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Unusual facial rash of 3 months
Last reviewed: December 2022
Author: Dr Ian Coulson, Consultant Dermatologist and Editor-in-Chief, 2022.
Edited by the DermNet content department
Background
This 65-year-old man has developed an unusual rash on his face. It has been present for 3 months. He is on medication for diabetes and nocturnal cramps.
How would you classify this eruption?
The eruption has a violaceous hue, and the area covered by his hat and shirt (below the collar line) is spared. These features together suggest a photolichenoid eruption.
What would you expect to see on histology?
Biopsy will show epidermal hyperkeratosis, hypergranulosis, basal cell liquefactive degeneration, and a dense upper dermal band-like lymphocytic infiltrate.
For more information see lichenoid drug eruption pathology.
What is the likely cause?
Photolichenoid eruptions are usually due to medication, and quinine is a well-known cause. Some HIV medications, thiazide diuretics, and docetaxel are other incriminated drugs.
How would you manage this patient?
Stop suspect medicines (eg, quinine) and use a sunscreen with a good UVA spectrum of protection, as well as other general sun protection measures. A potent topical steroid will need to be used for a short period of time to suppress the lichenoid reaction.