Drug-induced / Lichenoid Drug Eruption

  • Medicamentos associados
    • ACE inhibitors
    • Thiazide diuretics: HCTZ/chlorathiazide
    • Antimalarials (quinidine)
    • Gold (past)
    • Immune checkpoint inhibitors
      • Anti CTLA-4 - ipilimumab
      • Anti PD-1: pembrolizumab, nivolumab
    • TNFalfa inhibitors → may induce, and some patients have posterior resolution or improvement
    • Beta blocker
    • Penicillamine
    • Estatinas
    • Recurrence of the lesions subsequent to drug rechallenge has not been documented for the majority of these drugs
        • notion image
  • Clinical presentation
    • May have photodistribution
    • Latency period (from drug introduction to cutaneous eruption): usually several months
      • Penicillamin 2 months - 3 years
      • Beta-blockers ~1 year
      • Quinacrine 4-6 weeks
      • TNF inhibitors 3-16 weeks
      • Immune checkpoint induced → delayed onset, may appear after treatment discontinuation
    • Time from drug suspension to resolution: several weeks to months
  • Lichenoid granulomatosis dermatitis / giant cell lichenoid dermatitis
    • Lichenoid dermatitis with a granulomatous infiltrate composed histiocytes and multinucleated giant cells