Drug Induced (Acetylsalicylic Acid/ASS) Pityriasis Lichenoides Chronica: First Report In The Medical Literature!?

Abstract

According to the literature data, pityriasis lichenoides chronica (PLC) can also be considered as a drug-induced disease among many other possible causes, e.g. parainfectious!. Currently, the following medications are described as possible triggers among drugs: antidepressants and statins, adalimumab, HMG-CoA reductase inhibitors, pemetrexed and infliximab. We present a 82-year-old man with ischemic cerebral infarction on the occasion of which he accepts acetylsalicylic acid 100mg (0-0-1) since December 2018. According to the patient, immediately (or about 2 months) after starting medication with acetylsalicylic acid, he observed raised itchy lesions on the skin of the trunk. During the dermatological examination, presence of disseminated erythemo-papulous, partially lichenoid lesions, excoriations and fine desquamation was established on the skin of the trunk and the extremities. Possibility for pityriasis lichenoides chronica, parapsoriasis small plaque form or lichen planus was considered. A skin biopsy was taken, and histological examination revealed evidence for pityriasis lichenoides chronica. Due to the suspicion for drug induced pityriasis, acetylsalicylic acid treatment was discontinued and replaced with clopidogrel. After a period of 6 weeks, we observed a good clinical response and reversal of the skin symptoms. We present the first case of acetylsalicylic acid induced PLC think the conclusion with certainty is not possible. Only the disappearance after change of medication does not prove the induction by ASS. In case of recurrence of the skin changes after reexposition with ASS could prove the causative role of ASS. Patients with this type of disease should be closely monitored because of the possibility for development of lymphoproliferative disorders.