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A fixed drug eruption on the penile shaft due to a tetracycline - genital lesions are a common location for fixed drug eruptions. A fixed drug eruption on the cheek; it resolved to leave hyperpigmentation. A recurrent blistering lesion on the tongue - it arose within a day of ingesting cotrimoxazole on each occasion it was taken.
- 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.
May 23, 2022 · 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 ).
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A drug rash or other reaction may occur for several reasons, such as: an allergic reaction. a buildup of the drug that causes toxicity to the skin. a drug makes the skin more sensitive to sunlight ...
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 with hyperpigmentation and may recur at the same site with reexposure to the drug. Repeated exposure to the offending drug may cause new lesions to develop ...
Fixed drug eruption. FDEs occur as an allergic reaction to drug exposure and appear as round, dark spots on the skin. Pain and burning can sometimes be associated with the spots. Image Source: ISM / Medical Images. Text Source: QxMD Medline. View an Illustration of Fixed Drug Eruption and learn more about Papules, Scales, Plaques and Eruptions.
Aug 23, 2022 · Introduction. 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, metronidazole), and barbiturates.