What blood pressure medications cause lichen planus?

October 7, 2025 •

4 min read

Antihypertensive medications are among the most common class of drugs implicated in causing lichenoid drug eruptions (LDE), a condition that mimics idiopathic lichen planus [1.2.2]. Understanding what blood pressure medications cause lichen planus is crucial for both patients and healthcare providers for accurate diagnosis and management.

Quick Summary

A detailed examination of the link between common antihypertensive drugs and the development of lichenoid drug eruptions. This overview covers specific medication classes, symptoms, diagnosis, and treatment approaches for this adverse reaction.

Key Points

Antihypertensives are a leading cause: Blood pressure medications are one of the most common drug classes to trigger lichenoid drug eruptions (LDE) [1.2.2].
Main culprits: The most frequently implicated classes are Beta-Blockers, ACE Inhibitors, and Thiazide Diuretics [1.5.2, 1.6.1].
Long latency period: The time from starting a medication to the rash appearing can be long, from weeks to over a year, which complicates diagnosis [1.2.3, 1.2.8].
Diagnosis is key: Diagnosis relies on medication history, clinical examination, and often a skin biopsy. LDEs can mimic idiopathic lichen planus but may be more widespread or sun-sensitive [1.2.2].
Withdrawal is treatment: The primary management strategy is to stop the suspected medication, which typically leads to the resolution of the rash over weeks to months [1.2.2, 1.3.5].
Other classes involved: Angiotensin II Receptor Blockers (ARBs) and Calcium Channel Blockers (CCBs) are also associated with LDE, though less frequently than the main three classes [1.2.8, 1.7.4].
Symptoms can be managed: While waiting for the rash to resolve after drug cessation, topical corticosteroids can be used to manage itching and inflammation [1.3.4].

Understanding Lichen Planus and Drug-Induced Eruptions

Lichen planus (LP) is a chronic inflammatory condition that can affect the skin, mucous membranes (like the mouth), nails, and scalp [1.4.2, 1.6.6]. The classic signs are often described by the "Six P's": planar (flat-topped), purple, polygonal, pruritic (itchy), papules, and plaques [1.6.6]. While many cases are idiopathic (meaning the cause is unknown), a significant number are triggered by medications. This is known as a lichenoid drug eruption (LDE) or drug-induced lichen planus [1.3.2].

Antihypertensive drugs are one of the most frequently reported triggers for LDEs [1.2.2, 1.3.2]. A key challenge is the long and variable latent period between starting a medication and the appearance of the rash, which can range from a few weeks to over a year, making it difficult to pinpoint the culprit drug [1.2.3, 1.2.8].

Distinguishing LDE from Idiopathic Lichen Planus

While clinically similar, there are subtle differences that can suggest a drug-induced cause. LDEs are often more widespread and symmetric, with a tendency to appear in sun-exposed areas [1.2.2]. They may also appear more eczematous or psoriasiform. Histologically, a skin biopsy in LDE cases may show a higher presence of certain inflammatory cells, like eosinophils, compared to idiopathic LP [1.4.7].

Key Antihypertensive Classes Linked to Lichen Planus

Several classes of blood pressure medications have been associated with lichenoid eruptions. The most commonly cited are Beta-Blockers, ACE Inhibitors, and Thiazide Diuretics [1.5.2, 1.6.1].

Beta-Blockers

There is sufficient evidence that beta-blockers play a role in causing LDE [1.4.5]. Long-term use, in particular, has been associated with an increased risk, with some studies noting the onset after 3-4 years of therapy [1.4.2]. The mechanism is thought to involve the modulation of the immune system [1.4.2].

Commonly Implicated Beta-Blockers:

Propranolol [1.2.1, 1.4.2]
Labetalol [1.2.1, 1.4.7]
Metoprolol [1.2.4, 1.4.2]
Bisoprolol [1.2.4, 1.4.2]
Atenolol [1.4.2]
Nebivolol [1.4.3]

Angiotensin-Converting Enzyme (ACE) Inhibitors

ACE inhibitors are another class frequently associated with classic cutaneous lichenoid eruptions [1.5.2]. Specific drugs like captopril and enalapril are often mentioned in case reports [1.2.1, 1.2.2]. One case even reported ramipril-associated lichen planus pemphigoides, a rare blistering variant [1.5.5].

Commonly Implicated ACE Inhibitors:

Captopril [1.2.1, 1.7.1]
Enalapril [1.2.1, 1.5.1]
Ramipril [1.5.5]

Thiazide Diuretics

Thiazide diuretics, such as hydrochlorothiazide (HCTZ), are well-documented as a cause of LDE [1.2.1, 1.6.1]. These reactions are often photodistributed, meaning they appear on skin exposed to sunlight [1.6.3, 1.6.5]. The time from starting the drug to the eruption can be long; one case reported a latent period of six months with hydrochlorothiazide [1.2.2].

