It is seen most commonly on the buccal mucosa inside cheeks. Release of byproducts of these degradations sets off the adverse reaction. In the differential diagnosis of lde, the following conditions need to be borne in mind. To the best of our knowledge, this is the second report describing a case of olr induced by rituximab administration in a patient with a diagnosis of nonhodgkin bcell lymphoma. The current observation describes the association between statins and lichenoid drug eruptions in patients. Lichenoid reaction to carbamazepine in the oral mucosa. After 5 doses of rituximab, a typical pattern of olp was identified with bilateral and symmetrical lesions on the buccal mucosa and on the right.
Lichenoid drug eruption, also called druginduced lichen planus, is an uncommon cutaneous adverse effect of several drugs. The diagnosis may be suspected from the unusual clinical features and a skin biopsy then taken. Oral lichenoid reactions olr can be caused by systemic drug exposure. In addition, the drug can trigger the eruption, which eventually will not regress, even after its withdrawal. Lichen planus and lichenoid reactions of the oral mucosa. Patch testing and recognition of the proximity of an offending substance to the eruption can aid with diagnosis. Unlike idiopathic lichen planus, which typically involves flexural surfaces, lichenoid drug eruption is characterized by an extensive symmetric eruption of flattopped violaceous plaques involving the trunk and extremities. Drug induced lichenoid eruptions lde can differ in clinical and histological aspects from lichen planus. Currently, no side effects concerning oral and genital mucosa have been reported. Dec 19, 2017 the histopathologic differential diagnosis included lichen planus and lichenoid drug eruption, but the presence of eosinophils supported a diagnosis of a medication reaction. Lichen planus and lichenoid drug eruption after vaccination.
We consider that this is an unusual case of oral lichenoid drug reaction triggered by herbal medication. Oral lichenoid lesions or reactions ollsolrs are clinical and histological contemporaries of the classical oral. Statins and lichenoid drug eruption introduction statins inhibit the enzyme hmgcoa 3hydroxymethylglutarylcoenzyme areductase, which plays an important role in the synthesis of cholesterol by catalysing the conversion from hmgcoa to mevalonate. Examples include lichen planus, lichen sclerosus and lichen nitidus. Lichenoid drug eruption, also known as druginduced lichen planus, is an uncommon cutaneous adverse effect of several drugs. Photosensitive lichenoid skin reaction to capecitabine bmc. Oral lichenoid lesion oll is a chronic inflammatory lesion of the oral mucosa that occurs as an allergic response to dental materials, to use of certain medications, in patients with graftvshost disease gvhd, in patients with systemic diseases, e. Eastman dental institute for oral health care sciences.
Psoriasis, aggravation of psoriasis or psoriatiform skin reactions are described as very rare to uncommon adverse drug reactions 1. A temporal relationship between initiation of medication and onset of oldrs may not be readily apparent. Lichenoid drug eruption associated with bendamustine. It is interesting to note that despite the decades of use and many documented cases of cutaneous reactions after administration of 5fu, there are. Challenge management of oral lichenoid drug reaction. Oral lichenoid eruption secondary to imatinib glivec. Lichen planus is a relatively common, often clinically distinctive, mucocutaneous condition with an uncertain aetiology.
Oral lichenoid reactions may result from systemic drug exposure involving the skin, oral mucosa, or both. This book is a practical guide on adverse cutaneous drug reactions to cardiovascular drugs. The most common agents are nonsteroidal antiinflammatory drugs and angiotensin converting enzyme inhibitors. Clinicopathologic correlation of oral lichen planus and. Pdf oral lichenoid reactionan overview researchgate. Simvastati n and oral lichenoid drug re action roger et al. The clinical and histologic features of oral lichenoid contact reactions are similar to oral lp. Lichen planus lp is a chronic inflammatory dermatosis of unknown origin that involves the skin and mucous membranes, and lichenoid drug eruption lde is an uncommon cutaneous adverse reaction to a medication. Oral lichenoid reactions, oral lichenoid lesions, drugs, medicines, druginduced oral lesions. The search words included oral lichen planus, oral lichenoid lesions, oral drug reactions, lichenoid dysplasia, and adverse effects of dental materials. Drug induced oral lichenoid reaction was first described in 1971 by. The dental clinician is in a prime position to identify these lesions and liaise with medical colleagues regarding their management. In contrast to idiopathic lichen planus, lichenoid drug eruptions, where practicable, may be managed by substitution of the offending drug.
