Lichenoid drug eruption (LDE) is a rare form of delayed-type drug eruption. Among anti-tuberculosis (Tb) agents, cycloserine (CS) has been reported as a rare cause of LDE. Positive results on the lymphocyte transformation test (LTT) have not been reported in patients with LDE. In the present case, we performed LTT and a patch test, and successfully proved CS as the offending drug in this patient, who had been treated with multiple anti-Tb drugs. These observations suggest that CS should be considered a possible cause of LDE and that LTT can be an option for the diagnosis of LDE.
Cycloserine ; Diagnosis ; Drug Eruptions* ; Drug Hypersensitivity ; Humans ; Lichenoid Eruptions ; Lymphocyte Activation* ; Lymphocytes* ; Patch Tests

BACKGROUND: Drug eruption is a relatively common disorder and may cause significant problems. Nevertheless, there have only been a few clinical studies of drug eruption in Korea. OBJECTIVE: The purpose of this study was to define the clinical features and causative drugs of drug eruption, and to evaluate the diagnostic value of skin test and provocation test. METHODS: We reviewed clinical data and laboratory results from 161 patients with drug eruptions. Furthermore, we performed skin test and provocation test on 12 and 8 patients, respectively. RESULTS: The common clinical types were fixed drug eruption (31%), exanthematous eruption (29.8%), urticaria (9%), and EM/Stevens-Johnson syndrome/TEN (5%). The mean latent period was 14.1 days, varying from 3.6 days for fixed drug eruption to 175 days for lichenoid eruption. The major causative drugs were antibiotics (23.6%), common cold remedies (20.5%), nonsteroidal antiinflammatory drugs (10.6%), and herb medication and health foods (5.6%). The evaluation of the frequencies of drug eruption revealed 43.5% of the patients with one attack, and 32% of the patients be more than two attacks. The common underlying diseases were upper respiratory infection (26.7%), postoperative prophylactic medications (15.0%), infections (14.3%), and gastrointestinal troubles (6.2%). The skin test was positive in 5 of 12 patients (41.7%), and provocation test was positive in 2 of 8 patients (25%). Among the clinical types of drug eruption, EM/Stevens-Johnson syndrome/TEN had the earliest onset (25 years) and pustular type showed the latest onset (49.1 years). Females were more commonly affected than males in exanthematous type (2.7:1) and EM/Stevens-Johnson syndrome/ TEN (3:1). Comparing frequencies of drug eruption, fixed drug eruption and urticarial type showed higher frequencies than other types. CONCLUSION: Although there were some limitations in estimating the values of skin test and provocation test in this study, they still remain the most reliable methods for evaluating drug eruption.
Anti-Bacterial Agents ; Common Cold ; Drug Eruptions* ; Female ; Food, Organic ; Humans ; Korea ; Lichenoid Eruptions ; Male ; Skin Tests* ; Skin* ; Urticaria

No abstract available.
Asian Continental Ancestry Group* ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Lichenoid Eruptions* ; Imatinib Mesylate

Lichen planus (LP) is a chronic mucocutaneous inflammatory condition that typically affects middle-aged adults. Esophageal involvement in LP is rare and underrecognized, often leading to delayed diagnosis and treatment of LP. Herein, we describe three cases of esophageal LP (ELP) in clinically symptomatic patients with endoscopic lesions in the upper to mid-esophagus. This case series suggests that ELP is be more common than was previously thought and emphasizes that clinicians should have a high index of suspicion for this diagnosis, particularly when evaluating proximal esophageal lesions in patients presenting with dysphagia. The series also highlights the successful treatment of our patients with budesonide-honey slurry.
Adult ; Deglutition Disorders ; Delayed Diagnosis ; Diagnosis ; Humans ; Lichen Planus ; Lichenoid Eruptions ; Lichens ; Skin Diseases, Papulosquamous

