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and no fever&#46; Due to the intense pruritus&#44; the patient had received treatment in primary care with 5&#37; topical permethrin and methylprednisolone at low doses&#44; with no improvement&#46; No other family members suffered from pruritus&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A punch biopsy was performed&#44; and histology revealed intense lichenoid interface dermatitis&#44; with lymphocyte infiltrate with no eosinophils or plasma cells&#44; with apoptotic Civatte bodies in the basement layer and absence of parakeratosis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; A general analysis was ordered &#40;blood count&#44; biochemistry&#44; renal function&#44; liver function&#44; and lipid profile&#41; with normal results&#46; Serology for HVB&#44; HVC&#44; HIV&#44; and syphilis&#44; and antinuclear antibody determination&#44; anti-SSA-Ro&#44; and anti-SSB-La were negative&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Given the results of the general analysis and while waiting for the other additional tests&#44; treatment with cyclosporin &#40;400&#8239;mg&#47;24&#8239;h&#41; was instated&#44; as its use was not contraindicated and covered other potential causes of erythroderma&#44; such as atopic dermatitis and psoriasis&#46; After a week&#44; the patient reported notable improvement of the lesions&#44; with complete disappearance of the pruritus&#46; A month later&#44; only residual hyperpigmentation was observable &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; It was possible to suspend medication and the patient remained without signs of recurrence after 6 months of follow-up&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Because the patient stated that he had not previously taken or applied drugs or been exposed to toxins&#44; and based on the clinical and pathology findings&#44; a diagnosis was made of erythrodermic lichen planus&#44; a very rare variety of both lichen planus and erythroderma&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Lichen planus or an extensive lichenoid drug reaction must be taken into account in the differential diagnosis of erythroderma&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> The presence of lesions with a lichenoid sheen in the habitual locations &#40;wrists and&#47;or ankles&#41; and the blue-violaceous color can provide clinical guidance that the erythroderma is due to a lichen planus&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The distinction between an extensive lichenoid drug reaction &#40;ELDR&#41; and an erythrodermic lichen planus &#40;ELP&#41; may be difficult to establish&#46; ELDR is secondary to the use of drugs and it is therefore important when taking the patient&#8217;s history to inquire about previous ingested or topical drugs or other substances&#46; These signs and symptoms appear mainly on the torso&#44; do not usually involve the ankles and wrists &#40;at least initially&#41;&#44; and may present an eczematous or psoriasiform appearance&#44; with a photosensitive or symmetrical pattern&#46; Histology may reveal eosinophils and plasma cells&#44; which are much less common in cases of ELP&#44; together with parakeratosis and cytoid bodies in the upper layers of the epidermis&#44; which are also rare in ELP&#46; ELDR does not usually present Wickham striae when examined using dermoscopy&#46; ELP&#44; however&#44; tends to initially appear in the typical areas&#44; is not distributed in areas exposed to sunlight&#44; and more frequently involves the mucosa&#46; Lichenoid reactions have been reported after use of nonsteroidal anti-inflammatory drugs&#44; antihypertensive drugs &#40;angiotensin-converting enzyme inhibitors&#41;&#44; antifungal agents &#40;ketoconazole&#41;&#44; antiretroviral drugs&#44; antibiotics &#40;tetracyclines&#41;&#44; beta-blockers &#40;propanolol&#41;&#44; antimalarials&#44; cytostatic drugs&#44; tuberculostatic agents &#40;ethambutol&#41;&#44; diuretics &#40;thiazides&#41;&#44; anticonvulsives &#40;carbamazepine&#41;&#44; gold and lithium salts&#44; heavy metals&#44; hypouricemic agents &#40;alopurinol&#41;&#44; hypoglycemic agents &#40;sulfonylureas&#41;&#44; thyrosine kinase inhibitors&#44; anti-TNF drugs&#44; and others &#40;methyldopa&#44; penicillamine&#44; diltiazem&#44; chlorpromazine&#44; etc&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In the case of our patient&#44; no drugs prior to the rash were identified&#46; Moreover&#44; the response to cyclosporin was excellent&#44; with no relapse when the drug was suspended&#46; This drug has been used sporadically and successfully in lichen planus<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and its use may be considered to achieve rapid control of symptoms when lesions are very extensive&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Erythrodermic Lichen Planus
Liquen plano eritrodérmico
P.J. Gómez Arias
Corresponding author
pjga10@hotmail.com

Corresponding author.
