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Lichenoid and granulomatous dermatitis.

C M Magro1, A N Crowson

  • 1Department of Pathology, Cell Biology, and Anatomy, Medical College of Thomas Jefferson University, Philadelphia, PA, USA.

International Journal of Dermatology
|February 26, 2000
PubMed
Summary
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This study identifies a novel lichenoid dermatitis with granulomatous inflammation, often linked to drug reactions, infections, or underlying medical conditions like rheumatoid arthritis. It highlights diverse clinical presentations and histopathological patterns.

Area of Science:

  • Dermatopathology
  • Immunodermatology
  • Histopathology

Background:

  • Lichenoid eruptions are characterized by band-like lymphocytic infiltrates.
  • Traditional lichenoid eruptions include lichen planus, drug reactions, syphilis, and collagen vascular diseases.
  • A novel form of lichenoid dermatitis with a granulomatous component is described.

Purpose of the Study:

  • To characterize a novel lichenoid dermatitis with a granulomatous component.
  • To identify potential triggers and associated medical illnesses.
  • To elucidate the diverse clinical and histopathological features.

Main Methods:

  • Retrospective analysis of 40 skin biopsies over 4 years.
  • Biopsies showed band-like lymphocytic infiltrate with granulomatous inflammation.

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  • Clinical correlation with patient history to identify triggers and comorbidities.
  • Main Results:

    • Diverse clinical presentations included lichenoid dermatitis, linear eruptions, vasculitis, annular erythema, and erythroderma.
    • Identified drug etiology in 14 cases (antibiotics, lipid-lowering agents, etc.).
    • Microbial triggers implicated in 12 patients (herpes zoster, EBV, M. tuberculosis, etc.).
    • Other causes included hepatobiliary disease, rheumatoid arthritis, CTCL, and idiopathic disorders.
    • Histopathological patterns included histiocytic aggregates, granulomata, diffuse interstitial patterns, giant cells, and granulomatous vasculitis.

    Conclusions:

    • Cutaneous lichenoid and granulomatous reactions can be associated with various systemic conditions.
    • Potential triggers include hepatobiliary disease, endocrinopathy, rheumatoid arthritis, Crohn's disease, infections, and drug reactions.
    • Idiopathic lichenoid disorders account for one-fifth of cases.
    • Lymphoproliferative disease or pseudolymphomatous drug reactions should be considered in cases with lymphoid atypia.