Captopril is an angiotensin-converting enzyme (ACE) inhibitor which is a widely prescribed drug. Cutaneous reactions to captopril are common including pruritus, urticaria, maculopapular rashes, pityriasis rosca-like eruptions and pemphigus. 1 We report a case of lichenoid eruption probably induced by captopril.A 53-year-old woman with a history of arterial hypertension treated by captopril 100 mg/day for 5 years developed, four months earlier, lichenoid lesions on extremities, face and neck. She presented to the dermatology department for exploration.On admission, the patient was afebrile and in good general condition. On examination, the eruption consisted of erythematous to violaceous pruritic confluent papules crossed by fine white lines (Wickham's striae) localized on the face, the neck and extremities (Figure 1A). The patient was taking no other medications or herbal products at the time. Hepatitis B and C serology were negative. A skin biopsy was performed. Histological examination showed hyperkeratosis, acanthosis, several necrotic keratinocytes known as Civatte bodies and a dense lichenoid infiltrate with lymphocytes, histiocytes, melanophages and abundant eosinophilis (Figure 2).Based on the clinical and histological features, the diagnosis of captopril-induced lichenoid eruption was suspected. Captopril was interrupted and substituted by a calcium channel blocker (amlodipine) with prescription of a topical corticosteroid. Four weeks after withdrawal of captopril, the pruritus disappeared and lesions significantly improved (Figure 1B).Given the clinical features and the response to withdrawal of captopril, this latter is probable to have to have induced lichenoid eruption in our patient according to Narranjo probability scale.Lichenoid drug eruption (LDE) can be defined as lichen planus-like rash caused by drugs such as beta-blockers, antimalarial, diuretics and ACE inhibitors. It is a reaction that is difficult to diagnose and establish drug imputability. The challenge remains in the establishment of the diagnosis since it could be difficult to distinguish these eruptions from idiopathic lichen planus due to similarities in clinical and histological features. No criterion was found to be
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