Fixed drug eruptions – the common and novel culprits since 2000

Abstract

SummaryA fixed drug eruption (FDE) is a common cutaneous adverse drug reaction which occurs following administration of an offending drug. The aim of this review is to provide an update on the list of drugs causing FDE, with a focus on emerging drug culprits reported since the start of the century. Across published literature, triggers for FDE are widely varied. The most frequently implicated drugs include analgesics (nonsteroidal anti‐inflammatory drugs [NSAIDs] and paracetamol) and antibiotics. Co‐trimoxazole is perhaps the most well described single agent. Since the start of the century there have been over 200 drugs named in case reports on FDE. Newer, novel agents of note include cyclooxygenase‐2 specific inhibitors, fluconazole, and phosphodiesterase 5 inhibitors. Other implicated drugs include vaccines, such as various SARS‐CoV‐2 vaccines.Drugs incriminated in FDE vary based on the geographical region studied and prescribing patterns at a given time. Newer drugs continue to enter the market and are playing an increasing role in the field of FDE. Awareness of rarer culprits and emerging novel agents can help identify a trigger, allowing for prompt withdrawal of the causative agent, preventing recurrence.

Autoimmune skin disorders and SARS‐CoV‐2 vaccination – a meta‐analysis

“…16 In addition, some reports have suggested that mRNA-based SARS-CoV-2 vaccines may influence the development of inflammatory skin diseases. 17,18 The mechanism of autoimmune reactions following vaccination is still unclear. On the one hand, a genetic predisposition to vaccine-induced autoimmunity has been suggested, since only few subjects developed autoimmune diseases after vaccinations.…”

Recurrent large perianal plaque, conjunctivitis, erosive stomatitis, penile erosions and generalized bullous skin lesions

“…Ornidazole was reported to cross‐react with secnidazole 5 and fluconazole, 6 which share the propan‐2‐ol side chain in their structure. Oral provocation testing is the gold standard for the diagnosis of FDE, whereas topical provocation by open or occlusive patch testing is considered a safer first‐step diagnostic procedure, based on the knowledge that FDE is a delayed type IV hypersensitivity reaction 7,8 . It is performed in loco , that is, in a previously affected FDE site, in addition to normal skin as the control site.…”

“…Oral provocation testing is the gold standard for the diagnosis of FDE, whereas topical provocation by open or occlusive patch testing is considered a safer firststep diagnostic procedure, based on the knowledge that FDE is a delayed type IV hypersensitivity reaction. 7,8 It is performed in loco, that is, in a previously affected FDE site, in addition to normal skin as the control site. Patch testing appears to be an eligible tool for identifying the culprit drug in FDE from nitroimidazoles such as ornidazole and metronidazole as well as for investigating cross-reactivity among nitroimidazoles.…”

The flood of drug allergy cases

“…The very interesting article by McClatchy and colleagues in this JDDG issue deals knowledgeably and comprehensively with a supposedly rare form of a T-cell mediated drug allergy, fixed drug exanthema [9]. Since it was shown in this paper that more than a quarter of affected patients suffer ten reaction episodes or more until diagnosis, fixed drug exanthema is more frequently observed in clinical practice.…”