Drug-Induced Lichenoid Eruptions
A drug-induced lichenoid eruption is a distinctive inflammatory skin reaction that closely resembles lichen planus, both on examination and under the microscope. Rather than being a primary autoimmune disease, however, it is triggered by certain medications, which draw lymphocytes into the skin where they damage the basal layer of the epidermis.
At Haute-Derma, we assess drug-induced lichenoid eruptions with careful attention to the pattern of the rash. Our goal is to tell ordinary lichen planus apart from a drug reaction, remove the cause, and treat the skin so that it recovers without the long-lasting post-inflammatory hyperpigmentation that is so common with this condition.
Our Approach at Haute-Derma
Our specialists look closely for the features that set this condition apart:
- Appearance: flat-topped, many-sided bumps, purple or pink, with a shiny surface and usually itchy.
- Distribution: unlike classic lichen planus, the drug-induced form tends to spread more widely over the trunk and limbs and affects the inside of the mouth less often.
- Timing: the reaction starts slowly, often weeks or even months after the medication was first taken.
We understand that itchy, darkened patches can have a real impact on how you look and feel. At Haute-Derma, treatment does not stop at flattening the inflamed bumps; we also focus on improving the dark marks left behind once the rash fades.
How We Diagnose It at Haute-Derma
Haute-Derma uses a thorough clinical and laboratory workup:
- Reviewing high-risk medications: with particular attention to drug groups commonly used in Vietnam that can cause lichenoid eruptions:
- Blood pressure medicines (ACE inhibitors, beta blockers).
- Diuretics (thiazides).
- Synthetic antimalarials.
- Nonsteroidal anti-inflammatory drugs (NSAIDs).
- Dermoscopy: looking for telltale signs such as Wickham striae (fine white lines on the surface of the bumps) to confirm a lichenoid pattern.
- Skin biopsy: we take a biopsy to look for a band-like lymphocytic infiltrate in the upper dermis and dying keratinocytes (Civatte bodies).
- Ruling out look-alikes: idiopathic lichen planus, pityriasis rosea and other light-sensitivity reactions.
Specialized Treatment at Haute-Derma
Treatment at Haute-Derma aims to switch off the inflammation and prevent lasting pigment changes:
- Stopping or switching the medication: we work with your prescribing physician to move you to a drug from a different class.
- Potent topical corticosteroids: ointments or creams that flatten the bumps and quickly relieve itching.
- Calcineurin inhibitors (tacrolimus): a good option for keeping sensitive areas under control without the risk of skin thinning.
- Phototherapy: for widespread rashes, we use narrowband UVB to calm the local immune response.
- Treating post-inflammatory hyperpigmentation: once the bumps have flattened, we use laser or brightening ingredients to fade any remaining purple or brown marks.
