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Background: Lichen ruber planus (LP) and lichenoid skin reaction (LSR) are clinically and histologically similar. The performance of histological diagnosis in these diseases remains controversial. Materials and methods: We prospectively studied 33 patients with clinical manifestations and histological signs of the classic form of LP and LSR to assess the accuracy of an isolated histological LP and LSR examinations and to identify a variety of microscopic features. Each histological study was conducted by a pathomorphologist, who was blinded to the patients clinical characteristics and diagnosis. Results: Isolated histopathological examination made it possible to make a correct diagnosis in 25 (75%) of 33 patients: in particular, the diagnosis of LRC was established in 10 (30%), CPL-in 15 (45%) cases. Based on a combined assessment of histological and clinical data and response to therapy, the final diagnosis was established in 30 (91%) of the 33 patients who were divided into two groups. The first group comprised 18 patients diagnosed with LSR, and the second group comprised 12 patients diagnosed with the classic form of LP. Conclusions: Through this investigation, some differences in these diseases based on their clinical and pathomorphological features were identified. The diseases were characterized by different typical localizations and lesion sizes. The pathomorphology of both diseases is represented by lichenoid type of interface dermatitis.

Anti-PD-1/PD-L1 monoclonal antibodies result in a unique spectrum of side effects, widely known as immune-related adverse events. Toripalimab is an anti-PD-1 monoclonal antibody used for the treatment of some cancers. Here we report the first case, to our knowledge, of oral lichenoid drug reaction triggered by toripalimab. A 78-year-old man who was diagnosed with systemic metastatic prostate cancer presented with ulcers on the lower lip after the fifth cycle of toripalimab. We diagnosed him with oral lichenoid drug reaction based on clinical manifestation, histopathological findings and the history of anti-PD-1 therapy. The patient responded well to oral corticosteroids combined with helium–neon laser therapy. The anti-PD-1 therapy was not restarted because of stable disease, and the eruptions did not recur.

Porphyria cutanea tarda (PCT) is a phototoxic cutaneous disease linked to elevated liver iron levels and photosensitizing heme precursors. Here, we report a 65-year-old man with a history of hypertension and heavy alcohol and tobacco use who presented to clinic for evaluation of an intensely pruritic rash on his arms present for 6 years. A biopsy completed 3 years prior demonstrated a lichenoid drug eruption.

Pembrolizumab is an immune checkpoint inhibitor approved for use in many cancer types such as non-small cell lung cancer (NSCLC), metastatic melanoma, head and neck cancers, hepatocellular carcinoma, and renal cell carcinoma. There are many reported cases of patients on immunotherapy who have discontinued treatment due to the development of immune-related adverse effects (irAE). Recognition of the histopathologic patterns of dermatologic toxicities due to immunotherapy will become increasingly important for ensuring appropriate management and optimal patient care. Here, we present a case of a 72-year-old man with metastatic carcinoma of unknown primary origin treated with pembrolizumab who developed an immune-related cutaneous adverse event (ircAE) in the form of lichenoid dermatitis.

Background Lichenoid drug eruption is rare and can mimic idiopathic lichen planus and other dermatoses. Clonazepam, a commonly used drug for the treatment of anxiety-related disorders and seizures, is known to be an unlikely cause of cutaneous adverse effects. Only one case report of LDE due to clonazepam has been reported. Case presentation A 81-year-old male patient with Alzheimer’s disease developed a lichenoid eruption after taking clonazepam. He developed a violaceous scaly patch on his lower extremities, from both buttocks to the feet. The cutaneous eruption resolved 2 months after cessation of clonazepam and with initiation of corticosteroid therapy. Conclusion A skin eruption that develops after clonazepam administration can be a lichenoid drug eruption, which is less likely to resolve spontaneously and requires discontinuation of clonazepam administration.

Levothyroxine (LT4) is frequently used as thyroid hormone replacement to treat hypothyroidism. Adverse skin reactions are not common. Lichenoid drug eruption is a one such medication-related reaction. the lesion morphology and pathology mimic lichen planus. The current case describes a 47-year-old man who presented to us with a diffuse levothyroxine-induced lichenoid drug eruption. The Naranjo adverse drug reaction probability assessment score suggested this was likely an ADR to levothyroxine. The eruption resolved after discontinuation of the medication. We also reviewed the literature on levothyroxine-associated adverse events.

