Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications

Maul, Julia-Tatjana; Guillet, Carole; Oschmann, Anna; Maul, Lara Valeska; Meier‐Schiesser, M. B. S.; Stadler, Pia‐Charlotte; French, Lars E.; Kerl, Katrin

doi:10.1111/jdv.18879

Cited by 11 publications

(6 citation statements)

References 236 publications

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“…The longest latency period was observed in lichenoid drug eruption (4.33 +/- 3.93 months), which correlated with Maul et al's study [ 22 ], which found a 15.7-week latency between drug initiation and the manifestation of cutaneous lichenoid drug eruptions. Anticonvulsants were found to be the common drug causing erythroderma, which did not correlate with a study conducted by Tan et al [ 23 ] where cases of drug-related erythroderma, traditional medications, and antituberculous medications are common causes.…”

Section: Discussionsupporting

confidence: 84%

A Study of Cutaneous Adverse Drug Reactions at a Tertiary Care Center in Andhra Pradesh, India

Ashifha¹,

Vijayashree²,

Vudayana³

et al. 2023

Cureus

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Introduction: Practically all physicians encounter a diverse range of suspected cutaneous adverse drug reactions (CADRs) in their daily clinical practice. The skin and mucosa are the most often encountered areas for the early presentation of numerous adverse drug reactions. Cutaneous adverse drug reactions are classified as benign or severe. The clinical manifestations of drug eruptions can range from mild maculopapular exanthema to severe cutaneous adverse drug reactions (SCARs).Objective: To determine the varied clinical and morphological presentations of CADRs and to identify the culprit drug and common drugs causing CADRs.Materials and methods: Patients with clinical features suspected of CADRs presenting to the outpatient department (OPD) of dermatology, venereology, and leprosy (DVL) between December 2021 to November 2022 at Great Eastern Medical School and Hospital (GEMS), Srikakulam, Andhra Pradesh, India, were considered for the study. This was a cross-sectional, observational study. The patient's clinical history was taken in detail. This included chief complaints (symptoms, site of onset, duration, drug history, latency time between drug administration and the appearance of cutaneous lesions), family history, associated diseases, the morphology of lesions, and mucosal examination. Upon drug discontinuation, improvement in cutaneous lesions and systemic features were noted. A complete general examination, systemic examination, dermatological tests, and mucosal examination were performed.Results: A total of 102 patients were involved in the study, of whom 55 were males and 47 were females. The male-to-female ratio was 1.17:1, with a slight male majority. The most common age group was 31 to 40 years for both males and females. Itching was the predominant complaint in 56 patients (54.9%). The mean latency period was shortest in urticaria (2.13+/-0.99 hours) and longest in lichenoid drug eruption (4.33+/-3.93 months). Most patients developed symptoms after a week of taking the drug (53.92%). A history of similar complaints was present in 38.23% of patients. Analgesics and antipyretics (39.2%) were the most common culprit drugs followed by antimicrobials (29.4%). Among analgesics and antipyretics, aceclofenac (24.5%) was the commonest culprit drug. Benign CADRs were observed in 89 patients (87.25%), and severe cutaneous adverse reactions (SCARs) were observed in 13 patients (12.74%). The common CADRs presented were drug-induced exanthem (27.4%). Imatinib-induced psoriasis vulgaris and lithium-induced scalp psoriasis were observed in one patient each. Severe cutaneous adverse reactions were observed in 13 patients (12.74%). Anticonvulsants, nonsteroidal anti-inflammatory drugs (NSAIDs), and antimicrobials were the culprit drugs for SCARs. Eosinophilia was present in three patients, deranged liver enzymes was present in nine patients, a deranged renal profile was present in seven patients, and death occurred in one patient with toxic epidermal necrolysis (TEN) of SCARs.Conclusion: Before prescribing any drug t...

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Section: Discussionsupporting

confidence: 84%

A Study of Cutaneous Adverse Drug Reactions at a Tertiary Care Center in Andhra Pradesh, India

Ashifha¹,

Vijayashree²,

Vudayana³

et al. 2023

Cureus

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“…Among the cutaneous adverse reactions linked to antitubercular treatment, lichenoid drug eruptions make up approximately 10%. [ 13 ] Typically, the management of lichenoid drug eruptions involves the administration of oral and topical corticosteroids. In this particular case, the patient was treated with corticosteroids, antihistamines, and phosphodiesterase inhibitors.…”

Section: Discussionmentioning

confidence: 99%

Antitubercular drug-induced lichen planus: A case study with a mini literature review

Shanmukhappa,

John,

Kevalramani

et al. 2024

Journal of Family Medicine and Primary Care

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Introduction: Drug-induced lichen planus is a cutaneous adverse effect that manifests as a systemic eruption of flat-topped, erythematous, or violaceous papules resembling lichen planus on the trunk and extremities. Although antitubercular therapy has been linked to cutaneous hypersensitivity reactions, the literature on such cases is scarce. Here, we present a case to contribute to this field, reporting on its presentation and management, and reviewing previous case studies. Case Report: Our patient, a 63-year-old male, presented with black pigmented patches on the skin, having been diagnosed with pulmonary tuberculosis and on antitubercular therapy for the past two months. A diagnosis of ATT-induced lichen planus was made, and all ATT was stopped. The patient was treated with antihistamines, apremilast, tacrolimus, and corticosteroids, and rechallenge of each drug was performed consecutively. No new lesions appeared after rechallenge with isoniazid and rifampicin. However, ethambutol was not reintroduced due to strong suspicion, by exclusion, that it was the offending agent, whereas on rechallenge with isoniazid and rifampicin, the patient’s skin lesions gradually improved with eventual resolution of hyperpigmentation. Discussion and Conclusion: Lichenoid drug eruptions are characterized by type IV hypersensitivity reactions, and rechallenge is required to ensure safer treatment since the risk of disseminated and multi-drug-resistant tuberculosis increases with the cessation of antitubercular therapy.

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“…May appear as erythematous papules or plaques with a wheal-like or erythematous border Table 1: Morphologies and clinical characteristics [3][4][5][6][7][8][9][10][11].…”

Section: Urticarialmentioning

confidence: 99%

Most Common Drug Eruptions by Pattern and Drug Class: A Review

Klepper

2024

JDR

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Cutaneous drug reactions come in many different morphologies, distributions and severities ranging from pruritus and erythema to diffuse epidermal denudation requiring hospitalization. The wide variety of presentations and medications responsible make identification and elimination of the offending agent difficult. Here these authors present a review of the common morphologic drug eruptions and their offending drugs.

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Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications

Cited by 11 publications

References 236 publications

A Study of Cutaneous Adverse Drug Reactions at a Tertiary Care Center in Andhra Pradesh, India

A Study of Cutaneous Adverse Drug Reactions at a Tertiary Care Center in Andhra Pradesh, India

Antitubercular drug-induced lichen planus: A case study with a mini literature review

Most Common Drug Eruptions by Pattern and Drug Class: A Review

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