Case and Research Letter
Pytiriasis Lichenoide Chronica Following Influenza Vaccination, and Review of the Literature
Pitiriasis liquenoide crónica asociada a vacuna contra la influenza, y revisión de la literatura
M. Santos-Coelho
, J. Alves Barbosa, J. Cabete, A. Brasileiro
Corresponding author
Dermatology and Venereology Department, Centro Hospitalar Universitário de Lisboa Central, E.P.E., Lisboa, Portugal
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"apellidos" => "del Pozo" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731024001777?idApp=UINPBA000044" "url" => "/00017310/0000011500000005/v1_202405030647/S0001731024001777/v1_202405030647/es/main.assets" ] "asociados" => array:1 [ 0 => array:18 [ "pii" => "S0001731024001765" "issn" => "00017310" "doi" => "10.1016/j.ad.2024.02.021" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "3875" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2024;115:T513-T514" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTA CIENTÍFICO-CLÍNICA</span>" "titulo" => " Pitiriasis liquenoide crónica asociada a vacuna antigripal, y revisión de la literatura" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T513" "paginaFinal" => "T514" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pytiriasis Lichenoide Chronica Following Influenza Vaccination, and Review of the Literature" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 508 "Ancho" => 1340 "Tamanyo" => 261262 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hallazgos histopatológicos de la biopsia por punción de una pápula abdominal-H-E, 100× (a) y H-E, 400× (b), compatible con PLC.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">PLC: pitiriasis liquenoide crónica.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Santos-Coelho, J. Alves Barbosa, J. Cabete, A. Brasileiro" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Santos-Coelho" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Alves Barbosa" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Cabete" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Brasileiro" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731024001765?idApp=UINPBA000044" "url" => "/00017310/0000011500000005/v1_202405030647/S0001731024001765/v1_202405030647/es/main.assets" ] ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Pytiriasis Lichenoide Chronica Following Influenza Vaccination, and Review of the Literature" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "513" "paginaFinal" => "514" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Santos-Coelho, J. Alves Barbosa, J. Cabete, A. Brasileiro" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Santos-Coelho" "email" => array:1 [ 0 => "mscoelho.derma@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Alves Barbosa" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Cabete" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Brasileiro" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Dermatology and Venereology Department, Centro Hospitalar Universitário de Lisboa Central, E.P.E., Lisboa, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pitiriasis liquenoide crónica asociada a vacuna contra la influenza, y revisión de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 507 "Ancho" => 1340 "Tamanyo" => 293680 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathological findings of a punch biopsy of an abdominal papule – H–E, 100× (a) and H–E, 400× (b), compatible with pytiriasis lichenoide chronica.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pytiriasis lichenoides (PL) is a spectrum of uncommon inflammatory conditions with considerable clinical overlap. These disorders seem to affect equally both sexes and are more prevalent in children and young adults.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,2</span></a> Besides pytiriasis lichenoide chronica (PLC), the most common presentation,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> PL also encompasses pityriasis lichenoides et varioliformis acuta (PLEVA) and febrile ulceronecrotic Mucha-Habermann disease (FUMHD). PLEVA has a more acute onset than PLC, can be accompanied by systemic symptoms and presents with erythematous scaly papules that can develop central vesicopustules and hemorrhagic crusts, with subsequent varioliform scars<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a>; FUMHD has exuberant systemic symptoms and progresses rapidly to necrotic lesions, ulcers, and blisters, with a higher mortality rate.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In recent years, there have been several reported cases of PL developing after vaccination. Here, we present a case of PLC that followed the influenza vaccine, and a revision of cases of PL associated with vaccination.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 66-year-old man with a past medical history of type 2 diabetes and hypertension presented to our Dermatology Department with a pruriginous rash that had started three days after he was vaccinated against the influenza virus. The lesions first appeared on the forearms and later spread to the trunk and lower limbs.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient worked as a patient care technician at a hospital, there was no history of recent infection or any other illness, and there were no other newly introduced systemic or topical drugs other than the vaccine.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Clinical examination revealed multiple discrete erythematous papules with a fine silvery scale, located on the extensor aspects of the upper limbs, trunk and anterior aspect of the thighs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The remaining physical examination was unremarkable.