*Kemeriz, Funda ( Aksaray, Yazar ) *Ordu, Melike ( Aksaray, Yazar ), Dear Editor Omalizumab is a humanized monoclonal antibody against human immunoglobulin E that is mainly indicated in asthma, allergic rhinitis, chronic spontaneous urticaria and is being increasingly used for other dermatological diseases, including atopic dermatitis, mastocytosis, hyper-IgE syndrome, and bullous pemphigoid.1,2 Rare cutaneous side effects, such as itching, skin rash, urticaria, and photosensitivity, have been reported to be associated with omalizumab use.

Deriving from the Greek word λeιχήν for "tree moss" and the Latin word planus for "planar," lichen planus is a relatively uncommon and heterogeneous cutaneous disorder that typically develops in middle-aged adults. Despite the significant clinical burden associated with the disorder, little well-conducted molecular research has been undertaken, possibly because of heterogeneity impeding consistent and confident phenotyping. The multiple variants of lichenoid disease bear overlapping clinical and pathologic features despite manifesting as distinct clinical disorders. The first article in this 2-part continuing medical education series provides a comprehensive overview of the clinical and pathologic characteristics of cutaneous lichenoid dermatoses and links these manifestations to recent advances in our understanding of the underlying pathobiology of such diseases.

Summary The advent of therapeutic antibodies, or biological medications, has transformed the treatment of many inflammatory diseases in dermatology. Recently, the development of biosimilars, biological drugs that are highly similar in quality, safety and efficacy to approved biologics, has changed this landscape. Although biosimilars are not identical to their reference product, they are required to have the same mechanism of action, route of administration, dosage form and strength as the reference product. This also leads to the possibility that subtle differences in the activity of these biosimilars can lead to differing clinical responses. We report the first case of a lichenoid eruption induced by a biosimilar to infliximab after switching from infliximab. Several days after initial infusion of the biosimilar, the patient developed a pruritic papulosquamous eruption that was biopsied to reveal a lichenoid drug eruption. Possible mechanisms for lichenoid drug eruptions as a result of tumour necrosis factor-α inhibitor administration are discussed, along with reasons why such a reaction may occur with a biosimilar but not the original, reference product. This case report calls attention to the unique differences between biosimilars and biological medications that a clinician should consider prior to prescribing these medications.

Lichenoid drug eruption is an uncommon adverse effect of several drugs, including antihypertensives, diuretics, and antimalarials. The pathogenesis has not been completely identified. As in lichen planus, activation of CD8+ autocytotoxic T lymphocytes promoted by helper T (Th) cell type 1 immune response seems to be the crucial pathophysiologic factor.1 Dupilumab, which blocks both interleukin 4 and interleukin 13 signaling, has been used to treat moderate-to-severe atopic dermatitis (AD).2 This results in the downregulation of Th2-mediated inflammation. Consequently, Th2 pathway inhibition shifts the Th cell profile to a Th1/Th17 predominant pattern.3 Here, we present an unreported association between dupilumab and de novo lichenoid eruption.

Cutaneous reactions from targeted biologics are increasingly common. We describe a case of a cutaneous lichenoid drug eruption from the RANK inhibitor denosumab and a previously unreported lymphohistiocytic reaction pattern. The clinical and histopathological details of this case will aid in recognition, diagnosis, and treatment of drug rashes from denosumab.

Cladribine is an approved drug for the treatment of highly active multiple sclerosis. We report a 28-years-old man with a poor response to previous treatments, elected to treatment with Cladribine. He developed a lichenoid rash two weeks after taking the first and second treatment cycles. This symptom regressed with specific therapy. A lichenoid drug eruption is a rare side effect which can occur following the administration of several different medications, but it has never been described after treatment with oral Cladribine.

