Eruptive lichen planus triggered by acupuncture

We report the case of a 41-year-old, previously fit and healthy woman who developed a widespread eruption following acupuncture treatment for musculoskeletal back pain. Four days after the treatment, she noticed a pruritic papular eruption on her lower back, where the acupuncture needles had punctured her skin. The eruption then spread to her feet, wrists, and chest. She took no regular medica- tions apart from levothyroxine for hypothyroidism and was penicillin allergic.

On examination, we found that she had a florid, wide- spread eruption on her trunk and limbs, coalescing at skin fold sites on her back. On closer inspection, we noted dense crops of flat-topped, polygonal, red-brown and vio- laceous papules and plaques at sites of acupuncture needle placement on her lower back (Figure 1). The eruption also involved her trunk, back, and limbs, with dense foci on her wrists and ankles (Figure 2). Her face, palms, and soles were spared. She had a florid white lacy pat- tern consistent with Wickham striae on her buccal mu- cosa, but her genital mucosa was spared.

The results of blood tests, including hepatitis B and C serologic assays, were unremarkable. A 4-mm punch biopsy specimen showed a dense bandlike lymphocytic infiltrate in the upper dermis obscuring the dermoepi- dermal junction, with some scattered lymphocytes and occasional eosinophils extending to the epidermis. The histologic findings therefore confirmed the diagnosis of widespread eruptive lichen planus.