Case Report
Open Access
Multi-Drug Induced Palmar and Plantar Lichen Planus:
First Description in the Medical Literature!
Georgi Tchernev1,2*, Uwe Wollina3 and Ivanka Temelkova1,2
1Department of Dermatology, Venereology and Dermatologic surgery, Medical Institute of Ministry of Interior (MVR); Sofia, Bulgaria
2Onkoderma- Clinic for Dermatology, Venereology and Dermatologic Surgery; Sofia, Bulgaria
3Department of Dermatology and Allergology, Stadtisches Klinikum Dresden, Germany
2Onkoderma- Clinic for Dermatology, Venereology and Dermatologic Surgery; Sofia, Bulgaria
3Department of Dermatology and Allergology, Stadtisches Klinikum Dresden, Germany
*Corresponding author: Prof. Dr. Georgi Tchernev, Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of
Interior (MVR), General Skobelev 79, 1606 Sofia, Bulgaria; E-mail:
@
Received: July 17, 2019; Accepted: July 23, 2019; Published: July 26, 2019
Citation: Tchernev G, Wollina U, Temelkova I (2019) Multi-Drug Induced Palmar and Plantar Lichen Planus: First Description in the
Medical Literature!. Clin Res Dermatol Open Access 6(2): 1-2. DOI: http://dx.doi.org/10.15226/2378-1726/6/2/00190
Key words: Drug Induced Lichenoid Reaction; Lichen Planus;
ASS; Rosuvastatin; Ramipiril; Metoprolol
We report a case of a 43-year-old male patient who developed
palmoplantar violaceous papules, subsequently diagnosed as
drug-induced lichen planus (LP) based on the histopathological
findings and clinical correlation (figures. 1a, 1b).
Figs. Designations:1a. Lesions of the palmar aspect of the upper limbs characterized by shiny erythematous to purple-colored flat-topped papules.
1b. Lesions of the dorsal aspect of the upper limbs characterized by shiny erythematous to purple-colored flat-topped papules.
1c. Lesions of the plantar surface of the feet with diffuse violaceous erythema and erythematous to purple-colored flat-topped papules.
1d. Lesions of the palmar part of the upper limbs characterized by shiny erythematous to purple-colored flat-topped papules.
1b. Lesions of the dorsal aspect of the upper limbs characterized by shiny erythematous to purple-colored flat-topped papules.
1c. Lesions of the plantar surface of the feet with diffuse violaceous erythema and erythematous to purple-colored flat-topped papules.
1d. Lesions of the palmar part of the upper limbs characterized by shiny erythematous to purple-colored flat-topped papules.
The lesions had started three months earlier when the patient
noticed a rash characterized by redness and swelling of the skin
on the palms and soles (figures. 1c, 1d), accompanied by severe
itching.
Previous medical history was relevant for myocardial infarction (2014). His current diseases were glaucoma, arterial hypertension and hypercholesterolemia. Systemic medication at the time of hospitalization included rosuvastatin 20 mg (0-0- 1), metoprolol succinate 50 mg (1/2-0-0), ramipril 10 mg (1/2- 0-1/2) and acetylsalicylic acid 75 mg (0-0-1). One year later he developed cutaneous skin lesions, identified later as palmoplantar LP. At the time of hospitalization there were no evidence of bacterial or viral infections (Hepatitis B, Hepatitis C, HIV).
In consultation with a cardiologist it was decided to stop rosuvastatin, ramipril, metoprolol succinate and acetylsalicylic acid, and in replacement the patient started lercanidipine 10 mg bid, clopidogrel 75 mg id and ivabradine. After stopping the suspected drugs, treatment with acitretin 40 mg/daily was initiated. Additionally, the patient received desloratadine 5 mg id and topical therapy with methylprednisolone aceponate cream twice daily, with durable response after one month.
Recent literature suggests that drugs such as nebivolol and acetylsalicylic acid are associated with the induction of LP [1]. Current data also raise the possibility that drugs such as pembrolizumab, interferon-α, fenofibrate , telmisartan and brimonidine may also play a significant role in the induction of LP [2-6].
Lichen planus is a relatively common skin disorder of unknown etiology, but many studies in the literature suggest that one of the possible causes is systemic administration of different drugs. Sufficient evidence exists to support the thesis that betablockers, methyldopa, penicillamine, quinidine and quinine may play a pathogenic role and are potential triggers of the disease [7]. Given the available epidemiologic evidence, nonsteroidal antiinflammatory drugs could also be considered as a potential causative agents [1, 11].
The information we have gathered has lead us to the final conclusion that the medications that the patient was taking (rosuvastatin, metoprolol, ramipril and acetylsalicylic acid) may have triggered a multi- drug-induced palmoplantar LP [8 -11].
All information about our patient and data from world literature suggest that this is the first case of a patient developing a multi drug-related palmoplantar variant of LP.
Previous medical history was relevant for myocardial infarction (2014). His current diseases were glaucoma, arterial hypertension and hypercholesterolemia. Systemic medication at the time of hospitalization included rosuvastatin 20 mg (0-0- 1), metoprolol succinate 50 mg (1/2-0-0), ramipril 10 mg (1/2- 0-1/2) and acetylsalicylic acid 75 mg (0-0-1). One year later he developed cutaneous skin lesions, identified later as palmoplantar LP. At the time of hospitalization there were no evidence of bacterial or viral infections (Hepatitis B, Hepatitis C, HIV).
In consultation with a cardiologist it was decided to stop rosuvastatin, ramipril, metoprolol succinate and acetylsalicylic acid, and in replacement the patient started lercanidipine 10 mg bid, clopidogrel 75 mg id and ivabradine. After stopping the suspected drugs, treatment with acitretin 40 mg/daily was initiated. Additionally, the patient received desloratadine 5 mg id and topical therapy with methylprednisolone aceponate cream twice daily, with durable response after one month.
Recent literature suggests that drugs such as nebivolol and acetylsalicylic acid are associated with the induction of LP [1]. Current data also raise the possibility that drugs such as pembrolizumab, interferon-α, fenofibrate , telmisartan and brimonidine may also play a significant role in the induction of LP [2-6].
Lichen planus is a relatively common skin disorder of unknown etiology, but many studies in the literature suggest that one of the possible causes is systemic administration of different drugs. Sufficient evidence exists to support the thesis that betablockers, methyldopa, penicillamine, quinidine and quinine may play a pathogenic role and are potential triggers of the disease [7]. Given the available epidemiologic evidence, nonsteroidal antiinflammatory drugs could also be considered as a potential causative agents [1, 11].
The information we have gathered has lead us to the final conclusion that the medications that the patient was taking (rosuvastatin, metoprolol, ramipril and acetylsalicylic acid) may have triggered a multi- drug-induced palmoplantar LP [8 -11].
All information about our patient and data from world literature suggest that this is the first case of a patient developing a multi drug-related palmoplantar variant of LP.
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