BACKGROUND Clues in the stratum corneum (SC) can aide in histopathologic diagnosis of many conditions. OBJECTIVE To determine if SC configuration and thickness could help differentiate the lichenoid dermatoses. METHODS A retrospective study was performed. A total of 305 cases (55 lichenoid keratosis, 51 lichen planus, 7 hypertrophic lichen planus, 40 lichenoid drug eruption, 19 lichenoid graft-vs.-host disease, 14 hypertrophic lupus, 46 lichenoid actinic keratosis, 73 lentigo maligna) fulfilled the selection criteria. Cases were digitally scanned using the 40× (0.23 μm/pixel) mode of a Hamamatsu NanoZoomer 2.0-HT Slide Scanner (Hamamatsu Photonics, Hamamatsu City, Japan), allowing for the creation of virtual (digital) slides. SC thicknesses and configuration were assessed for each case. RESULTS Mixed SC patterns were common in cases of lichenoid keratoses. Compact parakeratosis was the most common pattern in lichenoid drug eruption. Tiered parakeratosis was the most predominant pattern in cases of lichenoid graft versus host disease and lichenoid actinic keratosis. Hypertrophic lupus had the highest average SC thickness. LIMITATIONS The sample size for cases of hypertrophic lupus and hypertrophic lichen planus was low. CONCLUSIONS SC thickness and configuration can be utilized to help differentiate the lichenoid dermatoses.

Lichenoid dermatoses, a group of inflammatory skin conditions with characteristic clinical and histopathologic findings, range from common to rare. Classic lichen planus typically presents as pruritic, polygonal, violaceous flat-topped papules and plaques; many variants in morphology and location also exist. Other lichenoid dermatoses share similar clinical presentations and histopathologic findings. These include lichenoid drug eruption, lichen planus-like keratosis, lichen striatus, lichen nitidus, and keratosis lichenoides chronica. Epidemiologic characteristics vary among each lichenoid disorder. While classic lichen planus is considered a disease of adults, other lichenoid dermatoses may be more common in younger populations. The literature contains an array of reports on the variations in presentation and successful management of lichen planus and lichenoid dermatoses among diverse populations. Familiarity with the characteristics of each lichenoid dermatosis, rare or common within each patient population, is key to accomplishing timely recognition and effective management.

La Presse Medicale - In Press.Proof corrected by the author Available online since samedi 10 mars 2018

Cutaneous adverse reactions are a common complication of anti-retroviral therapy. Tenofovir is a newer anti-retroviral drug belonging to the nucleotide reverse transcriptase inhibitor group. Systemic adverse effects like nausea, vomiting, diarrhea, hepatotoxicity and renal toxicity are common with tenofovir but cutaneous adverse effects are rare. Lichenoid drug eruptions are a common adverse effect seen with a large variety of drugs including antimalarials, antihypertensives, nonsteroidal anti-inflammatory drugs and diuretics. Lichenoid drug eruption is a rare cutaneous adverse effect of tenofovir with only a single case reported till date. Here, we report a case of tenofovir induced lichenoid drug eruption in a 54-year-old human immunodeficiency virus affected male who presented with generalized lichenoid eruption after 6 weeks of initiation of tenofovir and complete clearance on cessation of the drug.

We present six cases of multiple eruptive lichen planus-like keratoses (LPLK), occurring in older individuals predominately confined to previously solar exposed areas. Diagnosis was often confounded by the frequent histological reporting of 'lichenoid drug reaction' (LDR), despite many of the patients being unmedicated. We review the literature regarding eruptive LPLK and reflect on their etiology, clinical aspects, management and importantly their clinicopathological differentiation from LDR.

Capecitabine is a 5-fluorouracil basedchemotherapeutic drug widely used in the treatmentof solid tumors, especially colorectal and breast. Someof the most common side effects of capecitabine arecutaneous in nature, including hand-foot syndrome(palmar-plantar erythrodysesthesia). Several reports inthe literature link capecitabine use with photosensitivelichenoid eruptions. Herein, we present a case ofcapecitabine-induced lichenoid eruption in an elderlyfemale with metastatic breast cancer and discuss ourfindings in relationship to previously reported cases ofthis and other capecitabine-induced skin pathologies.

