L, Cardinali C, et al. A case of lichenoid drug eruption associated with sildenafil citratus. J Dermatol 2005; 32:972.
  3. Brauer J, Votava HJ, Meehan S, Soter NA. Lichenoid drug eruption. Dermatol Online J 2009; 15:13.
  4. Asarch A, Gottlieb AB, Lee J, et al. Lichen planus-like eruptions: an emerging side effect of tumor necrosis factor-alpha antagonists. J Am Acad Dermatol 2009; 61:104.
  5. Sontheimer RD. Lichenoid tissue reaction/interface dermatitis: clinical and histological perspectives. J Invest Dermatol 2009; 129:1088.
  6. Halevy S, Shai A. Lichenoid drug eruptions. J Am Acad Dermatol 1993; 29:249.
  7. West AJ, Berger TG, LeBoit PE. A comparative histopathologic study of photodistributed and nonphotodistributed lichenoid drug eruptions. J Am Acad Dermatol 1990; 23:689.
  8. Lage D, Juliano PB, Metze K, et al. Lichen planus and lichenoid drug-induced eruption: a histological and immunohistochemical study. Int J Dermatol 2012; 51:1199.
  9. Yawalkar N, Pichler WJ. [Mechanisms of cutaneous drug reactions]. J Dtsch Dermatol Ges 2004; 2:1013.
  10. Sugerman PB, Satterwhite K, Bigby M. Autocytotoxic T-cell clones in lichen planus. Br J Dermatol 2000; 142:449.
  11. Yawalkar N, Pichler WJ. Immunohistology of drug-induced exanthema: clues to pathogenesis. Curr Opin Allergy Clin Immunol 2001; 1:299.
  12. Yawalkar N, Egli F, Hari Y, et al. Infiltration of cytotoxic T cells in drug-induced cutaneous eruptions. Clin Exp Allergy 2000; 30:847.
  13. Yawalkar N, Shrikhande M, Hari Y, et al. Evidence for a role for IL-5 and eotaxin in activating and recruiting eosinophils in drug-induced cutaneous eruptions. J Allergy Clin Immunol 2000; 106:1171.
  14. Meller S, Gilliet M, Homey B. Chemokines in the pathogenesis of lichenoid tissue reactions. J Invest Dermatol 2009; 129:315.
  15. Wenzel J, Scheler M, Proelss J, et al. Type I interferon-associated cytotoxic inflammation in lichen planus. J Cutan Pathol 2006; 33:672.
  16. Erdem MT, Gulec AI, Kiziltunc A, et al. Increased serum levels of tumor necrosis factor alpha in lichen planus. Dermatology 2003; 207:367.
  17. Akasu R, From L, Kahn HJ. Lymphocyte and macrophage subsets in active and inactive lesions of lichen planus. Am J Dermatopathol 1993; 15:217.
  18. Fiorentino DF. The Yin and Yang of TNF-{alpha} inhibition. Arch Dermatol 2007; 143:233.
  19. Teraki Y, Shiohara T. Spontaneous tolerance to terbinafine-induced lichenoid drug eruption. Dermatology 2004; 208:81.
  20. Bong JL, Lucke TW, Douglas WS. Lichenoid drug eruption with proton pump inhibitors. BMJ 2000; 320:283.
  21. Van den Haute V, Antoine JL, Lachapelle JM. Histopathological discriminant criteria between lichenoid drug eruption and idiopathic lichen planus: retrospective study on selected samples. Dermatologica 1989; 179:10.
  22. De Simone C, Caldarola G, D'Agostino M, et al. Lichenoid reaction induced by adalimumab. J Eur Acad Dermatol Venereol 2008; 22:626.
  23. Vergara G, Silvestre JF, Betlloch I, et al. Cutaneous drug eruption to infliximab: report of 4 cases with an interface dermatitis pattern. Arch Dermatol 2002; 138:1258.
  24. 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.
  25. Powell FC, Rogers RS 3rd, Dickson ER. Primary biliary cirrhosis and lichen planus. J Am Acad Dermatol 1983; 9:540.
  26. Rotstein E, Rotstein H. Drug eruptions with lichenoid histology produced by captopril. Australas J Dermatol 1989; 30:9.
