Allopurinol-Induced Oral Lichenoid Drug Reaction with Complete Regression after Drug Withdrawal

Alexandre Perez,Tommaso Lombardi,Benjamin Lazzarotto,Jean-Pierre Carrel

doi:10.3390/dermatopathology7010004

Abstract

Background: Lichen planus is a chronic mucocutaneous inflammatory disease. Oral manifestations are common, and may remain exclusive to the oral mucosa without involvement of the skin or other mucosae. A differential diagnosis includes oral lichenoid drug reactions. Allopurinol, which is the first line hypo-uricemic treatment, is often quoted as being a possible offending drug, though oral reactions have rarely been reported. Case presentation: We describe a 59-year-old male gout patient, successfully treated with allopurinol, who developed acute onset of oral lichenoid lesions, involving bilaterally the buccal mucosa, the tongue and the labial mucosa. Histopathology was consistent with a lichen planus or a drug-induced lichenoid reaction. Improvement of the patient’s condition after withdrawal of allopurinol confirmed the lichenoid nature of the lesion. Remission was complete after a few weeks. Discussion: Although unusual, allopurinol may induce a lichenoid drug reaction. These reactions may mimic clinically and histopathologically idiopathic lichen planus. Improvement or complete regression of the lesions may be attempted to confirm the diagnosis. According to the latest WHO recommendations, these lesions have a potential for malignant transformation.

Highlights

Lichen planus is a common chronic inflammatory disorder, affecting the skin, oral and genital mucosa, scalp and nails
Case presentation: We describe a 59-year-old male gout patient, successfully treated with allopurinol, who developed acute onset of oral lichenoid lesions, involving bilaterally the buccal mucosa, the tongue and the labial mucosa
Allopurinol stands beside many classes of drugs involved, such as nonsteroidal anti-inflammatory drugs (NSAIDs), B-blockers, ACE inhibitors, thiazide diuretics as well as some antibiotics [3]

Summary

Introduction

Lichen planus is a common chronic inflammatory disorder, affecting the skin, oral and genital mucosa, scalp and nails. Allopurinol stands beside many classes of drugs involved, such as nonsteroidal anti-inflammatory drugs (NSAIDs), B-blockers, ACE inhibitors, thiazide diuretics as well as some antibiotics [3]. This anti-gout drug is often quoted but only a few reports are described in the literature. Improvement of the patient's condition after withdrawal of allopurinol confirmed the lichenoid nature of the lesion. Discussion: unusual, allopurinol may induce a lichenoid drug reaction These reactions may mimic clinically and histopathologically idiopathic lichen planus. Histopathology was consistent with a lichen planus or a drug-induced lichenoid reaction.

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Conclusion