Druginduced oral lichenoid reactions or oral lichenoid lesions were first cited in 1971 by almeyda and levantine. Challenge management of oral lichenoid drug reaction paswach wiriyakijja, patamaporn niwatcharoenchaikul and kobkan thongprasom. Lichenoid drug reactions are more commom in skin, but they may also occur in the oral mucosa. History drug interactions resulting in oral lesions clinically similar to olp were first mentioned in the literature in 1971 by almeyda and levantine. Lichenoid eruption an overview sciencedirect topics. We present a 45yearold man with a widespread, violaceous, papular, generalized exanthema with histologic features of a lichenoid reaction, which subsequently resolved with the cessation of labetatol. Oral lichen planus, a common and under recognized inflammatory disorder, shares many clinical and histopathological features with oral lichenoid drug reaction. Since then, many drug substances have been associated with such lesions.
Dec 12, 2012 lichen planuslike drug eruptions lde can appear similar or identical to idiopathic lichen planus. The search words included oral lichen planus, oral lichenoid lesions, oral drug reactions, lichenoid dysplasia. Photosensitive lichenoid skin reaction to capecitabine. It can also be associated with abrasion or drug use. Mitotane lysodren is used for treating adrenocortical carcinoma. Capecitabineinduced dermatologic reactions are most commonly associated with handandfoot syndrome but have also been implicated in oral lichenoid stomatitis, lupus erythematosus, and leukocytoclastic vasculitis, along with lichenoid skin eruption. It is characterized by a symmetric eruption of flattopped, erythematous or violaceous papules resembling lichen planus on the trunk and extremities. The occurrence of lesions resembling oral lichen planus clinically and histologically in response to inciting factors, for example, drugs and dental restorative materials. Lichenoid drug eruption with prominent nail changes due to leflunomide in a 12yearold child. Lichenoid eruption associated with antituberculous drug. The most serious of these are discussed elsewhere in t he m anual and include stevensjohnson syndrome and toxic epidermal necrolysis, hypersensitivity syndrome, serum sickness, exfoliative dermatitis, angioedema, anaphylaxis, and druginduced vasculitis.
Lichenoid dermatitis project gutenberg selfpublishing. Phenytoin induced oral lichenoid eruption and melasma. Thus, the aim of this study was to determine the correlation of histopathology and clinical olp. Jun 24, 2016 lichenoid drug eruption, also known as drug induced lichen planus, is an uncommon cutaneous adverse effect of several drugs. Various terminologies have been used to describe this condition, as. The aim of this study was to demonstrate contact allergy to dental materials in patients with oral lichenoid lesions using patch tests. Lichen planus affecting mucosal surfaces may have one lesion or be multifocal. Lesions may persist from days to weeks and then fade slowly to residual oval hyperpigmented patches. Oral involvementknown as oral lichenoid drug eruptionis more common in the adult population and has been associated with numerous medications. Conclusion oral lichenoid drug eruption is hardly ever reported with phenytoin therapy melasma and oral lichenoid drug eruption may occur after increasing the dose of phenytoin. Lichenoid drug eruption erythema dyschromicum perstans graftversushost disease keratosis lichenoides chronica pityriasis lichenoides see chapter 10 lichen nitidus lichen striatus fixed drug eruption see chapter 23 erythema multiforme see chapter 21 lupus erythematosus see chapter 43 dermatomyositis see chapter 44. Adverse cutaneous drug reactions to cardiovascular drugs. Oral lde may be indistinguishable from lp histopathologically.
Yuan a, woo sb 2015 adverse drug events in the oral cavity. Lichen planuslike drug eruptions lde can appear similar or identical to idiopathic lichen planus. Oral lichenoid drug eruptions oral lichenoid drug eruptions savage, nw 19970301 00. A 78yearold man presented with an eightmonth history of folliculocentric, pink, hyperkeratotic papules and plaques with thick white scale that involved the entire body, with confluence on the buttocks and genitalia. Imatinib mesylateinduced lichenoid drug eruption mdedge. Oral lichenoid contact reaction allergic contact mucositis oral lichenoid contact reactions may be caused by a variety of substances. A reliable differentiation between lichenoid drug eruption an drug induced lichen planus cannot be made, therefore the term lichenoid drug eruptions lde is used 8. Drugs can cause multiple skin eruptions and reactions. Some of the types of drugs that may trigger this condition include. Drug eruptions and reactions dermatologic disorders. Adverse drug events in the oral cavity sciencedirect. Although uncommon in flexural or mucosal sites, lichenoid drug eruptions may be histologically indistinguishable from lp.
