Bullous fixed drug eruption induced by etoricoxib, confirmed by patch testing, with tolerance to celecoxib

Abstract

Typical lesions, histopathology and patch testing confirmed the diagnosis of FDE induced by etoricoxib. Patch tests constitute a safe alternative for attempting to identify the culprit drug, and they should be performed within some weeks after the acute event, to avoid the refractory period. 2 They allow diagnostic confirmation in 40% of cases; however, a lack of reactivity of some allergens is a limitation on the diagnostic value of patch tests in cases of FDE. 3 Intraepidermal CD8 + memory T cells are mostly located in the epidermis of hyperpigmented patches, explaining the reactivation in these areas after oral drug re-exposure, and patch testing being exclusively positive in lesional skin. 2 Etoricoxib is a cyclo-oxygenase 2-selective inhibitor, and is rarely described as the responsible drug in FDE. In cases of etoricoxib-induced FDE, it is usually safe to use another coxib with a different chemical structure, although cross-reactivity is possible. 4-6 CONFLICTS OF INTERESTThe authors have no conflicts of interest to report. ORCIDAlexandre Miroux-Catarino https://orcid.org/0000-0001-8243-8724

Etoricoxib‐induced fixed drug eruption: Report of seven cases

“…In our series, lesional patch testing with celecoxib was performed in only two patients, with negative results, and one of them tolerated celecoxib oral intake. In previously reported cases, more than 80% of etoricoxib‐positive patients had negative lesional patch tests to celecoxib, and in most cases, there was natural or tested tolerance to celecoxib and/or parecoxib 4,6 …”

“…Etoricoxib (5‐chloro‐2‐[6‐methylpiridine‐3‐yl]‐3‐[4‐methylsulphonylphenyl]‐pyridine) is a highly selective COX2 inhibitor with a good safety profile, and a variety of infrequent adverse skin reactions 4‐9 . In recent years, cases of etoricoxib‐induced FDE have been appearing in the literature, confirmed by positive patch tests in residual lesions with etoricoxib 10% pet.…”

“…This broad group of compounds incite a lesser degree of allergic or idiosyncratic adverse reactions than conventional NSAID; however, they can provoke skin reactions of variable severity. Etoricoxib has a good safety profile, but has also been related to a variety of uncommon cutaneous adverse events, including several previous case reports on FDE 4‐7 . We report seven new cases of etoricoxib‐induced FDE, in six patients in whom the aetiology was demonstrated by patch testing on the involved sites.…”

The Role of Patch Testing in Evaluating Delayed Hypersensitivity Reactions to Medications

“…In smaller studies, high rates of positivity to piroxicam (85.7% in one study, 6 of 7 patients) [69] and antibiotics (beta-lactams, fluoroquinolones and sulfonamides) (50%, corresponding to 4 of 8 patients) have also been reported [61]. There are numerous case reports of patch test positivity in the setting of FDE to other drugs, including fluconazole [70][71][72], adalimumab [73], etoricoxib [74][75][76][77][78], piroxicam [69,79,80], nimesulide [81][82][83], and contrast medium [84,85].…”