Clinical Investigation of a New Cutaneous Entity

Schmitt, Charles L.

doi:10.1001/archderm.1945.01510280010002

Cited by 29 publications

(2 citation statements)

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“…The possible association of drugs with lesions similar to LP was noted when quinacrine and mepacrine, used as antimalarials during World War II, were seen to cause lichenoid lesions (Schmitt et al, 1945;Savage, 1958). Apart from these drugs, gold was probably the most common agent recognized as initiating an LP-like eruption (Penneys et al, 1974).…”

Section: (3) Drugsmentioning

confidence: 99%

Update On Oral Lichen Planus: Etiopathogenesis and Management

Scully

Beyli²,

Ferreiro

et al. 1998

Critical Reviews in Oral Biology & Medicine

470

461

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Lichen planus (LP) is a relatively common disorder of the stratified squamous epithelia, which is, in many ways, an enigma. This paper is the consensus outcome of a workshop held in Switzerland in 1995, involving a selection of clinicians and scientists with an interest in the condition and its management. The oral (OLP) eruptions usually have a distinct clinical morphology and characteristic distribution, but OLP may also present a confusing array of patterns and forms, and other disorders may clinically simulate OLP. Lesions may affect other mucosae and/or skin. Lichen planus is probably of multifactorial origin, sometimes induced by drugs or dental materials, often idiopathic, and with an immunopathogenesis involving T-cells in particular. The etiopathogenesis appears to be complex, with interactions between and among genetic, environmental, and lifestyle factors, but much has now been clarified about the mechanisms involved, and interesting new associations, such as with liver disease, have emerged. The management of lichen planus is still not totally satisfactory, and there is as yet no definitive treatment, but there have been advances in the control of the condition. There is no curative treatment available; immunomodulation, however, can control the condition. Based on the observed increased risk of malignant development, OLP patients should be offered regular follow-up examination from two to four times annually and asked to report any changes in their lesions and/or symptoms. Follow-up may be particularly important in patients with atrophic/ulcerative/erosive affections of the tongue, the gingiva, or the buccal mucosa. Much more research is required into the genetic and environmental aspects of lichen planus, into the premalignant potential, and into the possible associations with chronic liver, and other, disorders. More clinical studies are required into the possible efficacy of immunomodulatory drugs such as pentoxifylline and thalidomide.

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Section: (3) Drugsmentioning

confidence: 99%

Update On Oral Lichen Planus: Etiopathogenesis and Management

Scully

Beyli²,

Ferreiro

et al. 1998

Critical Reviews in Oral Biology & Medicine

470

461

View full text Add to dashboard Cite

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“…Since in both instances the rash rapidly subsided after the drug was discontinued, it is possible that in Case 2 the eruption was aborted after the macular stage and might have progressed to palpable infiltration and desquamation like Case 1, had chloroquine been continued longer. The A lichen-planus-like eruption not infrequently complicated quinacrine (atabrine) administration to troops overseas (5,6,7,8,9). Individuals with lichen-planus-like eruptions due to quinacrine have been successfully treated for malaria with chloroquine without causing exacerbation of their skin lesions (3).…”

Section: Discussionmentioning

confidence: 99%

A Lichen-Planus-Like Eruption Occurring During the Course of Chloroquine Administration 1

Craige

Whorton²,

Pullman³

et al. 1948

J. Clin. Invest.

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During the course of studies of the chronic toxicity of chloroquine (SN-7618) in a group of 30 individuals, two exhibited lichen-planus-like eruptions. Since similar lesions have been described following quinacrine administration, detailed protocols of these two cases are herewith presented.Chloroquine, [7-chloro-4-(4-diethylamino-lmethylbutylamino) quinoline], an antimalarial drug superior as a suppressive and therapeutic agent to both quinacrine (atabrine) and quinine (1,2,3) weighed, and interviewed and the laboratory tests were repeated.Of 30 individuals, two developed cutaneous eruptions which resembled lichen planus. Drug administration in both individuals, as in the other members of the group, consisted of a full year of weekly oral doses of 0.5 gram of chloroquine.4The concentration of chloroquine in the plasma reached a weekly peak of between 150 and 250 gamma per liter; and the weekly low level, taken just prior to the succeeding dose, ranged between 20 and 40 gamma per liter. CASE REPORTSCase 1: A 21-year-old otherwise healthy Negro male had had intermittently for several years dry circumscribed neurodermatitis on the nape of the neck. During the first eight months of the study, his only noteworthy symptoms were occasional headaches after taking chloroquine and occasional difficulty in rapid visual accommodation.In the eighth month of treatment there appeared on the trunk, a faint macular rash which suggested tinea versicolor, but no fungi were found in scrapings on direct microscopic examination. In the eleventh month there was more pronounced scaling of the lesions. At that time the eruption consisted of brown, sharply demarcated macules with branny scales, over the shoulders and trunk, mainly on the back. Mild pruritus was present. The condition somewhat resembled both seborrheic dermatitis and pityriasis rosea. The following month (four months after its first appearance and in the twelfth month of chloroquine administration) the rash spread and became papular and infiltrated.It then occupied the upper extremities, with a predilection for the flexor surfaces (Figure 1). There were scattered lesions on the medial aspects of the thighs and on the trunk, but none above the shoulders nor on the buccal mucous membranes or genitalia. The lesions varied in size from a few millimeters to several centimeters in diameter. The smaller lesions consisted of reddish violaceous papules with a smooth and slightly shiny surface. The larger lesions were annular and superficial, the center being depressed and paler than the periphery 4 Dosage is expressed in terms of base rather than salt. 56

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