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Drug-Induced Lichenoid Eruption — SCE Dermatology MCQ

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ModerateDrug ReactionsDrug-Induced Lichenoid EruptionSCE Dermatology

A 45-year-old man presents with lichenoid eruption 6 weeks after starting Atenolol. The lesions are violaceous flat-topped papules resembling idiopathic lichen planus. What clinical feature helps distinguish drug-induced lichenoid eruption from idiopathic lichen planus?

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Correct answer: C — Drug-induced lichenoid eruptions may be photodistributed, have eczematous features, and oral involvement is less common

Drug-induced lichenoid eruptions (DILE) can be clinically and histologically very similar to idiopathic LP, making distinction challenging. Features favouring DILE include: photodistribution, eczematous features (mixed LP-eczema morphology), less common oral mucosal involvement, temporal relationship with drug initiation, and resolution after drug withdrawal (though this may take months). Beta-blockers, ACE inhibitors, thiazides, antimalarials, and gold are common causes. Histologically, eosinophils in the infiltrate and para-keratosis favour DILE over idiopathic LP. However, Wickham striae CAN be present in drug-induced disease.

Reference: BAD 2019 Drug Eruption Guidelines; BJD