The Clinical,pathological,and Dermoscopic Manifestations Of Lichenoid Drug Eruption

BackgroundLichenoid drug eruption(LDE)is an unusual type of drug eruption,which clinically resembles lichen planus.However,a LDE patient has a history of medication administration before the onset of this disease;lesions of LDE have unique pathologic features different from those of lesions in LP;and LDE will not recur after the patient ceasing the offending medication and being cured by medical intervention,unlike LP has no established etiology and has a chronic and recurrent nature.Up to know,there is still no clinical study in the dermoscopy of LDE.ObjectiveWe sought to describe the clinical,pathologic and dermoscopic features of LDE by study 160 lesions in 8 LDE patients,in order to facilitate the physicians to understanding of this disease,and to reduce the misdiagnosis rate,and to lay the foundation for further investigation.Patient selection and methods1.Subjects 8 patients with LDE presented to the First Affiliated Hospital of Zhengzhou University from December 2017 to July 2019 were selected.All patients completed the relevant tests and signed the informed consent to participate in the study.Combining the clinical and pathological manifestations,the diagnosis of LDE was rendered by two dermatologists together.A patient who refused to take a biopsy or a patient whose diagnosis of LDE could not be confirmed was excluded.2.Data collection Clinical data of each case,including general condition,history of past illness,clinical features,dermoscopic features,pathological features,treatment and prognosis,were collected.Clinical and dermoscopic pictures of each patient’s lesions were taken.3.Statistical analysis Statistical analyses were performed using SPSS 22.0.Quantitative variables conforming to normal distribution were described as mean ±standard deviation;while median(quartile)[M(P25,P75)]was used to describe the quantitative variables not conforming to normal distribution.Qualitative variables were expressed as absolute frequencies and percentages;and Chi-Square test and Fisher’s exact test were applied to compare if there were statistical difference between the frequencies of lesion variables seen with naked eyes and with a dermoscope,P<0.05 was considered to be significant statistically.Results8 LDE patients with 160 eligible lesions were enrolled into this study.The clinical,dermoscopic,and pathologic features of the 8 LDE patients included:(1)The ratio of male to female wasl:1;(2)The ages at the first visit for this condition ranged from 26 to 69[50(38,63.25)]years old;(3)The disease duration ranged from 0.43 to 17[2(1,5.25)]months;(4)Among the 8 patients,six knew the specific medications taken before the onset of LDE.The latent periods causing LDE ranged from 1 to 60[3.50(1,18)]months.The other two patients had a history of medication administration,but the medications taken were unknown;(5)Offending medications included nifedipine,imatinib mesylate,levothyroxine sodium,nimodipine,and traditional Chinese medicine astragalus membranaceus;(6)Clinical manifestations:All of the160 LDE lesions presented as red or purplish red flat papules,or maculopapules,most of which were round or roundish;8.13%of the lesions had Wickham’s striae;52.50%of the lesions had homogeneous pigmentation;54.38%of the lesions were accompanied by scales,most of which were scattered;no vascular changes were observed in all of the lesions;(7)Pathologic examination:Hyperkeratosis with parakeratosis,hypergranulosis and focal interruption of the granular layer,exocytosis of lymphocytes and dyskeratoisis in the epidermis,basal layer vacuolar degeneration,colloid bodies under basal layer,band-like infiltrate of predominant lymphohistiocytes with some melanophages and eosinophils in the upper superficial dermis,and perivascular infiltrate of predominant lymphohistiocytes with a few eosinophils in the mid and deep dermis,plasma cells could be seen occasionally in the infiltrate;(8)Dermoscopy:Under the pink or purplish red background,50.00%of the lesions showed Wickham’s striae,71.25%lesions displayed different forms of pigmentation,47.50%lesions had dotted or glomerular,linear vessels,and 59.38%lesions could be seen scattered,collarette-like white scales;(9)The difference in the frequencies of Wickham’s striae,pigmentation,vessels,red background and white scale in the LDE lesions observed dermoscopically and with naked eyes were statistically significant;(10)After treatment,the lesions subsided with pigmentation sequela in all patients,and no recurrence occurred at 6 months of follow-up.Conclusion1.LDE lesions clinically present as round or roundish,red or purplish red papules or maculopapules,with Wickham’s striae,pigmentation and scales.2.Pathology of LDE shows hyperkeratosis with parakeratosis,hypergranulosis and focal interruption of the granular layer,dyskeratosis and exocytosis of lymphocytes in the epidermis,basal layer vacuolar degeneration,and there was a lymphohistiocytic infiltrate of the superficial and deep dermis with some eosinophils,occasionally plasma cells could be seen.3.Dermoscopy of LDE shows findings Wickham striae,pigmentation,vessels,scales,and red backgrounds with different hues.