Au brauer j, votava hj, meehan s, soter na so dermatol online j. Challenge management of oral lichenoid drug reaction juniper. In addition, the eruption of oral lesion after taking medication is also. Clinically, this patients presentation is most consistent with photosensitive lichenoid drug eruption, most likely to capecitabine. A lichenoid drug eruption is a reaction to a medication. Pdf is simvastatin associated with oral lichenoid drug. It appears the same as idiopathic oral lichen planus clinically and under the microscope, but an oral lichenoid drug eruption resolves if the triggering drug is ceased.
Clinical and histologic features of lichenoid mucocutaneous. Thongprasom k, sessririsombat s, singkharotai k, vathanasanti a, subbalek k 2014 topical steroids and co 2 laser in the treatment of refractory oral lichenoid drug reaction and lichenoid contact lesion. Rifampicin is a bactericidal drug extensively used for tuberculosis and leprosy. Oral lichenoid drug eruption in association with drinking. Lichen planus can also affect the oral mucosa, and blockade of the pd1pdl1 pathway significantly increases the proliferation of peripheral blood t cells in oral lichen planus, suggesting an inhibitory role of pd1. It is seen most commonly on the buccal mucosa inside cheeks but also on the tongue, floor of mouth, palate or gums. Common adverse drug reactions of rifampicin are hepatotoxicity, flulike syndrome, gastrointestinal symptoms and thrombocytopenia. Rifampicininduced lichenoid drug eruption postgraduate.
Fixed drug eruptions fdes in the oral cavity are lesions that recur at the same site each time the offending medication is taken. Betaadrenergic blockers and lichenoid drug eruption. Literature lichenoid drug eruptions as a class effect of betablockers have been described. Photo lichenoid drug induced eruptions may have all the features of lp, and few if any of the features of drug induced lp. The presence of eosinophils within the infiltrate, involvement of the deep vascular plexus, and the presence of parakeratosis and focal dyskeratotic cells within the stratum corneum are all clues to a lichenoid drug eruption. Oral lichen planus olp and oral lichenoid lesions oll are clinically and histologically similar lesions but their treatment planning and prognosis are different.
Pdf the concept of lichenoid tissue reactioninterface dermatitis was introduced in dermatology to define a number of diverse inflammatory. Oral lichenoid drug eruption is an uncommon medicationinduced chronic change inside the mouth. Lichenoid drug eruption with palmoplantar hyperkeratosis due to imatinib mesylate. Lichenoid drug eruption associated with bendamustine blood. One variant of lichen planus is the socalled lichenoid drug eruption. Pdf lichenoid reaction is a mucosal lesion characterized by linear. Lichenoid drug eruptions are not mentioned in the smpcs of metoprolol, bisoprolol or atenolol.
Oral and vulvovaginal lichenoid reactions due to mitotane. Lichenoid dermatitis represents a wide range of cutaneous disorders characterized by lichen planuslike skin lesions. Lichenoid drug eruption caused by imatinib mesylate in a chinese patient with gastrointestinal stromal tumor. Oral lichenoid lesions lichen planuslike lesions can be induced by hypersensitivity to dental restorative metals, acrylates. Drug induced oral lichenoid reactions or oral lichenoid lesions were first cited in 1971 by almeyda and levantine. View enhanced pdf access article on wiley online library html view. Fixed drug eruption timeframe with the initial fixed drug eruption attack, a delay of up to 2 weeks may occur from the initial exposure to the drug to the development of the skin lesion. Another oral fluorouracil agent, specifically tegafur, has also been implicated in development of lichenoid skin reaction. The pathological features of a lichenoid drug eruption may be difficult to distinguish from idiopathic lichen planus, but the diagnosis of lichenoid drug eruptions may be suggested by the types and distribution of inflammatory cells as well as other changes.
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