Lichenoid Drug Eruption with Prominent Nail Changes Due to Leflunomide in a 12-Year-Old Child

Pediatr Dermatol. 2017 Jul;34(4):e225-e226. doi: 10.1111/pde.13168. Epub 2017 May 23.


We present the case of a 12-year-old-girl who developed lichenoid dermatitis approximately 1 year after starting leflunomide for juvenile idiopathic arthritis. The eruption resolved promptly with discontinuation of the suspected culprit agent, supportive of a lichenoid drug eruption, but she subsequently developed markedly dystrophic nails with lichen planus-like features. A biopsy of her cutaneous findings at the time of initial presentation demonstrated lichenoid dermatitis, and a nail matrix biopsy was deferred given clinical correlation. Prominent nail changes in lichenoid drug eruptions, particularly in children, are rare but should be considered in children with new-onset nail dystrophy.

Publication types

  • Case Reports

MeSH terms

  • Antirheumatic Agents / adverse effects*
  • Child
  • Drug Eruptions / complications
  • Drug Eruptions / pathology*
  • Female
  • Humans
  • Isoxazoles / adverse effects*
  • Leflunomide
  • Lichenoid Eruptions / chemically induced*
  • Lichenoid Eruptions / complications
  • Lichenoid Eruptions / pathology
  • Nail Diseases / chemically induced*
  • Nail Diseases / complications
  • Nail Diseases / pathology
  • Nails / pathology
  • Skin / pathology


  • Antirheumatic Agents
  • Isoxazoles
  • Leflunomide