Candesartan-Associated Lichenoid Drug Eruption

Lichenoid drug eruption (LDE) is an uncommon adverse drug reaction, with few published cases implicating the angiotensin II receptor blocker candesartan. We report a 67-year-old woman who developed pruritic violaceous papules and plaques on the trunk and extremities two years after initiating candesartan. Skin biopsy confirmed LDE. The eruption gradually resolved over five to six months after candesartan was replaced by amlodipine, with no recurrence observed at the 12-month follow-up. This case underscores the diagnostic challenges associated with LDE: latency may extend over years, clinical and histopathologic features closely mimic idiopathic lichen planus, and confirmatory tests, such as patch testing and drug-induced lymphocyte stimulation testing, often yield low sensitivity. Dermatologists and prescribing physicians should maintain a high index of suspicion for drug-induced lichenoid reactions, even when no recent medication changes are reported, as prompt recognition and withdrawal of the offending agent are essential for achieving durable remission.