The Diagnosis of Lichen-planus-Like Contact Dermatitis to Chlorpheniramine Maleate

Abstract

In spite of the common use of the diagnostic category of lichen-planus-like contact dermatitis, we were unable to find established criteria for such a condition. An atypical distribution of otherwise typical lichen planus lesions is usually considered as a feature of a lichenoid eruption. When facing unusual or unexpected clinical features, it is always advisable to consider an adverse reaction to a medical intervention as a potential option. We report a lichen-planus-like eruption occurring after contact with a topical agent containing chlorpheniramine maleate. To our knowledge, this is the first reported case of lichen-planus-like contact dermatitis associated with chlorpheniramine maleate.

Case of allergic contact dermatitis due to a topical agent containing chlorpheniramine maleate, with a false‐negative patch test

“…Topical eye drops containing chlorpheniramine maleate have been shown to cause facial dermatitis 3 . A case of lichen planus‐like contact dermatitis to an antipruritic agent containing chlorpheniramine maleate has also been reported 11 . In our case, a patch test with chlorpheniramine maleate showed a positive reaction after 7 days of observation but was negative after 2 or 3 days.…”

“…3 A case of lichen planus-like contact dermatitis to an antipruritic agent containing chlorpheniramine maleate has also been reported. 11 In our case, a patch test with chlorpheniramine maleate showed a positive reaction after 7 days of observation but was negative after 2 or 3 days. Corticosteroids have been known as allergens eliciting delayed patch test reactions, and those phenomena are attributed to their antiinflammatory properties.…”

SARS CoV-2 Might Exploit Cells of the Innate Immune System to Induce the Novel Acute Immune Dysrhythmic Syndrome (n-AIDS) and Para COVID-19 Syndrome.

“…However, he was not counted among our COVID-19 patients due to insufficient suggestive criteria as he had declined to perform any further investigations and yet we recommended proper selfisolation while and after he was safely managed with our adopted COVID-19 protocol (Kelleni, 2021, January 19b). Notably, lichen planus and lichenoid eruptions have been previously described in some patients suffering from paraneoplastic pemphigus and suggested to be induced by dysregulated autoreactive T cell-mediated with subsequent B cell activation and humoral auto-immune responses (Bowen et al, 2000) and dysregulated CD8+ T cells have also been described in both diseases (Kuroda and Hisanaga, 2002) to be noted that half of hospitalized COVID-19 patients were reported to become, at least transiently, positive for some potentially pathogenic autoantibodies (Zuo et al, 2020) and COVID-19 has been described to induce several autoimmune diseases (Galeotti and Bayry, 2020). Interestingly, perivascular inflammatory lymphocytic infiltrate; 65% CD4+ and 35% CD8+ cells was described in the papillary dermis of a patient suffering from COVID-19 induced erythematous and pustular cutaneous rash and a direct SARS CoV-2 cytopathogenic effect on skin cells was suggested (Drak Alsibai et al, 2020).…”