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
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 article reports a clinically and histopathologically detailed case of oral lichenoid lesions associated with allopurinol therapy, that showed complete regression after the withdrawal of the drug
Summary
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. This article reports a clinically and histopathologically detailed case of oral lichenoid lesions associated with allopurinol therapy, that showed complete regression after the withdrawal of the drug. It is considered as the first line preventative treatment of chronic gout worldwide. The clinical presentation in all reported cases was painful oral ulcerations. In all reported cases, was that of erosive lichen planus. The latter was said to be consistent with lichen planus without further details
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