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What is the treatment for fixed drug eruptions (FDEs)?
How is a drug eruption treated?
What is a fixed drug eruption érythémato-pigmentée fixe (FDE)?
Apr 8, 2024 · Fixed drug eruption (FDE) is a recurrent skin reaction to certain drugs that causes red or purple plaques in the same areas. Learn about the common drugs that cause FDE, how to diagnose it, and how to treat it with antihistamines or corticosteroids.
- Tetsuo Shiohara, Md, PhD
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- Drug eruptions
Exanthematous (maculopapular) drug eruption; Fixed drug...
- Tetsuo Shiohara, Md, PhD
- 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?
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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.
Fixed drug eruption is a delayed type IV hypersensitivity reaction that recurs at the same site on re-exposure to a medication or other chemical agent. It can present as a red patch, plaque, blister or ulcer with post-inflammatory hyperpigmentation. Treatment involves avoiding the causative agent and managing symptoms.
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.
Treatment of localized FDE includes medication removal, patient counseling, and symptomatic relief. Failure to remove the causative agent in localized FDE can lead to recurrence, which is associated with increased inflammation, hyperpigmentation, and risk of a potentially lethal generalized bullous FDE (GBFDE), which may resemble Stevens ...
- Shreya Patel, Ann M. John, Marc Zachary Handler, Robert A. Schwartz
- 2020
The main goal of treatment is to identify the causative agent and avoid it. Treatment for fixed drug eruptions (FDEs) otherwise is symptomatic. Systemic antihistamines and topical...
Jul 7, 2022 · 17. Print. Medical Care. The ultimate goal is always to discontinue the offending medication if possible. Individuals with drug eruptions are often the most ill patients taking the most...
