Pigmented Macules of the Tongue following Fixed Drug Eruption

Abstract

A case with fixed drug eruption involving only an unusual site is reported. The patient was a 35-year-old Japanese woman who showed bizzare pigmented macules on the dorsum of the tongue; they were demonstrated to have been caused by fixed drug eruption due to aminopyrine contained in a medicine for headache which she had taken occasionally for the past 10 years. The patient is regarded as a peculiar case of fixed drug eruption because of the following facts; (1) the fixed drug eruption affected only the tongue, and (2) it left markedly pigmented areas.

Fixed drug eruption (FDE): changing scenario of incriminating drugs

“…Commonly incriminated drugs for bullous FDE are rifampicin, 53 metronidazole, 58 paracetamol, 57 paclitaxel, 56 vinburnine, 55 erythromycin, 54 and ibuprofen 52 . The involvement of the oral mucous membrane 59,60 /lips, glans penis/genitals, 45,61–63 perineal area, 64,65 and tongue 66 is fairly common. Abrupt appearance of bullous lesions and/or erosions is the presenting morphology, 65 and may or may not be accompanied by lesions elsewhere on the skin 60 .…”

“…Glans penis FDE often presents with balanitis in an uncircumcised penis, and is commonly caused by tetracycline or sulfonamides. Pigmented macules on the tongue, the relics of FDE, may often be overlooked 64–67 . In a series comprising 105 established FDE cases, 68 a correlation between the site of predilection and the offending drug was found, with cotrimoxazole commonly causing lesions on the genital mucosa, naproxen and oxicans on the lips, and dipyrone on the trunk and extremities.…”

Drug‐Induced Black Hairy Tongue

“…It is extremely important to clearly differentiate BHT from a discolored tongue. The presence of a black- [29][30][31][32][33][34][35][36][37][38][39] Minocycline and bismuth subsalicylate are relatively common causes of a black tongue but not necessarily BHT. 38,[40][41][42] A number of factors have been investigated as etiologic in BHT.…”

Fixed drug eruptions with intraoral presentation

“…To the best of our knowledge, we could find only seven cases of intraoral involvement of FDE in the English literature [Table 1]. [151617181920]…”