  27. Bauer F. Quinacrine hydrochloride drug eruption (tropical lichenoid dermatitis). Its early and late sequelae and its malignant potential: a review. J Am Acad Dermatol 1981; 4:239.
  28. Garcovich S, Manco S, Zampetti A, et al. Onset of lichen planopilaris during treatment with etanercept. Br J Dermatol 2008; 158:1161.
  29. Wahiduzzaman M, Pubalan M. Oral and cutaneous lichenoid reaction with nail changes secondary to imatinib: report of a case and literature review. Dermatol Online J 2008; 14:14.
  30. HARBER LC, LASHINSKY AM, BAER RL. Photosensitivity due to chlorothiazide and hydrochlorothiazide. N Engl J Med 1959; 261:1378.
  31. Kubo Y, Fukumoto D, Ishigami T, et al. Diltiazem-associated photodistributed hyperpigmentation: report of two Japanese cases and published work review. J Dermatol 2010; 37:807.
  32. Johnston GA. Thiazide-induced lichenoid photosensitivity. Clin Exp Dermatol 2002; 27:670.
  33. Stein KR, Scheinfeld NS. Drug-induced photoallergic and phototoxic reactions. Expert Opin Drug Saf 2007; 6:431.
  34. Moore DE. Drug-induced cutaneous photosensitivity: incidence, mechanism, prevention and management. Drug Saf 2002; 25:345.
  35. Bork K. Lichenoid eruptions. In: Cutaneous Side Effects of Drugs, Bork K (Ed), WB Saunders, Philadelphia 1988. p.170.
  36. Anderson TE. Lichen planus following quinidine therapy. Br J Dermatol 1967; 79:500.
  37. Seehafer JR, Rogers RS 3rd, Fleming CR, Dickson ER. Lichen planus-like lesions caused by penicillamine in primary biliary cirrhosis. Arch Dermatol 1981; 117:140.
  38. Oliver GF, Winkelmann RK, Muller SA. Lichenoid dermatitis: a clinicopathologic and immunopathologic review of sixty-two cases. J Am Acad Dermatol 1989; 21:284.
  39. Barbaud A, Gonçalo M, Bruynzeel D, et al. Guidelines for performing skin tests with drugs in the investigation of cutaneous adverse drug reactions. Contact Dermatitis 2001; 45:321.
  40. Barbaud A. Drug patch testing in systemic cutaneous drug allergy. Toxicology 2005; 209:209.
  41. Lomaga MA, Polak S, Grushka M, Walsh S. Results of patch testing in patients diagnosed with oral lichen planus. J Cutan Med Surg 2009; 13:88.
  42. Khelifa-Hamdani E, Touati-Serraj M, Perriard J, et al. Giant cell lichenoid dermatitis in a patient with baboon syndrome. J Cutan Pathol 2008; 35 Suppl 1:17.
  43. Böer A. Keratosis lichenoides chronica: proposal of a concept. Am J Dermatopathol 2006; 28:260.
  44. Konstantinov KN, Søndergaard J, Izuno G, Obreshkova E. Keratosis lichenoides chronica. J Am Acad Dermatol 1998; 38:306.
  45. Ellgehausen P, Elsner P, Burg G. Drug-induced lichen planus. Clin Dermatol 1998; 16:325.
  46. Cribier B, Frances C, Chosidow O. Treatment of lichen planus. An evidence-based medicine analysis of efficacy. Arch Dermatol 1998; 134:1521.
  47. Laurberg G, Geiger JM, Hjorth N, et al. Treatment of lichen planus with acitretin. A double-blind, placebo-controlled study in 65 patients. J Am Acad Dermatol 1991; 24:434.
  48. Le Cleach L, Chosidow O. Clinical practice. Lichen planus. N Engl J Med 2012; 366:723.
  49. Cheng S, Kirtschig G, Cooper S, et al. Interventions for erosive lichen planus affecting mucosal sites. Cochrane Database Syst Rev 2012; 2:CD008092.
  50. Thongprasom K, Carrozzo M, Furness S, Lodi G. Interventions for treating oral lichen planus. Cochrane Database Syst Rev 2011; :CD001168.