© 2016 The Authors. doi: 10.2340/00015555-2435 Journal Compilation © 2016 Acta Dermato-Venereologica. ISSN 0001-5555 Limaprost alfadex is a prostaglandin E1 (PGE1) deri­ vative, which is effective in the treatment of thrombo­ angitis obliterans through its pharmacological effect of improving peripheral blood circulation (1). Although some PGE1 analogue­related adverse events have been reported, e.g. liver dysfunction, to our knowledge, there have been only 2 case reports of cutaneous drug erup­ tion caused by PGE1 analogue published in English (2, 3). We report here a case of lichenoid drug erup­ tion caused by limaprost alfadex, as an unusual skin manifestation.

Drug-induced lichen planus has been induced by antibiotics, anticonvulsants, antidiabetics, antimalarials, antitubercular drugs, antihypertensives, psychiatric drugs, chemotherapeutic agents, diuretic, heavy metals, NSAIDs, etc. Terbinafine, an antifungal agent, is widely used for dermatophyte infections and onychomycosis. Cutaneous adverse effects of terbinafine are rarely reported. Here, we report a case of terbinafine-induced lichenoid drug eruption in a 22-year-old who presented with generalized lichenoid eruption 2 weeks after terbinafine initiation of. The body and lip cleared completely after 8 weeks of drug withdrawal; nail change cleared after 12 weeks.

63歳，男性。肺結核に対し，イソニアジド，リファンピシン(RFP)，エタンブトール，ピラジナミドにて治療開始後，多剤耐性結核と判明し，治療開始2ヵ月後よりエチオナミド(TH)，ストレプトマイシン(SM)，サイクロセリン(CS)，レボフロキサシン(LVFX)に変更したが肝機能障害が出現しTHを中止した。肺結核治療開始8ヵ月後よりリファブチン(RBT)を追加。9ヵ月後より両下腿に紅斑が出現して来た。ステロイドの外用や抗アレルギー剤の内服を行ったが皮疹は拡大した。肺結核治療終了後，精査を希望し当科受診。手背に紫紅色局面や頬部に色素沈着が認められた。手背皮膚の病理組織像は扁平苔癬様の変化であった。RBT，LVFX，CS，RFP，SMの薬剤添加リンパ球刺激試験(drug-induced lymphocyte stimulation test : DLST)は陰性，パッチテストは48，72時間後の判定でCSが陽性であった。肺結核の治療終了後，皮膚症状は軽快した。以上よりCSによる扁平苔癬型薬疹と診断した。結核は，耐性菌の出現を防ぐため多剤併用を標準治療としている。治療中，肝障害，発熱，薬疹などの副作用も多い。副作用出現時は原因薬剤を早くつきとめ治療を再開するため，パッチテストなどにより原因薬剤を同定することが望ましい。

Tumor necrosis factor (TNF)-α inhibitors are being widely and increasingly used for the management of a spectrum of rheumatologic diseases that are refractory to conventional disease modifying anti-rheumatic drugs. Various cutaneous side effects have been reported after treatment with TNF-α inhibitors. We present a case report of a 26-year-old male patient who developed a lichenoid drug eruption few months after the initiation of adalimumab for the management of Crohn's disease. We also highlight the clinical and histopathologic differences between lichenoid drug eruptions and idiopathic lichen planus.

Objective: To report a case of lichenoid drug eruption (LDE) after starting antihypertensive treatment with nebivolol, a cardioselective β-blocker. Case Summary: Five weeks after starting treatment with nebivolol, a 62-year-old woman presented with erythematous papules on both extremities and skin lesions spreading over the back. She was not being treated with any other drugs. Because the administration of levocetirizine, topical methylprednisolone, and systemic prednisone was unsuccessful, the treatment was stopped and the lesions were biopsied. The histopathological features of the lesions were consistent with LDE. After withdrawal of nebivolol and subsequent readministration of topical methylprednisolone and systemic prednisone, the skin lesions resolved within 12 days. Assessment of the causality revealed a probable relationship between nebivolol and the lichenoid eruptions. Discussion: Although β-blockers can be associated with LDE, as of July 7, 2006, this has not been previously reported with nebivolol. T cells invading the dermis are considered to be responsible for epidermal destruction associated with LDE, as has been described for lichenoid forms of chronic graft versus host disease and idiopathic lichen ruber planus. Conclusions: Nebivolol can cause LDE, as has been reported with other β-blockers. The underlying mechanism appears to be T cell–mediated. Cross-reactivity with other β-blockers cannot be excluded; therefore, the risk of recurrent LDE should be weighed carefully against the clinical benefit before switching to another β-blocker.

