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Lichenoid drug eruption in Adult
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Lichenoid drug eruption in Adult

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Contributors: Jeffrey M. Cohen MD, Belinda Tan MD, PhD, Susan Burgin MD
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Synopsis

Lichenoid drug eruption : Erythema, Widespread distribution, Pruritus, Fine scaly plaques, Fine scaly papules, Violaceous
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

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Oral lichenoid drug eruption:

Best Tests

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Management Pearls

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Therapy

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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.

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References

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Last Reviewed:07/25/2019
Last Updated:04/06/2021
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Lichenoid drug eruption in Adult
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A medical illustration showing key findings of Lichenoid drug eruption : Erythema, Widespread distribution, Pruritus, Fine scaly plaques, Fine scaly papules, Violaceous
Clinical image of Lichenoid drug eruption - imageId=301644. Click to open in gallery. caption: 'Scaly, violaceous papules and plaques on the arm and dorsal hand.'
Scaly, violaceous papules and plaques on the arm and dorsal hand.

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