UGC de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Reina Sofía, Córdoba, Spain
F. Leiva Cepas
UGC de Anatomía Patológica, Hospital Universitario Reina Sofía, Córdoba, Spain
M. Galán Gutiérrez, A.J. Vélez García-Nieto
UGC de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Reina Sofía, Córdoba, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Top left and right&#44; Extensive erythematous-violaceous Dermatitis with lichenoid sheen&#46; Bottom right&#44; Erythematous-violaceous papules with a lichenoid sheen on the backs of the hands and fingers&#46; Bottom left&#44; Shiny palmar keratoderma&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 51-year-old man with a history of morbid obesity and smoking&#44; who reported having recently taken medication&#44; visited the emergency department with a highly pruritic rash that had appeared 2 months earlier and had spread to practically the entire body area&#46; Physical examination revealed erythroderma consisting of the convergence of multiple erythematous-violaceous papules&#44; some with a lichenoid sheen&#44; accompanied by palmoplantar keratoderma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The facial area was spared&#44; together with some areas of skin on the lower part of the abdomen&#46; Several fingernails showed trachyonychia and onychorrhexis&#46; No abnormalities were observed in the oral or genital mucosa&#46; The patient&#8217;s general condition was good&#44; with no symptoms in other organs or systems&#44; no enlarged lymph nodes&#44; and no fever&#46; Due to the intense pruritus&#44; the patient had received treatment in primary care with 5&#37; topical permethrin and methylprednisolone at low doses&#44; with no improvement&#46; No other family members suffered from pruritus&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A punch biopsy was performed&#44; and histology revealed intense lichenoid interface dermatitis&#44; with lymphocyte infiltrate with no eosinophils or plasma cells&#44; with apoptotic Civatte bodies in the basement layer and absence of parakeratosis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; A general analysis was ordered &#40;blood count&#44; biochemistry&#44; renal function&#44; liver function&#44; and lipid profile&#41; with normal results&#46; Serology for HVB&#44; HVC&#44; HIV&#44; and syphilis&#44; and antinuclear antibody determination&#44; anti-SSA-Ro&#44; and anti-SSB-La were negative&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Given the results of the general analysis and while waiting for the other additional tests&#44; treatment with cyclosporin &#40;400&#8239;mg&#47;24&#8239;h&#41; was instated&#44; as its use was not contraindicated and covered other potential causes of erythroderma&#44; such as atopic dermatitis and psoriasis&#46; After a week&#44; the patient reported notable improvement of the lesions&#44; with complete disappearance of the pruritus&#46; A month later&#44; only residual hyperpigmentation was observable &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; It was possible to suspend medication and the patient remained without signs of recurrence after 6 months of follow-up&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Because the patient stated that he had not previously taken or applied drugs or been exposed to toxins&#44; and based on the clinical and pathology findings&#44; a diagnosis was made of erythrodermic lichen planus&#44; a very rare variety of both lichen planus and erythroderma&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Lichen planus or an extensive lichenoid drug reaction must be taken into account in the differential diagnosis of erythroderma&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> The presence of lesions with a lichenoid sheen in the habitual locations &#40;wrists and&#47;or ankles&#41; and the blue-violaceous color can provide clinical guidance that the erythroderma is due to a lichen planus&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The distinction between an extensive lichenoid drug reaction &#40;ELDR&#41; and an erythrodermic lichen planus &#40;ELP&#41; may be difficult to establish&#46; ELDR is secondary to the use of drugs and it is therefore important when taking the patient&#8217;s history to inquire about previous ingested or topical drugs or other substances&#46; These signs and symptoms appear mainly on the torso&#44; do not usually involve the ankles and wrists &#40;at least initially&#41;&#44; and may present an eczematous or psoriasiform appearance&#44; with a photosensitive or symmetrical pattern&#46; Histology may reveal eosinophils and plasma cells&#44; which are much less common in cases of ELP&#44; together with parakeratosis and cytoid bodies in the upper layers of the epidermis&#44; which are also rare in ELP&#46; ELDR does not usually present Wickham striae when examined using dermoscopy&#46; ELP&#44; however&#44; tends to initially appear in the typical areas&#44; is not distributed in areas exposed to sunlight&#44; and more frequently involves the mucosa&#46; Lichenoid reactions have been reported after use of nonsteroidal anti-inflammatory drugs&#44; antihypertensive drugs &#40;angiotensin-converting enzyme inhibitors&#41;&#44; antifungal agents &#40;ketoconazole&#41;&#44; antiretroviral drugs&#44; antibiotics &#40;tetracyclines&#41;&#44; beta-blockers &#40;propanolol&#41;&#44; antimalarials&#44; cytostatic drugs&#44; tuberculostatic agents &#40;ethambutol&#41;&#44; diuretics &#40;thiazides&#41;&#44; anticonvulsives &#40;carbamazepine&#41;&#44; gold and lithium salts&#44; heavy metals&#44; hypouricemic agents &#40;alopurinol&#41;&#44; hypoglycemic agents &#40;sulfonylureas&#41;&#44; thyrosine kinase inhibitors&#44; anti-TNF drugs&#44; and others &#40;methyldopa&#44; penicillamine&#44; diltiazem&#44; chlorpromazine&#44; etc&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In the case of our patient&#44; no drugs prior to the rash were identified&#46; Moreover&#44; the response to cyclosporin was excellent&#44; with no relapse when the drug was suspended&#46; This drug has been used sporadically and successfully in lichen planus<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and its use may be considered to achieve rapid control of symptoms when lesions are very extensive&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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ISSN: 15782190
Original language: English
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Idiomas
Actas Dermo-Sifiliográficas
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?