[Lichenoid drug reaction to leflunomide].
BACKGROUND
Leflunomide (Arava) is an immunomodulator, recently introduced for systemic treatment of rheumatoid arthritis. We report the first case of lichenoid drug reaction due to this drug.


METHODS
A sixty-four year-old woman received leflunomide for rheumatoid arthritis. Two months after initiation of treatment, pruritus and lichenoid papules appeared on her hands and subsequently on her arms and her trunk, with a few bullous lesions. A skin biopsy was evocative for the diagnosis of drug induced lichenoid eruption. The treatment was stopped, and a wash out with colestyramine and topical corticotherapy resulted in dramatic improvement. No relapse was observed. Two months later, patch-tests with leflunomide diluted to 30 p. 100 in white petrolatum were negative.


CONCLUSIONS
Side effects of leflunomide are frequent, generally benign for the cutaneous features. In our case, the delay, clinical and histological aspect and improvement on withdrawal of the drug emphasize the imputability of leflunomide. Few cases have been reported with others immunomodulators.
Canonne-Courivaud
D
D
Clinique de Dermatologie, Hôpital Claude-Huriez, CHRU Lille.
Carpentier
O
O
Dejobert
Y
Y
Hachulla
E
E
Delaporte
E
E
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001706:Biopsy; D003875:Drug Eruptions / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000009:adverse effects* / Q000627:therapeutic use; D000077339:Leflunomide; D017512:Lichenoid Eruptions / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D008875:Middle Aged; D010328:Patch Tests; D012867:Skin / Q000473:pathology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007555:Isoxazoles; D000077339:Leflunomide