Pirfenidone-Induced Lichenoid Drug Eruption in a Patient with Idiopathic Lung Fibrosis

Jeong, In Jae; Lee, Hee Jung; Kim, Dong Hyun

doi:10.5021/ad.2019.31.1.103

Cited by 8 publications

(5 citation statements)

References 6 publications

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“…Two cases (0.62%) for each of the following drugs were identified: Thioridazine, leflunomide, ibuprofen, sildenafil and ursodeoxycholic acid 124–133 . Single cases of a large number of additional drugs were identified as listed in Table S1 33,77,86,134–169 …”

Section: Resultsmentioning

confidence: 99%

Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications

Maul

Guillet

Oschmann

et al. 2023

Acad Dermatol Venereol

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Cutaneous lichenoid drug eruptions (LDE) are adverse drug reactions (ADR) characterized by symmetric, erythematous, violaceous papules reminiscent but rarely fully characteristic of lichen planus (LP). We aimed to analyse the literature describing cases of LDE within the last 20 years to provide additional insight into culprit drugs, typical latency to onset of the eruption, the spectrum of clinical presentations, severity and management. A literature search was conducted in MEDLINE between January 2000 and 27 January 2021. The keywords ‘lichenoid drug rash’ and ‘lichenoid drug eruption’ were used. Cases were included if LDE diagnosis was made, and culprit drugs were identified. A total of 323 cases with LDE were identified from 163 published case reports and studies. The mean patient age was 58.5 years (1 month to 92 years), and 135 patients (41.8%) were female. Checkpoint inhibitors (CKI) were the most frequently reported culprit drugs (136 cases; 42.1%), followed by tyrosine kinase inhibitors (TKI) (39 cases; 12.0%) and anti‐TNF‐α‐monoclonal antibodies (13 cases; 4.0%). The latency between initiation of the drug and manifestation was 15.7 weeks (range: 0.1–208 weeks). After discontinuing the culprit drug, the median time to resolution was 14.2 weeks (range: 0.71–416 weeks). One hundred thirty‐six patients (42.1%) were treated with topical, and 54 patients (16.7%) with systemic glucocorticoids. Overall, we conclude that, albeit rare, LDE is challenging to diagnose ADR induced by mostly CKI, TKI, and biologics. Treatment modalities resemble that of lichen planus, and the culprit drugs had to be discontinued in only 26%, which is low compared with other types of adverse drug reactions. This is probably due to the low risk of aggravation (e.g. toxic epidermal necrolysis) if the drug is continued and the benefit/risk ratio favouring the drug, as is often the case in cancer therapy.

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Section: Resultsmentioning

confidence: 99%

Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications

Maul

Guillet

Oschmann

et al. 2023

Acad Dermatol Venereol

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“…Pirfenidone can cause phototoxicity and photoallergic reactions. In total, 18 patients experienced phototoxic reactions (3 confirmed by photosensitivity test) and 4 patients experienced photoallergic reactions in our study 22,25,28 …”

Section: Discussionmentioning

confidence: 70%

“…A total of 22 patients from 20 studies were included (Table 1). 10–28 Of these patients, 15 patients were males, and 2 patients were females. The sex of 5 patients was not described in the articles.…”

Section: Resultsmentioning

confidence: 99%

Retrospective analysis of skin photosensitivity induced by pirfenidone

Wang

Sun

et al. 2021

Clinical Pharmacy Therapeu

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What is known and objective Knowledge regarding the association between photosensitivity and pirfenidone is based mainly on case reports. The purpose of this article was to evaluate the clinical characteristics of photosensitivity associated with pirfenidone. Methods We collected studies on photosensitivity induced by pirfenidone published from 2008 to 31 August 2021 in Chinese and English for a retrospective analysis. Results and discussion The median age was 70 years (range 57–80) in 22 patients with pirfenidone‐induced photosensitivity. The dose at the onset of symptoms ranged from 600 to 2403 mg for the treatment of idiopathic pulmonary fibrosis. Pirfenidone‐induced photosensitivity occurred within 1 week in some patients and up to 8 months in others. The most common clinical manifestation of photosensitivity caused by pirfenidone was itching on body parts exposed to sunlight (back of hands, face, neck, and limbs) in 15 patients followed by erythema in 13 patients. Histopathological examination revealed necrotic keratinocytes, lymphocytic inflammatory cell infiltrate, hyperkeratosis and liquefaction degeneration in 5 patients. The photosensitivity test showed a markedly decreased minimum erythema dose (MED) of 7–228 mJ/cm2 UV‐B in 4 patients and 4.86–12 J/cm2 UV‐A in 5 patients. The clinical symptoms were significantly improved or completely relieved with a median time of 4 weeks (range 1–8) after drug withdrawal, dose reduction or systemic and topical glucocorticoid therapy. What is new and conclusion Clinicians should be aware of the potential phototoxic effects of pirfenidone and should inform patients to take pirfenidone during (or after) a meal, avoid sun exposure, wear protective clothing, and apply broad‐spectrum sunscreen with high ultraviolet UVA and UVB protection.

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“…To date, numerous cases of LDE due to various drugs and pirfenidone-associated photosensitivity have been reported 1 3 6 9 10 . However, to our knowledge, only a case of pirfenidone-induced LDE has been reported 11 . Herein, we report a case of pirfenidone-induced LDE so that clinicians can be aware of the possibility of LDE when using pirfenidone.…”

Section: Discussionmentioning

confidence: 88%

A Case Report of Pirfenidone-Induced Lichenoid Drug Eruption in a Patient with Idiopathic Pulmonary Fibrosis

et al. 2022

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Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and lethal lung disease characterized by progressive dyspnea and irreversible loss of lung function. Pirfenidone is a novel anti-fibrotic and anti-inflammatory drug, which reduces deterioration in the lung function and prolongs progression-free survival in patients with IPF. However, it has adverse effects including gastrointestinal symptoms, hepatic dysfunction or skin photosensitivity, and rash. Lichenoid drug eruption (LDE) refers to lichen planus-like drug eruption usually presenting symmetric eczematous plaques with a purple hue. To date, numerous cases of LDE due to various drugs and pirfenidone-associated photosensitivity have been reported. However, a case of pirfenidone-induced LDE has been very rarely reported to our knowledge. Herein, is a case of pirfenidone-induced LDE so that clinicians can be aware of the possibility of LDE when using pirfenidone.

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Pirfenidone-Induced Lichenoid Drug Eruption in a Patient with Idiopathic Lung Fibrosis

Cited by 8 publications

References 6 publications

Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications

Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications

Retrospective analysis of skin photosensitivity induced by pirfenidone

A Case Report of Pirfenidone-Induced Lichenoid Drug Eruption in a Patient with Idiopathic Pulmonary Fibrosis

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