Fixed drug eruption from piroxicam

Galindo, Esther Cuerda; Buján, J J Goday; Silva, J M García; Martínez, W; Hernando, M Verea; Fonseca, Eduardo

doi:10.1111/j.1468-3083.2004.00977.x

Cited by 15 publications

(4 citation statements)

References 12 publications

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“…Subsequently, a few case reports and a nine‐case series of piroxicam‐induced FDE were published in the medical literature . We consider that the clinical manifestations in the present series were consistent with previously published data …”

Section: Discussionsupporting

confidence: 91%

Piroxicam‐induced fixed drug eruption: Cross‐reactivity with meloxicam

et al. 2019

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Background: Non-steroidal anti-inflammatory drugs constitute a main cause of fixed drug eruption (FDE). A few cases of piroxicam-induced FDE have been reported; however, the crossreactivity among oxicams has rarely been evaluated.Objectives: To describe a series of patients with piroxicam-induced FDE, mostly confirmed by a positive patch test reaction, in whom cross-reactivity to meloxicam was assessed. Methods:We included all cases of piroxicam-induced FDE diagnosed in the department of pharmacovigilance of Monastir. Patch tests for piroxicam and meloxicam were performed in the involved skin according to the European Network on Drug Allergy recommendations. Oral provocation tests (OPTs) were performed for patients with negative skin test results.Results: Seven patients were included in this study. FDE was multiple for five patients and solitary for two. Bullous eruption was noticed in two cases. Lesional patch tests for piroxicam gave positive results in six patients. To assess cross-reactivity with meloxicam, this was patch tested.The test gave a positive result in only one patient. OPTs with meloxicam gave positive results in two patients with negative patch test results.Conclusion: Meloxicam is not a safe alternative for the treatment of piroxicam-induced FDE, and OPTs can be used to confirm tolerance before this drug is prescribed as a safer alternative.

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Section: Discussionsupporting

confidence: 91%

Piroxicam‐induced fixed drug eruption: Cross‐reactivity with meloxicam

et al. 2019

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“…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 – 72 ], adalimumab [ 73 ], etoricoxib [ 74 – 78 ], piroxicam [ 69 , 79 , 80 ], nimesulide [ 81 – 83 ], and contrast medium [ 84 , 85 ]. The importance of the test vehicle for certain drugs is highlighted in a few studies by Ozkaya-Bayazit et al In one study of 27 patients with cotrimoxazole-induced FDE and 20 healthy controls, no positive results were obtained when testing with petrolatum, but 25 of 27 tested patients (92.6%) exhibited positivity when the drug was tested in varying concentrations in DMSO [ 86 ].…”

Section: Bodymentioning

confidence: 99%

Section: Bodymentioning

confidence: 99%

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

Woodruff

Botto

2022

Clinic Rev Allerg Immunol

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Confirming drug imputability is an important step in the management of cutaneous adverse drug reactions (CADR). Re-challenge is inconvenient and in many cases life threatening. We review the literature on ideal patch testing technique for specific CADRs. Testing should be performed approximately 3 months after the resolution of the eruption using standard patch testing techniques. Commercially available patch test preparations are available for a minority of drugs, so in most cases, testing should be performed with the drug at various recommended concentrations and in different vehicles. Testing to all known excipients, such as dyes, vehicles and preservatives is also important. Immunosuppressive medications should be discontinued or down titrated to the lowest tolerable dose to decrease the risk of false negative reactions. We provide an overview of expert recommendations and extant evidence on the utility of patch testing for identifying the culprit drug in common CADRs and for specific drug or drug classes. Overall, there appears to be significant variability in the patch test positivity of different drugs, which is likely the result of factors intrinsic to the drug such as dermal absorption (as a function of lipophilicity and molecular size) and whether the drug itself or a downstream metabolite is implicated in the immune reaction. Drugs with high patch test positivity rates include beta-lactam antibiotics, aromatic anticonvulsants, phenytoin, and corticosteroids, among others. Patch testing positivity varies both as a function of the drug and type of CADR. The sum of the evidence suggests that patch testing in the setting of morbilliform eruptions, fixed drug eruption, acute generalized exanthematous pustulosis, and possibly also drug-induced hypersensitivity syndrome, photoallergic and eczematous reactions may be worthwhile, although utility of testing may vary on the specific drug in question for the eruption. It appears to be of limited utility and is not recommended in the setting of other complex CADR, such as SJS/TEN and leukocytoclastic vasculitis.

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“…Piroxicam (Feldene ® ; Pfizer SA, Brussels, Belgium) is a non‐steroidal anti‐inflammatory drug of the oxicam group, and is widely used as an analgesic, antipyretic, and antiplatelet agent. Multiple adverse systemic effects of piroxicam have been reported, among which are several cutaneous disorders, including fixed drug eruptions (FDEs) (1).…”

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confidence: 99%