Lichen planus penicillamine

Cheilosis has also been reported (178). Oral lesions in patients using penicillamine may be due to pemphigus, cicatricial pemphigoid, or lichen planus, even in the absence of lesions outside the oral cavity. In 56 consecutive patients taking penicillamine, oral lichen planus was found in as many as seven (179). Penicillamine-induced cicatricial pemphigoid can be associated with oral ulcers as well as lesions of the esophagus, and stenosis can develop. 

With seven cases in 56 consecutive patients taking penicillamine in one study, oral lichen planus may be fairly frequent (179). Most patients have erosive oral lichen planus, but bullous, plaque-like, or classic lichen planus can occur. Rarely a psoriasiform eruption has been reported with penicillamine (320). 

Powell FC, Rogers RS, Dickson ER. Lichen planus, primary biliary cirrhosis and penicillamine. Br J Dermatol 1982 107(5) 616. 

In usual doses, 600-800 mg/day, pyritinol has a profile of adverse reactions reminiscent of that of penicillamine (2,3). Some 40% of users have adverse reactions, leading to withdrawal in about 23% of the total. The most common are non-specific rashes and stomatitis in addition, pemphigus, lichen planus, and photosensitivity have occurred. Gastrointestinal symptoms (diarrhea, gastral-gia, nausea, loss of taste) can occur, but are less frequent than with penicillamine. Thrombocytopenia, reversible extramembranous glomerulonephritis with nephrotic syndrome (4), a myasthenia-like picture, and acute polymyositis with positive rechallenge have also been described (5). 

The first case of lichen planus attributed to the use of penicillamine has been reported (9 -). 

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