Topical provocation in 27 cases of cotrimoxazole‐inducedxed drug eruption

Abstract

The purpose of this study was to investigate the usefulness of topical provocation in the diagnosis of cotrimoxazole-induced fixed-drug eruption (FDE). 27 patients with established cotrimoxazole-induced FDE by oral provocation and 20 healthy controls were tested with drugs at increasing concentrations in white petrolatum and dimethyl sulfoxide (DMSO) both on previously involved and uninvolved skin sites. Tape-stripping occlusive patch testing in petrolatum remained negative in 19 tested patients. Open testing with drug preparations in DMSO revealed positive results in 25 of 27 tested patients. 1 patient showed an additional positive reaction on previously uninvolved skin. Lesions on male genitalia and on face reacted to testing once with 10% or 20% of the suspected drug, whereas repeated testing with concentrations up to 50% was necessary in lesions on trunk & extremities. Open testing with drug preparations in DMSO at concentrations of 10%, 20% and 50% and pure DMSO remained negative in 20 healthy controls. The present study shows that repeated open testing with graded concentrations of the drugs up to 50% in DMSO is a reliable test method in sulfamethoxazole/trimethoprim-induced FDE. Patients and physicians should be aware of the transient irritant reaction to DMSO that is not infrequent, so as to avoid false-positive interpretations.

Fixed drug eruption caused by mefenamic acid: a case series and diagnostic algorithms

“…Alternativ wurden die zu untersuchenden Substanzen in steigenden Konzentrationen in chemischen Penetrationsverstärkern wie Dimethylsulfoxid oder Ethanol gelöst und appliziert[26][27][28]. In unserer Fallserie konnten wir zeigen, dass Mefenaminsäure als Reinsubstanz in der Lage ist, als Auslöser für fixe Arzneimittelexantheme zu fungieren.…”

Fixed drug eruption induced by atenolol

“…Topical provocation testing has been reported to be useful and safe for the diagnosis of FDE when applied on previously affected sites (Alanko et al 1987; Alanko 1994; Lee 1998; Ozkaya-Bayazit et al 1999). Patch testing in FDE is still not standardized (Ozkaya 2008).…”

Old dog begging for new tricks: current practices and future directions in the diagnosis of delayed antimicrobial hypersensitivity

“…utilized PT in 29 cases of pristinamycin-associated IM-ADRs, with a higher that expected sensitivity noted (69%) [66]. In 27 patients with oral challenge confirmed FDE to TMP-SMX, a 93% sensitivity for PT was demonstrated [117]. However, in a recent study by Andrade et al .…”