Patch testing in fixed drug eruptions-a 20-year review

Abstract

SummaryBackground. The fixed drug eruption is a common adverse drug reaction. Clear identification of the culprit drug is not always possible in the clinical setting, and oral rechallenge may induce new lesions or severe reactions. Objectives. The main purpose of this study was to evaluate the diagnostic value of patch testing in establishing an aetiological diagnosis in fixed drug eruptions. Method. A retrospective analysis was conducted evaluating 52 patients (17M/35F, mean age 53±17 years) with clinical diagnoses of fixed drug eruptions submitted to patch tests in a 20-year period in a Dermatology Department. Nonsteroidal anti-inflammatory drugs (NSAID) were clinically suspected in 90.4% of the cases, followed by antibiotics (28.9%) and paracetamol (15.4%). Results. Patch tests on pigmented lesions were reactive in 21 patients (40.4%), 20 of those to NSAID (nimesulide, piroxicam and etoricoxib) and 1 to an antihistamine (cetirizine). All patch tests using other drugs were negative, even under conditions of high clinical suspicion. Oral rechallenge allowed confirmation of drug imputability in 5 of 31 test-negative cases. Cross reactivity was frequently observed between piroxicam and other oxicams, and between different antihistamines. Conclusions. Patch testing was shown to be a simple and safe method to confirm drug imputabililty in fixed drug eruption, mainly when NSAID or multiple drugs are suspected. Persistent lack of reactivity to drug classes such as antibiotics and allopurinol represent an important limitation.

Fixed drug eruption due to etoricoxibe – A case report

“…1,2 Lesions usually develop 48 h after drug intake and recur at the same sites upon reexposure to the offending drug. 3,4 Spontaneous resolution with residual hyperpigmented postinflammatory patches is also characteristic. 3,4 Non-steroidal anti inflammatory drugs (NSAIDs), in particular nimesulide and piroxicam, are the most frequent culprit agents, followed by antibiotics and anticonvulsants.…”

“…3,4 Spontaneous resolution with residual hyperpigmented postinflammatory patches is also characteristic. 3,4 Non-steroidal anti inflammatory drugs (NSAIDs), in particular nimesulide and piroxicam, are the most frequent culprit agents, followed by antibiotics and anticonvulsants. 1,3,4 Etoricoxib is a recently developed selective cyclooxygenase (COX) isoenzyme 2 inhibitor which has rarely been described as a cause of FDE.…”

“…3,4 Non-steroidal anti inflammatory drugs (NSAIDs), in particular nimesulide and piroxicam, are the most frequent culprit agents, followed by antibiotics and anticonvulsants. 1,3,4 Etoricoxib is a recently developed selective cyclooxygenase (COX) isoenzyme 2 inhibitor which has rarely been described as a cause of FDE. 5---8 We report a case of fixed drug eruption due to etoricoxib.…”

“…8 Non-lesional skin patch tests are useful only for control purposes and negative results are expected in the vast majority of patients. 1,4 +Model ALLER-533; No. of Pages 2 2 RESEARCH LETTER For this reason, we only applied the drugs on lesional skin.…”

A Study to Evaluate the Role of Patch Test in the Etiological Diagnosis of Fixed Drug Eruption

“…15 The lesions usually flare within 30 min to 8 hours 15 after drug intake; mean length of time from drug intake to the onset of symptoms is approximately 2 hours. The previously involved sites do not necessarily flare with each exposure, which is known as the refractory period 16 . The duration of this period is also variable, lasting from a few weeks to several months 17 .…”