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Apr 8, 2024 · INTRODUCTION. 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 ).
- Tetsuo Shiohara, Md, PhD
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- Drug eruptions
Classic and less common clinical presentations of cutaneous...
- 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?
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.
Sep 1, 2021 · In some cases, there is an extensive eruption of bullae in addition to the characteristic patches of FDE, a condition referred to as generalized bullous fixed drug eruption (GBFDE) . One study of bullous FDEs presenting to a dermatology department in Tunisia over an 18-year period found that 44.4% of cases were localized and 55.6% of cases were ...
- Hannah J Anderson, Jason B Lee
- 10.3390/medicina57090925
- 2021
- Medicina (Kaunas). 2021 Sep; 57(9): 925.
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What is the treatment for fixed drug eruptions (FDEs)?
What is a fixed drug eruption érythémato-pigmentée fixe (FDE)?
What is fixed drug eruption (FDE)?
Jan 30, 2020 · A fixed drug eruption (FDE) is a relatively common reaction associated with more than 100 medications. It is defined as a same-site recurrence with exposure to a particular medication. The primary approach and treatment for all types of FDEs are to identify and remove the causative agent, often accomplished by a thorough history of medication and other chemical exposures, and possibly prior ...
- Shreya Patel, Ann M. John, Marc Zachary Handler, Robert A. Schwartz
- 2020
Oct 9, 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 corticosteroids may be all that are required. In cases in which infection is suspected, antibiotics and proper wound care are advised.
Abstract. Fixed drug eruption (FDE) is a well-defined, circular, hyperpigmenting plaque that recurs as one or a few lesions always in fixed locations upon ingestion of a drug. FDE commonly occurs on the genitals, lips, trunk, and hands. Although the lesions are distinctive, the diagnosis of FDE often is missed because it shares none of the ...
