Terbinafine
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Terbinafine Erosive plantar lichen planus: case report
A 36-year-old woman developed erosive plantar lichen planus during treatment with terbinafine for suspected onychomycosis [route, dosage and duration of treatment to reaction onset not stated]. The woman presented with painful left foot erosion and pruritic eruptions. She informed that she had been receiving terbinafine prescribed by an outside provider for suspected onychomycosis. She developed erosions during this treatment. She discontinued taking terbinafine on her own without consulting and despite discontinuation, the lesions did not improve. Upon presentation, erosions on the left foot were associated with significant pain and impaired ambulation were noted. On acral surfaces, trunk and extremities, there were scattered hyperpigmented macules. Lesions on the plantar surface of the left great toe and the left foot were shallow, erythematous and progressed over a period of 2 weeks to an irregular shaped beefy red ulceration. Additionally, there were fissures and maceration in the first inter-digital space. Her laboratory work up was normal and culture test was negative for infection. Thus, a punch biopsy was performed. Biopsy of the left arm lesion demonstrated basket weave orthokeratosis with a vacuolar interface dermatitis, colloid bodies, pigment incontinence and occasional necrotic keratinocytes, whereas the biopsy of the left foot lesion showed compact orthokeratosis with a lichenoid process showing dyskeratosis and pigment incontinence. Based on the investigations, a diagnosis of erosive plantar lichen planus was made. The woman was treated with prednisone taper and showed initial improvement, but following discontinuation of prednisone, relapse was noted. Therefore, further treatment was started with doxycycline, tacrolimus and clobetasol during flares which resulted in improvement and healing of the ulceration. Cohen BE, et al. Painful plantar erosions. International Journal of Dermatology 59: 1341-1342, No. 11, Nov 2020. Available from: URL: http://doi.org/10.1111/ ijd.14922
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Reactions 21 Nov 2020 No. 1831
