Diagnosis: HIV-1–associated lichenoid photodrug eruption.
MICROSCOPIC FINDINGS AND CLINICAL COURSE
Parakeratosis, acanthosis, and scattered dyskeratotic cells were seen in the epidermis. A dermal lichenoid lymphocytic infiltrate with occasional eosinophils and pigment incontinence were also present.
Treatment consisted of the use of topical 0.05% fluocinonide cream and a broad-spectrum sunscreen, sun avoidance, and discontinuation of sulfamethoxazole-trimethoprim therapy. The lesions slowly resolved over several weeks. Postinflammatory hyperpigmentation was noted at involved sites during the resolution phase.
DISCUSSION
Lichenoid photoeruption is a rare dermatosis associated with advanced HIV disease. The clinical differential diagnosis includes idiopathic lichen planus, lichen planus actinicus, Kaposi sarcoma, and sarcoidosis.
In a retrospective review of 32 patients with a histologic diagnosis of lichen planus, lichenoid dermatitis, or photodermatitis seen over a 15-month period in the dermatology clinics of the University of California at San Francisco, Berger and Dhar1 identified a subset of 12 HIV-infected patients with initially photodistributed eruptions. Ten of the 12 patients were African American, and 10 were . . . [Full Text of this Article]
