Differential Diagnosis for Lichenoid Drug Eruption and Lichen Planus
Single Most Likely Diagnosis
- Lichen planus: This is a chronic inflammatory mucocutaneous condition that presents with polygonal, flat-topped, violaceous papules and can affect the skin, mucous membranes, nails, and hair. The clinical presentation, along with the presence of Wickham's striae, makes it a strong candidate for the single most likely diagnosis.
Other Likely Diagnoses
- Lichenoid drug eruption: This condition is a cutaneous adverse reaction to medications, presenting similarly to lichen planus but often with a more sudden onset and potential for systemic symptoms. The history of recent medication use would support this diagnosis.
- Graft-versus-host disease (GVHD): This is a complication that can occur after a transplant, where the immune cells from the donor attack the recipient's body. It can present with lichenoid skin lesions, among other symptoms.
- Chronic graft-versus-host disease can also mimic lichen planus, making it another likely diagnosis in the appropriate clinical context.
Do Not Miss Diagnoses
- Lymphoma: Certain types of cutaneous T-cell lymphoma, like mycosis fungoides, can present with lichenoid lesions. Missing this diagnosis could have severe consequences due to the potential for progression and the need for specific treatment.
- Hepatitis C: This viral infection can be associated with lichen planus-like lesions, and missing the diagnosis could lead to delayed treatment of the underlying hepatitis C infection.
- Syphilis: Secondary syphilis can present with a wide range of skin manifestations, including lichenoid lesions. Given the potential for serious complications if left untreated, syphilis should not be missed.
Rare Diagnoses
- Lichen nitidus: A rare condition characterized by tiny, shiny, flat-topped papules that can resemble lichen planus but are typically smaller and more numerous.
- Keratosis lichenoides chronica: A rare skin condition with lichenoid and psoriasiform features, often presenting with a distinctive clinical appearance and histopathology.
- Lichenoid dermatitis due to other causes: Such as contact dermatitis or atopic dermatitis with lichenification, which can mimic lichen planus or lichenoid drug eruptions in their presentation.