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March 14, 2012

Reticulated White Lip—Reply

Author Affiliations

Author Affiliations: Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania (englishjc@upmc.edu).

JAMA. 2012;307(10):1025-1026. doi:10.1001/jama.2012.284

In Reply: Lichenoid drug eruptions often have polymorphic, atypical presentations. In the case presented in our article, the patient also had violaceous papules and plaques on her palms and upper back. These lesions lacked the characteristic changes of lichen planus and raised the differential diagnosis of drug-induced subacute lupus erythematous (angiotensin-converting enzyme inhibitors are commonly responsible1), lupus erythematosus/lichen planus overlap syndrome, interstitial granulomatous drug reaction, and interstitial granulomatous dermatitis due to a drug (angiotensin-converting enzyme inhibitors are commonly implicated2). In addition, discoid lupus was a diagnostic consideration for the white striae on the patient's lips. It was for this reason that the patient's primary care physician referred her for consultation and eventual skin biopsy. Histological findings were helpful in supporting the clinical diagnosis of lichenoid drug eruption. Depending on the particular clinical presentation of lichenoid drug eruption, the differential diagnosis may also include a number of other conditions such as lichen sclerosus, psoriasis, discoid lupus, graft-vs-host disease, and secondary syphilis.

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