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">A punch biopsy of an abdominal papule was obtained and histopathological examination revealed hydropic degeneration of the basal cell layer, pityriasiform spongiosis, lymphocyte exocytosis, and isolated apoptotic keratinocytes. The corneal layer showed parakeratosis and neutrophiles (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A diagnosis of PLC was made and the patient was treated with topical betamethasone dipropionate b.i.d., and a six-week course of doxycycline 100<span class="elsevierStyleHsp" style=""></span>mg id. There was gradual improvement of established lesions and no recurrence after one-year of follow-up.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We have found 17 published cases of PL developing after vaccination. Most patients were male, aged under 40 years, with an average time between inoculation and the beginning of symptoms of 10 days. While PLEVA was the most commonly reported diagnosis, PLC was found in four cases. These findings can be found in <a class="elsevierStyleCrossRef" href="#sec0010">Supplementary Table 1</a>.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Local injection site reactions are the most commonly reported cutaneous adverse effects of the influenza vaccine, but there are reports of other reactions such as lichen planus<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> and cutaneous leukocytoclastic vasculitis<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> developing after this immunization. In this review, we identified only a case of PLEVA associated with the influenza vaccine.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The pathophysiology of PL is incompletely understood. It is regarded by some authors as an inflammatory response to a wide range of external agents, such as infectious agents (Epstein–Barr and the human immunodeficiency virus for example)<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,3</span></a> in PLEVA, and drugs (chemotherapy agents, hormonal therapy)<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> in PLC. Other pathophysiologic explanations for PLC include T-cell dyscrasia (as progression to mycosis fungoides has been reported) and immune complex mediated hypersensitivity vasculitis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">We believe this clinical case is related to the influenza vaccine due to temporal association between the vaccination and the symptoms, lack of other identifiable initiating factors, and lack of recurrence during follow-up.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding treatment, it is noteworthy that clinical trials are lacking, making, sometimes, PL management a clinical challenge. Topical corticosteroids are often the first-line therapy, but complete responses are rare. Systemic antibiotics (erythromycin, doxycycline, minocycline, azithromycin) have a higher response rate and are usually well-tolerated.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,5,8</span></a> Various modalities of UV phototherapy have been used with good clinical response, being narrow-band UVB the most used due to its relative safety.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In those cases where PLC seems to be associated with vaccination, we believe that the decision to receive further inoculations (when applicable) should be individualized, taking in consideration the risks associated with disease recurrence and the benefits of immunization. In this particular case, the patient repeated the inoculation the following year given his age, past medical history and occupation. There was no recurrence or other adverse effects.</p><p id="par0070" class="elsevierStylePara elsevierViewall">We believe this case is of interest as PL following vaccination is relatively uncommon, and there is only one other reported case associated with the influenza vaccine. Follow-up for over one year and after a second immunization is also significant, since lack of published data of recurrence after a booster makes the decision of a new inoculation difficult.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0085" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0015" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 659 "Ancho" => 1340 "Tamanyo" => 89604 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pityriasis lichenoides chronica induced by Influenza vaccination. Erythematous-desquamative lesions located on the thorax and right arm (a) and dorsal region (b).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 507 "Ancho" => 1340 "Tamanyo" => 293680 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathological findings of a punch biopsy of an abdominal papule – H–E, 100× (a) and H–E, 400× (b), compatible with pytiriasis lichenoide chronica.</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.doc" "ficheroTamanyo" => 29620 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pityriasis lichenoides and its subtypes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 6 | 18 |
| 2024 October | 109 | 76 | 185 |
| 2024 September | 110 | 36 | 146 |
| 2024 August | 151 | 72 | 223 |
| 2024 July | 113 | 34 | 147 |
| 2024 June | 146 | 94 | 240 |
| 2024 May | 264 | 86 | 350 |
| 2024 April | 111 | 45 | 156 |
| 2024 March | 78 | 48 | 126 |
| 2024 February | 67 | 51 | 118 |
| 2024 January | 70 | 65 | 135 |
| 2023 December | 61 | 65 | 126 |
| 2023 November | 73 | 55 | 128 |
| 2023 October | 74 | 54 | 128 |
| 2023 September | 57 | 47 | 104 |
| 2023 August | 62 | 47 | 109 |
| 2023 July | 89 | 81 | 170 |
| 2023 June | 58 | 67 | 125 |
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