Fixed drug eruptions to tetracyclines

Abstract

We observed 11 cases of fixed drug eruption to tetracyclines. Two cases were in a mother and her adult son, and two patients experienced fading of their lesions while continuing to take 1 g of the drug per day. Several patients were cross-reactive to different salts.

Fixed drug eruption:state of the art

“…Increased expression of MHC class I molecules in cutaneous drug reactions, such as increased HLA‐B12 and HLA‐A2 expression in Stevens‐Johnson syndrome/toxic epidermal necrolysis have been reported [37]. Individual reports of the occurrence of FDE in relatives of the first degree point to the genetic basis of the disease [38–42]. Tetracyclines [38], dimenhydrinate and acetylsalicylic acid [39], feprazone [40], T‐S [41] and ibuprofen [42] were the causative drugs in these reports.…”

“…Individual reports of the occurrence of FDE in relatives of the first degree point to the genetic basis of the disease [38–42]. Tetracyclines [38], dimenhydrinate and acetylsalicylic acid [39], feprazone [40], T‐S [41] and ibuprofen [42] were the causative drugs in these reports. Statistically highly significant correlations are found between feprazone‐induced FDE and HLA‐B22 [25, 26] as well as between T‐S‐induced FDE and HLA‐A30 or the haplotype HLA‐A30 B13 Cw6 [43].…”

Case of anaphylaxis due to tetracycline hydrochloride

“…Several cases with fixed drug eruption and one case with anaphylaxis have been reported with cross‐sensitivity between tetracycline hydrochloride and oxytetracycline, 7,9–11 which is probably because oxytetracycline shares a common structure with tetracycline except for the presence of a hydroxyl group at the C5 position. Demethylchlortetracycline, 11,12 doxycycline 13 and minocycline 14 also have cross‐sensitivity with tetracycline hydrochloride, which suggests that the common tetracycline nucleus itself is the structural determinant of reactivity. Our case and previously reported cases indicate that clinicians should be aware of the possibility of anaphylaxis due to tetracycline hydrochloride, although this condition is rare.…”

A Review of Fixed Drug Eruption with a Special Focus on Generalized Bullous Fixed Drug Eruption

“…FDEs to the same drug have been reported in immediate family members, indicating that there may be a genetic component to the pathogenesis of FDE [ 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Medications implicated in familial cases of FDE include tetracycline/demeclocycline [ 16 ], feprazone [ 17 , 18 ], trimethoprim/sulfamethoxazole [ 19 , 20 ], diphenhydramine and aspirin [ 21 ], and ibuprofen [ 22 ]. Specific associations have been found between human leukocyte antigen (HLA) genes and FDE from certain drugs.…”