Lichenoid drug eruption (LDE) is a common cutaneous side effect of drugs including antimalarials, antihypertensives, nonsteroids, anti-inflammatory drugs and diuretics. The physiopathologic relationship between colchicine treatment and LDE is unclear. There is very little documentation of LDE induced by colchicine in the literature. In this report, we present a case that developed LDE on the abdomen and the legs during the colchicine treatment.

Interface dermatitis refers to disorders in which the primary site of pathology is the interface between the epidermis and the dermis, that is, the dermo-epidermal junction. Interface dermatitis is divided into two subgroups: vacuolar and lichenoid. The prototype of lichenoid interface dermatitis is lichen planus (LP).

64歳の男性に生じた扁平苔癬型薬疹の1例を報告した。躯幹·四肢に生じた痒疹に対し, 塩酸ホモクロルシクリジン(ホモクロミン®), 塩酸エピナスチン(アレジオン®)を内服し, その約1ヵ月後から扁平隆起性紅斑が躯幹·四肢に多発した。その後も内服を続け, 内服2ヵ月後に舞鶴共済病院皮膚科を受診した。主に躯幹·四肢伸側に扁平隆起性紅斑が多発し, 発熱·全身倦怠·食欲不振のほか末梢血好酸球増多, 中等度肝障害も認められた。上記2剤の中止·ステロイド外用により1ヵ月で皮疹は消退し肝機能も正常化した。両薬剤ともパッチテストは陰性, スクラッチパッチテストは陽性であった。リンパ球幼若化試験は, 塩酸エピナスチンが陽性, 塩酸ホモクロルシクリジンは陰性であった。内服誘発テストでは両薬剤とも, 1/10錠で紅色丘疹が新生し, 塩酸ホモクロルシクリジン1錠内服2日後には肝酵素上昇も認められた。以上から扁平苔癬型薬疹および薬剤性肝障害の原因として上記2剤が考えられた。

Lichenoid drug eruption (LDE) is a rare form of delayed-type drug eruption. Among anti-tuberculosis (Tb) agents, cycloserine (CS) has been reported as a rare cause of LDE. Positive results on the lymphocyte transformation test (LTT) have not been reported in patients with LDE. In the present case, we performed LTT and a patch test, and successfully proved CS as the offending drug in this patient, who had been treated with multiple anti-Tb drugs. These observations suggest that CS should be considered a possible cause of LDE and that LTT can be an option for the diagnosis of LDE.

Lichenoid drug reactions have been linked to a long and growing list of medications, most of which are used mainly in adults, making these reactions exceedingly rare in children. To the best of our knowledge, this case report is the first of a lichenoid drug eruption in a child after human papillomavirus vaccination.

Lichen planus-like or lichenoid eruptions from certain drugs and compounds can closely mimic idiopathic lichen planus. The patient's history and physical examination, histopathologic criteria, and certain tests can assist in the differentiation between a lichenoid drug eruption and idiopathic lichen planus and in the identification of the offending drug.

