Denosumab and lichen planus: two cases

Oral and non-oral lichen planus show genetic heterogeneity and differential risk for autoimmune disease and oral cancer

“… 67 The risk of lichen planus is associated with genetically mediated lower expression of TNFSF11 , and intriguingly, several case reports suggest lichenoid reaction may be a rarely observed side effect of denosumab, a RANKL (encoded by TNFSF11 ) inhibitor that has been widely utilized for more than a decade as a treatment for osteoporosis. 68 , 69 The genetic evidence here suggests a possibly similar mechanism for variants at TNFSF11 that correlate with lower levels of TNFSF11 and associate with a higher risk for LP. However, in our cohort, we do not see significant excess risk following denosumab treatment; 51/7,678 LP-affected individuals had denosumab in the year preceding their first LP diagnosis, compared to 2,261/367,349 sex- and birth year-matched control subjects ( p = 0.56, OR = 1.08).…”

The diverse landscape of dermatologic toxicities of non‐immune checkpoint inhibitor monoclonal antibody‐based cancer therapy

“…Infrequently, alopecia areata has occurred in some cases treated with denosumab 25–27 . Rarer dermatologic toxicities include lichenoid dermatitis (Figure 3), lichen planus, 26,51 vasculitis, 82 and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome 43 . One patient had an extremely pruritic lichenoid drug eruption, with histopathology showing focal vacuolar interface changes and perivascular lymphohistiocytic infiltrates with eosinophils 52 .…”

Lichen Planus After Denosumab

“…Lichenoid reactions secondary to denosumab therapy have been reported in adult patients with osteoporosis [7][8][9]. This is the first case of a lichenoid reaction to denosumab in a pediatric patient and with an off-label indication.…”