Commonly Implicated Thiazide Diuretics:

Hydrochlorothiazide (HCTZ) [1.2.1, 1.2.4]
Chlorothiazide [1.2.1]

Other Implicated Antihypertensives

While the above classes are the most common, other blood pressure medications have also been linked to lichenoid reactions.

Angiotensin II Receptor Blockers (ARBs): Though less frequent, ARBs like losartan, valsartan, and candesartan have been implicated in causing LDE [1.2.2, 1.2.8, 1.3.8].
Calcium Channel Blockers (CCBs): Medications like amlodipine and nifedipine have been associated with LDEs, though reports are less common than for beta-blockers or ACE inhibitors [1.2.2, 1.3.2, 1.7.5]. One study noted CCBs as a frequent class of medication taken by patients with oral lichenoid lesions, following beta-blockers and ARBs [1.7.4].
Methyldopa: This older antihypertensive drug is also recognized as a cause [1.2.1, 1.4.5].

Comparison of Antihypertensive Classes and Lichen Planus Risk


Medication Class	Common Examples	Reported Association with Lichen Planus	Key Characteristics of Eruption
Beta-Blockers	Propranolol, Labetalol, Metoprolol	Sufficient evidence of a causal role, especially with long-term use [1.4.5, 1.4.2].	Often classic LP-like papules; can be widespread [1.4.7].
ACE Inhibitors	Captopril, Enalapril, Ramipril	Frequently associated with cutaneous lichenoid eruptions [1.5.2].	Classic lichenoid presentation, can be photosensitive [1.2.2, 1.5.1].
Thiazide Diuretics	Hydrochlorothiazide (HCTZ)	Well-documented cause, often associated with photosensitivity [1.6.1, 1.6.5].	Typically photodistributed (appears on sun-exposed skin) [1.6.3].
ARBs	Losartan, Valsartan, Candesartan	Less frequently reported but cases exist; candesartan has a very long latency [1.2.8, 1.3.8].	Can mimic idiopathic LP; long latency period [1.2.8].
Calcium Channel Blockers	Amlodipine, Nifedipine	Associated, but reports are less frequent than other classes [1.3.2, 1.7.4].	May present as a rare perforating lichenoid reaction [1.7.7].

Management and Diagnosis

The primary step in managing a suspected LDE is to identify and withdraw the offending drug [1.2.2]. Diagnosis involves a thorough review of the patient's medication history, the clinical appearance of the rash, and often a skin biopsy to confirm the lichenoid pattern and rule out other conditions [1.2.1].

After stopping the medication, the eruption typically resolves, although this can take several weeks to months [1.3.5]. Post-inflammatory hyperpigmentation (darkening of the skin where the rash was) is a common after-effect. For symptomatic relief of itching and inflammation, doctors may prescribe topical corticosteroids [1.3.4]. In severe cases, systemic steroids or other immunosuppressants may be used [1.2.6].

Conclusion

Multiple classes of blood pressure medications, most notably beta-blockers, ACE inhibitors, and thiazide diuretics, are known to cause lichenoid drug eruptions. These reactions can be challenging to diagnose due to a variable and often long delay between starting the drug and the onset of symptoms. A careful medication history is essential for any patient presenting with new-onset lichen planus. Discontinuation of the suspected drug is the cornerstone of treatment and usually leads to resolution of the rash.

For more detailed information, DermNet provides a comprehensive overview of lichenoid drug eruptions.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment.

Frequently Asked Questions

Beta-blockers (like propranolol and labetalol), ACE inhibitors (like captopril and enalapril), and thiazide diuretics (like hydrochlorothiazide) are the most commonly reported blood pressure medications to cause lichenoid drug eruptions [1.2.1, 1.5.2, 1.6.1].

The latent period is highly variable. A lichenoid drug eruption can appear anywhere from a few weeks to over a year after starting the medication [1.2.3, 1.2.8]. In some cases, the average latency is around 2-3 months [1.2.3].

Yes, in most cases of drug-induced lichen planus, the rash will resolve after the offending medication is discontinued. However, complete resolution can take several weeks to months [1.3.5].

Drug-induced lichenoid eruptions often have a more widespread and symmetric distribution, may favor sun-exposed areas, and can look more eczematous. Classic lichen planus is more likely to involve flexural sites and show Wickham's striae (fine white lines on the lesions) [1.2.2].

Yes, calcium channel blockers, including amlodipine and nifedipine, have been associated with lichenoid reactions, although they are reported less frequently than beta-blockers or ACE inhibitors [1.2.2, 1.3.2, 1.7.4].

The most important step is to stop taking the medication that is causing the reaction, as advised by a doctor. To manage symptoms like itching, physicians may prescribe topical corticosteroids [1.2.2, 1.3.4].

No, you should not stop any prescribed medication without first consulting your healthcare provider. They can properly diagnose the rash and determine the safest course of action, which may involve switching to an alternative medication.