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Oct 9, 2020 · The term fixed drug eruption (FDE) describes the development of one or more annular or oval erythematous patches as a result of systemic exposure to a drug; these reactions normally resolve...
Apr 8, 2024 · Fixed drug eruption (FDE) is a distinctive type of cutaneous drug reaction that characteristically recurs in the same locations upon re-exposure to the offending drug. Acute FDE usually presents with a single or a small number of dusky red or violaceous plaques that resolve leaving postinflammatory hyperpigmentation ( picture 1A-C ).
- What Is Fixed Drug Eruption?
- Who Gets Fixed Drug Eruption?
- What Causes Fixed Drug Eruption?
- What Are The Clinical Features of Fixed Drug Eruption?
- Clinical Variants of Fixed Drug Eruption
- What Are The Complications of Fixed Drug Eruption?
- How Is Fixed Drug Eruption Diagnosed?
- What Is The Differential Diagnosis For Fixed Drug Eruption?
- What Is The Treatment For Fixed Drug Eruption?
- What Is The Outcome For Fixed Drug Eruption?
Fixed drug eruption is a distinctive cutaneous allergic reactionthat characteristically recurs at the same site(s) on re-exposure to the medication or other chemical agent.
Fixed drug eruption affects both sexes, and affects adults more commonly than children. There are some examples of HLA-associations with fixed drug eruptionsdue to specific drugs eg, HLA-A30 with cotrimoxazole-induced fixed drug eruption.
Fixed drug eruption is a delayed type IV hypersensitivity reaction. In the initial phase memory CD8+ T-cells at the dermo-epidermal junction release interferon-gamma when activated by the medication antigen causing epidermal basal layer damage. Recruited T-cells and neutrophils damage melanocytes and keratinocytes. During the resolution phase, derm...
Fixed drug eruption can be categorised by clinical morphology. The most common form is the localised pigmenting type; other presentations include bullous (localised or generalised), mucosal, non-pigmenting, or generalised. Fixed drug eruption typically presents as a single (or small number of) well-defined, round or oval red or violaceous patch or ...
Mucosal fixed drug eruption
1. Involves lips, tongue, hard palate, genitalmucosa 2. Blisters and erosionsare common 3. Can be isolated/localised or may occur with cutaneous lesions 4. Oral mucosal lesions commonly due to cotrimoxazole and naproxen 5. Genital mucosal lesions: glans penis – cotrimoxazole; vulva – NSAIDs.
Non-pigmenting fixed drug eruption
1. Often symmetricallesions 2. Resolves without post-inflammatory hyperpigmentation 3. Associated with piroxicam and pseudoephedrine.
Generalised fixed drug eruption
1. Presents with numerous lesions 2. Lesions may be targetoid resembling erythemamultiforme.
Blisters and erosionsPost-inflammatory hyperpigmentationRecurrenceCross-reaction with other medicationsFixed drug eruption should be considered on history and examination but may be difficult on the first occasion. On subsequent episodes, a detailed history of oral intake in the preceding 24 hours may identify the culprit. Investigations may include: 1. Skin biopsy — shows an interface dermatitis in an early lesion with scattered apoptotic keratinoc...
First episode of single or few lesions — bullous insect bite reaction, bullous pemphigoid and other autoimmunebullous disordersTargetoid lesions — erythema multiformeMultiple bullous lesions — Stevens-Johnson syndrome/toxicepidermal necrolysisOral lesions — herpes simplex, aphthous ulcer, oral autoimmune blistering diseasesDiscontinuation of suspected medicationAvoiding implicated medication indefinitelyTopical steroids/systemic corticosteroidsGeneralised bullous fixed drug eruption requires intensive care or burns unitFixed drug eruption is generally a benignself-resolving eruption that recurs on re-exposure, leaving post-inflammatory hyperpigmentation. Subsequent flares can be more severe. Generalised bullous fixed drug eruption can be life-threatening, and has been reported to have a 20% mortalityrate.
Aug 23, 2022 · Fixed drug eruptions (FDEs) are cutaneous manifestations that are associated with the usage of certain drugs. There are over 100 drugs associated with FDEs, but some of the most commonly implicated drugs include trimethoprim-sulfamethoxazole (and other sulfonamides), naproxen, ibuprofen, tetracyclines, other antibiotics (ampicillin ...
- 10.7759/cureus.28299
- 2022/08
- Cureus. 2022 Aug; 14(8): e28299.
Sep 1, 2021 · Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by the onset of rash at a fixed location on the body each time a specific medication is ingested. With each recurrence, the eruption can involve additional sites.
- Hannah J Anderson, Jason B Lee
- 10.3390/medicina57090925
- 2021
- Medicina (Kaunas). 2021 Sep; 57(9): 925.
Fixed drug eruptions present as small (usually <8 cm in diameter), red, round plaques that may sting, usually result in long-lasting pigmentation, particularly in persons with more skin pigment,
Aug 8, 2022 · Fixed drug eruptions are common, 1, 2 and constitute 14%–22% of cutaneous drug reactions among children. 3 They are type IV hypersensitivity reactions that appear within 1 week after initial drug exposure, but may occur within minutes upon re-exposure. 1, 2.