Actinic lichen planus is a particular subtype of lichen planus with a distinct photodistribution. This disease has been variously named lichen planus in subtropical countries, such as lichen planus subtropicus annularis, lichen planus tropicus, summertime actinic lichenoid eruption, and lichenoid melanodermatitis. It is a disorder seen most frequently in Africa, the Middle East, and the Indian subcontinent, favoring Asians. This disease presents in the spring or summer and is frequently quiescent during the winter. A 61-year-old man with unusual lichenoid photosensitive eruption is presented. The lesions developed during the late spring, appearing on both dorsa of hands, wrists, and lower legs. We report a case of actinic lichen planus with a review of the literature.
Actins* ; Africa ; Asian Continental Ancestry Group ; Hand ; Humans ; Leg ; Lichen Planus* ; Lichenoid Eruptions ; Lichens* ; Middle Aged ; Middle East ; Wrist

BACKGROUND: As much as 90% of adverse drug reactions (ADR) present with cutaneous manifestations. Epidemiologic data on reported ADR from all over the world are being used to predict which drugs may produce a reaction and to identify risk factors in the population. This study is the first such endeavor in the PGH Section of Dermatology
Study Objective: To gather and present data on the incidence rate, demographic characteristics, and clinical spectrum of dermatologic consults of drug reactions; to list the identity and classes of the drugs involved; to compare gathered data with trends seen in world literature
Study Design: Retrospective study
Participants: Cases of cutaneous drug reactions seen by the Section of Dermatology as out patients or as referrals from the wards, for the period January 2001 to March 2003. Acneiform drug eruptions and coumadin necrosis were not included in the study
Outcome Measures and Analysis: Incidence rates of cutaneous drug reactions for the past two years were computed. Epidemiologic data and the clinical profile of drug reactions, as well as the causative drugs were tabulated; frequencies were taken
Results: Of the 188 suspected cases of drug reactions, 155 (82%) charts were retrieved. Of these, 119 cases were confirmed to be drug reactions and included in the study. Incidence rates for the years 2001 and 2002 were 4.2 and 5 per 1000 new consults, respectively. The age of the patients ranged from 1 month to 81 years old. Majority (72%) was in the adult age group (19-64 years old). The male to female ratio was fairly equal at 1:1.4. Diagnosis was confirmed by biopsy in 44% of the cases. The top 3 clinical presentations of cutaneous drug reactions were: morbilliform rash, fixed drug eruption, and urticaria. Other cutaneous lesions included erythroderma/exfoliative dermatitis, vessiculobullous lesions, erythema multiforme, lichenoid eruptions, vasculitis, photoallergy, Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). The most common causes of drug reactions were antibiotics (Cotrimoxazole, Amoxicillin), NSAIDs and anti-Kochs drugs. Antibiotics were responsible for 42% of cutaneous drug reactions and 41.9% of morbilliform rashes. Cotrimoxazole was the culprit drug in 40.7% of FDE. Anticonvulsants were responsible for half of the cases of life-threatening SJS and TEN
Conclusions: There is no sex predilection for ADR. Various clinical manifestations of cutaneous drug reactions are seen at the PGH Section of Dermatology. They are caused by varied drugs, of which the most common causes are antibiotics (Cotrimoxazole, Amoxicillin), NSAIDs and anti-Kochs. The clinical pattern and drugs causing cutaneous drug reactions are similar to those observed in other countries, with minor variations.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Adolescent ; Erythema Multiforme ; Lichenoid Eruptions ; Stevens-johnson Syndrome ; Urticaria ; Vasculitis

OBJECTIVETo investigate the histopathological findings of primary cutaneous lichenoid amyloidosis (LA) and macular amyloidosis (MA).

METHODSThe pathological features of 82 patients with primary cutaneous amyloidosis (PCA) admitted from 2003 to 2008 were summarized.

RESULTSThere were 52 cases (63%) of LA and 30 cases (37%) of MA, among which 49 cases (60%) presented with pyknotic nucleus of the basal keratinocytes above the amyloid in the upper dermis and 18 cases (22%) presented with pagetoid dyskeratosis (PD) cells among their prickle cells. More amyloid in LA and more severe incontinent of pigment in MA. The deposition level of amyloid protein was significantly higher in patients with LA and the incontinent of pigment was significantly higher in patients with MA (P < 0.01).

