Lichenoid photoeruptions in human immunodeficiency virus infection

The clinical features of lichenoid eruptions in the setting of human immunodeficiency virus (HIV) infection are poorly described. Idiopathic lichen planus is rarely reported. All patients (n = 32) with a histologic diagnosis of a lichenoid eruption or photodermatitis at the University of California, San Francisco, over a 15-month period were reviewed and studied.

Twelve of the 32 patients were HIV infected, and all 12 had photodistributed eruptions. Ten of 12 patients had received photosensitizing medication (usually nonsteroidal anti-inflammatory drugs or sulfamethoxazole/trimethoprim) at the onset of eruption. Most patients were black (10 of 12), and all had acquired immunodeficiency syndrome and a helper T-cell count of less than 50 cells per cubic milliliter. Nine patients had lichenoid eruptions, two showed histopathologic features of lichen niditus, and one had a photodistributed subacute dermatitis. Two patients with lichenoid eruptions developed marked depigmentation. No cases of lichen planus were found in HIV-infected persons.

Lichenoid photoeruptions are seen in advanced HIV disease (CD4, < 0.05 x 10(9)L), and black patients are disproportionately affected. Idiopathic lichen planus in HIV-infected patients seems to be less common than lichenoid photoeruptions. Previously reported cases of idiopathic lichen planus in HIV-infected patients may represent lichenoid photodermatitis.