Radiation induced lichen planus - an uncommon side effect

Cutaneous lichen planus is classically characterized by violaceous, pruritic, planar papules and plaques, most commonly affecting the extremities. Lichen planus following radiation therapy is extremely rare and lichen planus following radiation therapy for prostate carcinoma has not been previously reported in the literature. We report a 66-year-old man who presented to the dermatology clinic with a symmetric pruritic eruption affecting the pelvic and gluteal region within two months of radiation therapy targeting the prostate and pelvic lymph nodes for prostate adenocarcinoma. The patient did not have a prior history of lichen planus. Physical examination demonstrated well demarcated, violaceous papules and plaques in a circumferential band-like distribution on the bilateral gluteal, lumbosacral, and pelvic region. In addition, he had a few discrete lesions on the calves and dorsal feet. Punch biopsy revealed an acanthotic epidermis with "saw-tooth" rete ridges and a lichenoid inflammatory infiltrate. A diagnosis of hypertrophic lichen planus was made, reinforcing the importance for clinicians to recognize radiation therapy as a risk factor for developing lichen planus despite no prior history of lichen planus

Graves′ Disease With Pretibial Myxoedema

A 45 year old man presented with asymptomatic skin coloured nodules, erythmatous plaques on both legs along with features of thyrotoxicosis. Investigations confirmed the diagnosis of Graves†disease with pretibial mayxoedema. The patient became euthyroid with carbimazole and the skin lesions responded partially to antithyoroid treatment and local corticosteroids

Nilontinib induced keratosis pilaris atrophicans

Keratosis pilaris (KP) is a disorder of follicular keratinization that is characterized by keratin plugs in the hair follicles with surrounding erythema. A 46-year-old man with chronic myelogenous leukemia (CML) was started on nilotinib, a second generation tyrosine kinase inhibitor (TKI). Two months later the patient noticed red bumps on the skin and patchy hair loss on the arms, chest, shoulders, back, and legs. Cutaneous reactions to nilotinib are the most frequent non-hematologic adverse effects reported. However, it is important to distinguish KP-like eruptions from more severe drug hypersensitivity eruptions, which can necessitate discontinuing the medication. Also, it is important to classify the cutaneous eruptions in patients on TKI according to the morphology instead of labeling them all as “chemotherapy eruption” to be able to better manage these adverse effects

Post-zoster fibroelastolytic papulosis: an example of Wolf isotopic response

Wolf isotopic response describes the onset of a new dermatosis at the site of a previous, healed dermatosis, which is usually a herpes zoster infection. Fibroelastolytic papulosis is a poorly understood elastolytic condition defined by a loss of elastic fibers specific to the papillary dermis. The present report describes a case of fibroelastolytic papulosis with onset following herpes zoster infection. This association provides new evidence for an immunopathogenic origin for fibroelastolytic papulosis and further supports current theories of the pathogenesis of Wolf isotopic response

Acantholytic Pityriasis Rubra Pilaris Associated with Imiquimod 3.75% Application

Imiquimod is an immunomodulator with both antitumor and antiviral properties. It is currently available in two cream formulations as Aldara (imiquimod 5%) and the newly approved Zyclara (imiquimod 3.75%). Imiquimod has been associated with localized erythema, crusting, and scaling at the site of application. However, more severe generalized skin eruptions including erythema multiforme, psoriasis, and hyperpigmentation have been described. The newly approved imiquimod 3.75% cream is a presumably safer alternative due to its lower concentration. This paper describes the development of generalized acantholytic pityriasis rubra pilaris after the treatment of an actinic keratosis on the forehead with imiquimod 3.75% cream

Infection or allergy? The multifaceted nature of vulvar dermatoses

AbstractChronic dermatitis or pruritus affecting the female genital and perianal skin can be challenging to properly diagnose and manage. The differential diagnosis generally includes allergic, inflammatory, infectious, and neoplastic conditions. We report the case of a 52-year-old woman with a 6-month history of a progressive, debilitating vulvar and perianal rash that highlights the multifaceted nature of female genital dermatoses

Radiation induced lichen planus - an uncommon side effect

Cutaneous lichen planus is classically characterized by violaceous, pruritic, planar papules and plaques, most commonly affecting the extremities. Lichen planus following radiation therapy is extremely rare and lichen planus following radiation therapy for prostate carcinoma has not been previously reported in the literature. We report a 66-year-old man who presented to the dermatology clinic with a symmetric pruritic eruption affecting the pelvic and gluteal region within two months of radiation therapy targeting the prostate and pelvic lymph nodes for prostate adenocarcinoma. The patient did not have a prior history of lichen planus. Physical examination demonstrated well demarcated, violaceous papules and plaques in a circumferential band-like distribution on the bilateral gluteal, lumbosacral, and pelvic region. In addition, he had a few discrete lesions on the calves and dorsal feet. Punch biopsy revealed an acanthotic epidermis with "saw-tooth" rete ridges and a lichenoid inflammatory infiltrate. A diagnosis of hypertrophic lichen planus was made, reinforcing the importance for clinicians to recognize radiation therapy as a risk factor for developing lichen planus despite no prior history of lichen planus