CONCLUSIONThe amyloid protein may be derived from the apoptotic keratinocytes.

Adult ; Aged ; Aged, 80 and over ; Amyloidosis ; classification ; pathology ; Female ; Humans ; Lichenoid Eruptions ; pathology ; Male ; Middle Aged ; Skin ; pathology ; Skin Diseases ; classification ; pathology

BACKGROUND: Imatinib mesylate is an inhibitor of the tyrosine kinase Bcr–Abl and a first-line treatment for Philadelphia chromosome-positive chronic myeloid leukaemia (CML). Dermatological side effects include superficial oedema, pustular eruption, lichenoid reactions, erythroderma, and skin rash. Depigmentation of the skin and/or mucosa is uncommon, and hyperpigmentation is rare. CASE PRESENTATION: We present the case of a 63-year-old Caucasian male with widespread hyperpigmentation of the hard palate associated with a 9-year history of imatinib therapy to treat CML. He did not complain of any symptoms. Clinical examination did not reveal any abnormal pigmentation of the skin or other region of the oral mucosa. He did not smoke cigarettes or drink alcohol. His medication regimen was a proton pump inhibitor, a beta-blocker, cardioaspirin, atorvastatin, and imatinib 400 mg/day. Histopathologically, melanin and haemosiderin deposits were evident in the lamina propria. The lesion persisted, with no clinical change, through several follow-ups. We reviewed the literature to explore the possible relationship between oral hyperpigmentation and long-term imatinib mesylate treatment. CONCLUSIONS: We diagnosed oral pigmentation associated with imatinib intake based on the medical history and clinical features of the pigmented macules. Oral pigmentation may have a variety of causes, and differential diagnosis requires nodal analysis. Clinicians should be aware of possible oral mucosal hyperpigmentation in patients taking imatinib mesylate. Such pigmentation is benign and no treatment is needed, but surveillance is advisable.
Atorvastatin Calcium ; Dermatitis, Exfoliative ; Diagnosis, Differential ; Exanthema ; Follow-Up Studies ; Humans ; Hyperpigmentation* ; Imatinib Mesylate* ; Lichenoid Eruptions ; Male ; Melanins ; Middle Aged ; Mouth Mucosa ; Mucous Membrane* ; Palate, Hard* ; Pigmentation ; Protein-Tyrosine Kinases ; Proton Pumps ; Skin ; Smoke ; Tobacco Products

Drug eruptions are common problems in hospital inpatients and outpatients. Cutaneous drug reactions range from mild to severe and from those localized only to skin to those associated with systemic disease. Cutaneous drug reactions are also a challenging diagnostic problem since they can mimic a large variety of skin diseases, including viral exanthem, collagen vascular disease, neoplasia, bacterial infection, psoriasis, and autoimmune blistering disease, among others. Furthermore, determining a particular medication which caused an eruption is often difficult when the patient is taking multiple drugs. In this review, clinical manifestations of adverse cutaneous drug reactions are described. A morphologic approach to drug eruption includes those that are classified as exanthematous eruption, urticaria, pustular eruption, bullous eruption, fixed drug eruption, photosensitive eruption, skin necrosis, lichenoid eruption, cutaneous pseudolymphoma, lupus erythematosus, and hand-foot syndrome. And also, recently reported cutaneous adverse reactions associated with newly developed drugs, such as epidermal growth factor receptor inhibitors, low molecular weight tyrosine kinase inhibitors, tumor necrosis factor-alpha antagonists, sirolimus and granulocyte colony-stimulating factor, are discussed.
Bacterial Infections ; Blister ; Collagen ; Drug Eruptions ; Exanthema ; Granulocyte Colony-Stimulating Factor ; Hand-Foot Syndrome ; Humans ; Hydrazines ; Inpatients ; Lichenoid Eruptions ; Molecular Weight ; Necrosis ; Outpatients ; Protein-Tyrosine Kinases ; Pseudolymphoma ; Psoriasis ; Receptor, Epidermal Growth Factor ; Sirolimus ; Skin ; Skin Diseases ; Tumor Necrosis Factor-alpha ; Urticaria ; Vascular Diseases