Lichen planus-like drug eruptions/drug induced LE Flashcards
(15 cards)
What is the primary characteristic that makes lichen planus-like drug eruptions hard to distinguish from normal LP?
Temporal relationship with onset drug
Both conditions also rely on drug withdrawal for diagnosis.
What is pathogenesis of lichen planus-like / drug induced LE drug eruptions?
May be from autoreactive T cells against drug-MHC antigen complex
Keratinocytes and Langerhans cells are identified as non-self.
List the biopsy histology features of lichen planus-like drug eruptions.
- Hyperkeratosis
- Hypergranulosis
- Saw tooth acanthosis
- Band-like infiltrate
Drug clues include eosinophils, infiltrating plasma cells, and necrotic keratinocytes in clusters.
Name some important drug triggers for lupus erythematosus.
- ACE-I
- B-blocker
- Ca-channel blockers
- Isoniazid
- Thiazide
- Statin
- Terbinafine
- Sulfasalazine
These are significant causes of drug-induced lupus.
What are considered low-risk drug triggers for lupus erythematosus?
- Carbamazepine/anticonvulsants
- Cipro
- Griseofulvin
- Lithium
- NSAID
- Penicillin
- PPI
- Rifampicin
These drugs are less likely to induce lupus erythematosus.
What are well-established drug triggers for lichen planus?
- Antimalarials
- Gold
- Mercury
- NSAIDs
- Penicillamine
- Anti-TNF agents
- Nivolumab
- Pembrolizumab
- Thiazide diuretics
These drugs have a strong association with lichen planus.
What are some clinical features of lichen planus?
- Non-specific changes
- Classic small shiny papules with Wickham striae
- Mucosal lichenoid reactions can be caused by drugs
- Oral LP less frequently associated with drugs
Oral LP typically occurs on buccal mucosa, tongue, and gingiva.
How common is drug-mediated lupus erythematosus in lupus cases?
10% of LE cases are mediated by drugs
More commonly, systemic lupus erythematosus than subacute is seen.
What type of lesions are hyperpigmented lichenoid drug eruptions more common in?
Skin of colour
Photodistributed lichenoid lesions occur with many drugs.
What is the essential investigation for diagnosing lichen planus-like drug eruptions?
Skin biopsy
This is crucial for accurate diagnosis.
What laboratory findings are associated with drug-induced lupus erythematosus?
- Positive ANA
- Positive anti-Ro antibodies
- Positive antihistone antibodies in 75% of patients
These findings help confirm the diagnosis.
What is the first step in the management of lichen planus-like drug eruptions?
Drug removal
Improvement time depends on the drug’s half-life.
How can itching be managed in patients with lichen planus-like drug eruptions?
- TCS (topical corticosteroids)
- Oral antihistamines
- Gabapentin
- Pregabalin
These options help alleviate discomfort.
What caution should be taken when using oral corticosteroids for lichen planus-like drug eruptions?
May mask underlying disease activity if diagnosis is incorrect
Careful consideration is necessary.
If stopping the drug is not possible, what alternative treatments may be considered?
- Oral retinoids
- Methotrexate (MTX)
These treatments can be used when drug withdrawal is not an option.
