Double Trouble With Zoster: Report of Lichenoid and Granulomatous Dermatitis Following Reactivated Varicella Zoster Infection and Review of Literature.

Lichenoid and granulomatous dermatitis is an uncommon cutaneous reaction pattern, which combines features of lichenoid and granulomatous inflammatory patterns. It can represent an idiopathic lichenoid eruption or be associated with a variety of disorders including drug reactions, hepatobiliary disorders, rheumatoid arthritis, infections, tattoo reactions, pigmented purpuric dermatosis, lichenoid contact dermatitis, and cutaneous T-cell lymphoma. Clinical manifestations include pruritic, pink to violaceous, macules, papules, plaques, or nodules, with or without scaling, usually distributed on the trunk and extremities. In this article, we present a case of a 70-year-old woman with a history of rheumatoid arthritis and diabetes mellitus who developed a pruritic rash within the exact distribution of a preceding varicella zoster infection. Histopathology showed a dense lymphocytic lichenoid interface dermatitis with superficial and deep perivascular lymphocytic and granulomatous inflammation, consistent with the diagnosis of lichenoid and granulomatous dermatitis. The patient was started on a topical steroid and at 3-month follow up, demonstrated significant improvement of the skin lesions.