Clinical features, culprit drugs, and allergology workup in 41 cases of fixed drug eruption

Abstract

Background: Fixed drug eruption (FDE) represents a drug-related cutaneous reaction.Many drugs been associated with this clinical entity, with continually evolving documentation of implicated agents and clinical presentations. A bullous form can occur although it is rare.Objectives: To assess the epidemiological and clinical characteristics of FDE. Methods: We retrospectively analysed all FDE cases who presented to the ClinicalPharmacology Department at the University Hospital, Monastir, Tunisia, for allergy workup.Results: The mean age of the 41 confirmed FDE cases was 43.8 ± 15.5 years. The time between first lesion onset and FDE diagnosis was less than 1 month for 13 patients (31.7%). Fifteen patients had bullous lesions. The upper limbs were the most common location (65.9% of cases). The patch tests were positive in 27 cases; a provocation test yielded a positive response in the four cases tested. Nonsteroidal anti-inflammatory drugs (NSAIDs) were involved in 51.2%, antibiotics in 24.4%, and other analgesics in 19.5%. The most common offending drug was mefenamic acid in 24.4% of cases. Bullous lesions were significantly associated with paracetamol intake (P = .014; odds ratio 16.7; 95% confidence interval: 1.76-158).Conclusions: NSAIDs and antibiotics were the most implicated in inducing FDE; paracetamol was associated with bullous lesions. K E Y W O R D Sepidemiology, fixed drug eruption, oral rechallenge, patch test

Esomeprazole fixed drug eruption

“…However, PPI‐induced FDE is rare. This otherwise relatively common drug‐induced skin eruption is usually caused by nonsteroidal anti‐inflammatory drugs and antibiotics . FDE has been reported in three patients with omeprazole use, and only one case of a diffuse nonpigmented FDE was described with esomeprazole and confirmed with a patch test as well as an oral provocation test .…”

“…Fixed drug eruption (FDE) is a unique type of cutaneous adverse drug reaction characterized by one or multiple erythematous and edematous plaques that recur in the same locations within 48 hours after re‐exposure to the offending drug and resolve leaving residual postinflammatory hyperpigmentation . A bullous form can also occur . To date, only seven cases due to proton‐pump inhibitors (PPIs) have been reported.…”

Etoricoxib‐induced fixed drug eruption: Report of seven cases

“…The culprit agent may cause new lesions to develop in addition to flaring up of the older ones. FDE is thought to be an antibody‐dependent, cell‐mediated cytotoxic response, in which CD8 + effector/memory T cells play an important role in reactivation of lesions with re‐exposure 1 …”

“…NSAID, now considered the most common cause of FDE, 1 exert their effects by COX blockade, an enzyme consisting of two isoenzymes, COX‐1 and COX‐2. Selective inhibitors of inducible COX‐2 were brought into the market with the intention of producing its anti‐inflammatory effect without COX‐1‐induced effects on gastrointestinal tract, kidney, and platelets.…”

“…Fixed drug eruption (FDE) is a characteristic form of intraepidermal CD8 + T cell‐mediated drug reaction, with recurrent appearance of isolated or multiple skin lesions in the same location when taking the culprit drug. Non‐steroidal anti‐inflammatory drugs (NSAID) are the most common cause of FDE 1 …”