Generalized bullous fixed drug eruption successfully treated with cyclosporine

Severe Generalized Bullous Fixed Drug Eruption Treated with Cyclosporine: A Case Report and Literature Review

“…In this case, cyclosporine was initiated due to the patient's rapidly progressive blistering, severe pain, and extensive body surface area involvement (28%). Cyclosporine was chosen over continuing the prednisone as multiple GBFDE studies have shown that cyclosporine results in rapid cessation of blistering, re-epithelialization of skin, and resolution of lesions with minimal changes in pigmentation [ 11 , 12 , 14 , 22 ]. Due to its minimal side effects when used acutely and the direct mechanism of inhibiting T-cell activation, it has been suggested to be a therapeutic agent for treating FDE superior to prednisone and intravenous immunoglobulin [ 11 ].…”

“…A further literature search identified 5 adult cases of GBFDE treated with cyclosporine, but no paediatric cases (Table 1 ) [ 11 , 12 , 13 , 14 ]. Variable dosages (100 mg/day, 2 mg/kg/day, or 5 mg/kg/day), routes of administration (oral or intravenous), and durations (5–7 days) were used, reflecting both the heterogeneity of institutional and practitioner preferences and the lack of evidence for use in GBFDE.…”

“…Despite differences in administration, all 5 patients experienced rapid cessation of erythema and complete resolution of their lesions within 7–14 days. While 1 patient had no residual pigmentary change [ 12 ], 3 experienced mild postinflammatory hyperpigmentation [ 11 , 13 , 14 ] and 1 had resultant hypopigmentation [ 12 ]. The response in our patient was consistent with the literature, demonstrating significant improvement of the erythema over 24 h with no further progression of blistering, and then resolution.…”

“…The literature suggests a potential response to systemic therapies including intravenous steroids and immunoglobulin [ 10 ]. Five cases of GBFDE in adult patients also demonstrate a benefit from systemic cyclosporine [ 11 , 12 , 13 , 14 ].…”

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

“…Due to increasing reports of severe cases of GBFDE, including the aforementioned study describing a high mortality rate in this condition [43], there has been recent interest in the use of cyclosporine for treatment. Thus far, there have been six cases of GBFDE treated with cyclosporine described in the literature [63][64][65][66][67]. Five of the cases were in adults, and these patients were treated with five to 14 days of cyclosporine, typically at doses of three or five mg/kg daily, with resolution of erythema and cessation of further blistering [63][64][65][66].…”