Clinical and histopathological aspects of lichenoid dermatitis in patients of retroviral diseases

Context: Lichen planus (LP) is known to be associated with viral infections such as hepatitis B and C, but its association with HIV is rarely reported. Lichenoid drug eruptions have been implicated as the side effects of anti-retroviral therapy. Aims and Objectives: The aim of this study is to study demographics, clinical, histological, and immunological profile of the HIV patients presenting with lichenoid dermatitis. Subjects and Methods: HIV patients presenting with LP such as lesions were evaluated with complete history and physical examination. Demographic profile of patients was studied with features such as age, sex, duration of disease, distribution of the lesions, CD4 count, concomitant medications, associated comorbidities, and response to the treatment. Results: Twenty-one HIV patients presenting with LP such as lesions were studied. Of these, 20 patients had LP and one patient had lichenoid drug reaction. The age of the patient ranged from 40 to 60 years with no sex predilection. The duration of lesions ranged from 15 days to 7 years. Eleven patients had simultaneous cutaneous and oral involvement, five patients had only oral involvement and four patients of LP and one patient of lichenoid drug reaction had only cutaneous lesions. All the patients were on antiretroviral therapy, mainly on lamivudine, zidovudine, and nevirapine. Almost all the patients had CD4 count of more than 250 at the time of presentation. One patient was diagnosed to have lupus erythematosus and LP overlap. Patients were treated with oral medications such as corticosteroids, methotrexate, and dapsone and topical medications such as corticosteroids and calcineurin inhibitors. Conclusions: The appearance of LP such as lesions in HIV patients is a rare occurrence with 11 cases of LP reported till date. Our case series of 20 patients will throw light on possible etiology and difficulties in the management of LP such as lesions in HIV patients.