Histologic examination of a hematoxylin-eosin–stained biopsy specimen revealed hyperkeratosis, wedge-shaped hypergranulosis, irregular acanthosis, degenerative keratinocytes (known as colloid or Civatte bodies), and a bandlike lymphohistiocytic infiltrate in the papillary dermis.
The patient reported a reduction in pruritus and softening of the lesions after 1 week of treatment with topical clobetasol propionate ointment under occlusion. There was no change in the lesions after ramipril therapy was discontinued, as there are reports of an association between the use of angiotensin-converting enzyme inhibitors and lichenoid drug eruptions.1-3 A short course of 0.1% tacrolimus ointment had minimal effect. Six months after treatment with 0.1% tazarotene cream twice daily was initiated and the clobetasol therapy was discontinued, physical examination revealed significantly fewer lesions, poorly defined erythematous macules, and postinflammatory hyperpigmentation. The patient still reported the intermittent recurrence of new lesions 8 months after the initial treatment.