— Biopsy samples from 67 cases with a primary history and histopathological changes highly indicative of a drug reaction were reviewed. The histopathological lesions in 39 dogs, 19 cats, six horses, two goats and one bull were classified into five different groups: erythema multiforme, toxic epidermal necrolysis, lichenoid interface dermatitis (lichenoid drug eruption), vasculitis and pemphigus foliaceus. In 53 cases additional information on the clinical history and follow-up was received. None of the patients was rechallenged. Clinical and histopathological observations were consistent with a diagnosis of drug reaction in four animals only. The diagnoses were erythema multiforme (one dog, one cat), lichenoid drug eruption (one dog), and pemphigus-like drug eruption (one cat). A drug reaction was ruled out in seven dogs. In 15 cases no further clinical information was available. No relationship between skin lesions and administered drugs could be established in the remaining 27 patients, as the skin lesions could have been provoked by different concurrent diseases. Resume— Des biopsies provenant de cas cliniques avec un historique et dans lesions histologiques tres suggestifs d'un accident medicamenteux ont ete revues. Les lesions histologiques chez 39 chiens, 19 chats, 6 chevaux, 2 chevres et un taureau ont ete classees en 5 categories; erytheme polymorphe, necrolyse epidermique toxique, dermatite lichenoide d'interface, vaculite et pemphigus foliace. Dans 53 cas des informations supplementaires concernant l'anamnese et le suivi ont pu etre obtenues. Aucun test de provocation n'a ete fait. Les observations cliniques et histopathologiques etaient compatibles avec un diagnostic d'accident medicamenteux chez seulement quatre animaux. Le diagnostic etait dans ces cas: erytheme polymorphe (1 chien, 1 chat), dermatite lichenoide d'inteface (1 chien) et pemphigus follace (1 chat). Une reaction medicamenteuse a pu etre eliminee chez sept chiens. Dans 15 cas aucune information clinique sur le suivi n'a pu etre obtenue. Aucune relation entre les lesions cutanees et l'administration de medicaments n'a pu etre etablie chez les 27 patients restants, les lesions cutanees ayant pu etre provoquees par d'autres maladies. Zusammenfassung— Biopsieproben von 67 Fallen, deren Anamnese und histopathologische Veranderungen deutlich auf eine Medikamentenreaktion hinwies, gelangten zu einer retrospektiven Beurteilung. Die histopathologischen Veranderungen bei 39 Hunden, 19 Katzen, 6 Pferden, 7 Ziegen und 1 Stier wurden in funf verschiedene Gruppen einegeteilt: Erythema multiforme, toxisch-epidermale Nekrolyse, lichenoide Interface Dermatitis, (lichenoide Medikamentenreaktion), Vaskulitis und Pemphigus foliaceus. In 53 Fallen wurden Zusatzinformationen uber die klinische Anamnese und Nachbehandlung ermittelt. Keiner der Patienten wurde nochmals in gleicher Weise wie zuvor behandelt, um eine erneute Hautreaktion auszulosen. Die klinischen und histopathologischen Befunde stimmten nur bei vier Tieren mit der Diagnose einer Medikamentenreaktion uberein. Die Diagnosen waren Erythema multiforme (1 Hund, 1 Katze), lichenoide drug eruption (1 Hund), und Pemphigusahnliche drug eruption (1 Katze) Eine Reaktion auf Medikamente wurde bei sieben Hunden ausgeschlossen. In 15 Fallen war keine weitergehende klinische Information verfugbar. Bei den ubrigen 27 Patienten konnte zwischen den Hautlasionen und den verabreichten Medikamenten ursachlicher Zusammenhang hergestellt werden, da die Hautlasionen auch durch andere gleichzeitig vorliegende Krankheiten hatten hervorgerufen worden sein konnen Resumen En este articulo se investigan 67 casos el los que las biopsias cutaneas, historia clinica y cambios histopatologicos, indicaban la posibilidad de reaccion adversa a la administracion de medicamentos. Las lesiones histopatologicas de 39 perros, 19 gatos 2 cabras y un toro, se clasificaron en cinco grupos diferentes: eritem multiforme, necrolisis toxica de la epidermis, dermatitis liquenoide interfasica (erupcion liquenoide a la administracion de medicamentos), vasculitis, y pemfigo foliaceo. En 53 casos se recibio informacion adicional de la historia clinica y chequeos periodicos. A niniguno de los pacientes se le volvio a administrar la medicacion. Solamente en 4 de los animales el examen histopatologico correspondio con la diagnosis de reaccion a la medicacion. Las diagnosis resultaron ser: eritema multiforme, (un perro, y un gato), erupcion liquenoide a la administracion de medicamentos (un perro), y reaccion de tipo penfigacea (un gato). En 7 de los perros se denego reacciones adversas a drogas. En los 27 pacientes restantes, no se encontro relacion entre las lesiones cutaneas y la administracion de drogas, y la aparicion de lesiones cutaneas se atribuyo a enfermadades concurrentes.