What Medications Can Trigger Lichen Planus?

October 9, 2025 •

3 min read

While many cases of lichen planus are idiopathic, or have no known cause, it is estimated that a significant portion can be triggered by medication, a condition known as a lichenoid drug eruption. Understanding what medications can trigger lichen planus is crucial for patients and clinicians to properly diagnose and manage the condition.

Quick Summary

A range of prescription drugs, including antihypertensives, NSAIDs, and antimalarials, can cause lichenoid drug eruptions that closely resemble lichen planus. Identifying the specific medication and discontinuing it is the primary treatment approach.

Key Points

Drug-Induced Reaction: A lichenoid drug eruption (LDE) is an adverse reaction to a medication that mimics the clinical and histological features of idiopathic lichen planus.
Common Culprits: Various drug classes can trigger LDEs, including cardiovascular medications (ACE inhibitors, beta-blockers, diuretics), NSAIDs, antimalarials, and anti-TNF-alpha agents.
Delayed Onset: The reaction can take weeks, months, or even years to appear after starting a new medication, making it difficult to identify.
Distinguishing Features: LDEs may show different rash distribution (e.g., widespread, photodistributed) and histological markers (e.g., eosinophils, parakeratosis) compared to idiopathic lichen planus.
Primary Treatment: The cornerstone of treatment is discontinuing the offending drug, which should only be done under medical supervision.
Symptom Management: Topical corticosteroids are typically used for symptomatic relief, with systemic corticosteroids reserved for more severe cases.

What is a Lichenoid Drug Eruption?

A lichenoid drug eruption (LDE) is an adverse skin reaction caused by medication that closely mimics idiopathic lichen planus (LP) in both clinical appearance and microscopic features. While LDE shares many characteristics with LP, certain features, such as rash distribution and timing, can provide clues to a drug-related cause. The reaction is thought to involve an abnormal T-cell-mediated immune response, where the drug alters the basal keratinocytes, triggering an immune system attack. The latency period between starting a medication and the onset of symptoms can be highly variable, ranging from a few weeks to more than a year.

Medications Commonly Associated with Lichenoid Reactions

A wide variety of medications have been linked to LDEs. Identifying the specific drug often requires careful review by a healthcare provider.

Cardiovascular Medications

ACE Inhibitors: Medications like captopril and enalapril are known triggers.
Beta-Blockers: Propranolol, metoprolol, and other beta-blockers can induce LDEs, especially with long-term use.
Diuretics: Thiazide diuretics and loop diuretics have been implicated.
Calcium Channel Blockers: Nifedipine and diltiazem have been associated with lichenoid reactions.

Anti-Inflammatory and Pain Management Drugs

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): A significant link has been found between NSAID use (such as naproxen and ibuprofen) and the development or aggravation of lichen planus.

Antimalarials

Hydroxychloroquine: This drug is a recognized trigger for LDE.

Biologics and Immunosuppressants

TNF-alpha Antagonists: Paradoxically, biologic agents like infliximab and adalimumab have been reported to cause lichenoid reactions.

Psychiatric and Neurological Medications

Anticonvulsants: Phenytoin and carbamazepine are linked to lichenoid eruptions.

Other Drug Classes

Oral Hypoglycemic Agents: Drugs used to manage type 2 diabetes can be a cause.
Anti-Tuberculosis Drugs: Medications like isoniazid, rifampicin, and ethambutol have been shown to trigger LDE.
Proton Pump Inhibitors (PPIs): Some studies have suggested a link between PPIs and LDE.
Gold Salts: Historically, gold salts are well-known culprits.
Allopurinol: This gout medication can cause cutaneous and oral lichenoid reactions.

Idiopathic vs. Drug-Induced Lichen Planus: A Comparison

Clinical and histopathological features of LDE can be nearly identical to idiopathic LP, making a detailed patient history essential for diagnosis. The following table highlights key differences that can assist in differentiation:


Feature	Idiopathic Lichen Planus	Lichenoid Drug Eruption
Cause	Unknown; autoimmune mediated.	Adverse reaction to a specific medication.
Onset	Spontaneous; can be gradual.	Delayed onset, ranging from weeks to years after starting the medication.
Rash Distribution	Symmetrical; often on wrists, ankles, and genitals.	Can be more widespread, photodistributed (sun-exposed areas), or have an eczematous appearance.
Oral/Nail Involvement	Oral lesions (Wickham's striae) and nail changes are common.	Oral and nail involvement is less common.
Histology	Dense lymphocytic infiltrate at the dermo-epidermal junction.	Often includes eosinophils, prominent parakeratosis, and a deeper perivascular infiltrate.
Resolution	May clear spontaneously within 1-2 years, but can be chronic.	Resolves gradually over weeks to months after discontinuing the offending drug.

Management and Treatment

The most important step in treating a lichenoid drug eruption is to identify and discontinue the suspected medication. This requires close collaboration with a healthcare provider, as abruptly stopping some medications can be dangerous. Resolution is often gradual.

Topical Corticosteroids: High-potency topical steroids are first-line for symptomatic relief.
Systemic Corticosteroids: For severe, widespread eruptions, a short course of oral corticosteroids may be prescribed.
Other Medications: Antihistamines or tacrolimus ointment might be used for itching or oral lesions.
Identifying the Culprit: A supervised drug challenge can sometimes confirm a diagnosis.

Conclusion

Lichenoid drug eruptions are a significant cause of lichen planus-like rashes, making a careful review of medication history essential for diagnosis. Many drugs have been implicated, particularly those for cardiovascular disease and inflammation. It's crucial not to stop any medication without consulting a healthcare provider. Treatment involves discontinuing the triggering agent, often with topical or systemic corticosteroids to manage symptoms. Identifying the cause allows for targeted treatment and helps prevent future recurrences. For additional information, consult resources like the National Center for Biotechnology Information (NCBI) on Lichen Planus.

Frequently Asked Questions

The primary cause is an adverse T-cell-mediated immune reaction to a specific medication that mimics the appearance and pathology of lichen planus.

Resolution is typically gradual and can take several weeks to many months after discontinuing the offending medication.

Yes, medications can trigger oral lichenoid eruptions, although oral involvement is less common in drug-induced cases than in idiopathic lichen planus.

Diagnosis relies on a thorough medication history and often involves confirming resolution of the rash after the suspected drug is discontinued.

While clinically and histologically similar, LDE has a clear drug trigger, potentially a longer latency period, and can have a more widespread or photodistributed rash compared to idiopathic lichen planus.

Yes, it is possible. The latency period for LDE can be long, sometimes appearing more than a year after starting the medication.

You should not stop or change any medication without first consulting your doctor. A healthcare professional can help identify the cause and determine the safest course of action.