Lichenoid reaction to hepatitis B vaccination.

Liver disease is now a well recognized association with lichen planus. Recent reports suggest that the hepatitis viruses may play a central role in this association. The present report describes a case of a lichenoid reaction to hepatitis B vaccination, which has only been rarely documented previously. A 16-year-old male developed a widespread pruritic erythematous eruption 5 weeks after receiving his second dose of hepatitis B vaccine. The eruption evolved to produce strikingly blue macules before spontaneously disappearing. A skin biopsy showed an intense lichenoid reaction. The hepatitis B surface antigen component of the vaccine is probably responsible for this reaction as well as for other rare immunologically mediated reactions to hepatitis B vaccination. These reactions may provide insight into the pathogenesis of the cutaneous features of natural hepatitis B infection.