Maul Julia-Tatjana, Guillet Carole, Oschmann Anna, Maul Lara Valeska, Meier-Schiesser Barbara, Stadler Pia-Charlotte, French Lars E, Kerl Katrin
Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
Faculty of Medicine, University of Zurich, Zurich, Switzerland.
J Eur Acad Dermatol Venereol. 2023 May;37(5):965-975. doi: 10.1111/jdv.18879. Epub 2023 Feb 4.
Cutaneous lichenoid drug eruptions (LDE) are adverse drug reactions (ADR) characterized by symmetric, erythematous, violaceous papules reminiscent but rarely fully characteristic of lichen planus (LP). We aimed to analyse the literature describing cases of LDE within the last 20 years to provide additional insight into culprit drugs, typical latency to onset of the eruption, the spectrum of clinical presentations, severity and management. A literature search was conducted in MEDLINE between January 2000 and 27 January 2021. The keywords 'lichenoid drug rash' and 'lichenoid drug eruption' were used. Cases were included if LDE diagnosis was made, and culprit drugs were identified. A total of 323 cases with LDE were identified from 163 published case reports and studies. The mean patient age was 58.5 years (1 month to 92 years), and 135 patients (41.8%) were female. Checkpoint inhibitors (CKI) were the most frequently reported culprit drugs (136 cases; 42.1%), followed by tyrosine kinase inhibitors (TKI) (39 cases; 12.0%) and anti-TNF-α-monoclonal antibodies (13 cases; 4.0%). The latency between initiation of the drug and manifestation was 15.7 weeks (range: 0.1-208 weeks). After discontinuing the culprit drug, the median time to resolution was 14.2 weeks (range: 0.71-416 weeks). One hundred thirty-six patients (42.1%) were treated with topical, and 54 patients (16.7%) with systemic glucocorticoids. Overall, we conclude that, albeit rare, LDE is challenging to diagnose ADR induced by mostly CKI, TKI, and biologics. Treatment modalities resemble that of lichen planus, and the culprit drugs had to be discontinued in only 26%, which is low compared with other types of adverse drug reactions. This is probably due to the low risk of aggravation (e.g. toxic epidermal necrolysis) if the drug is continued and the benefit/risk ratio favouring the drug, as is often the case in cancer therapy.
皮肤苔藓样药疹（LDE）是一种药物不良反应（ADR），其特征为对称性、红斑性、紫红色丘疹，类似扁平苔藓（LP），但很少具有其完全特征。我们旨在分析过去20年中描述LDE病例的文献，以进一步了解致病药物、皮疹发作的典型潜伏期、临床表现谱、严重程度及治疗方法。于2000年1月至2021年1月27日在MEDLINE数据库中进行文献检索。使用了关键词“苔藓样药疹”和“苔藓样药物性皮疹”。如果确诊为LDE且确定了致病药物，则纳入病例。从163篇发表的病例报告和研究中，共确定了323例LDE病例。患者的平均年龄为58.5岁（1个月至92岁），135例患者（41.8%）为女性。检查点抑制剂（CKI）是最常报告的致病药物（136例；42.1%），其次是酪氨酸激酶抑制剂（TKI）（39例；12.0%）和抗TNF-α单克隆抗体（13例；4.0%）。用药开始至出现症状的潜伏期为15.7周（范围：0.1 - 208周）。停用致病药物后，症状消退的中位时间为14.2周（范围：0.71 - 416周）。136例患者（42.1%）接受了局部治疗，54例患者（16.7%）接受了全身性糖皮质激素治疗。总体而言，我们得出结论，尽管LDE罕见，但诊断由大多数CKI、TKI和生物制剂引起的ADR具有挑战性。治疗方式与扁平苔藓相似，只有26%的患者必须停用致病药物，与其他类型的药物不良反应相比这一比例较低。这可能是因为继续用药时病情加重（如中毒性表皮坏死松解症）的风险较低，且药物的获益/风险比有利于药物，癌症治疗中经常如此。
