Fixed drug eruption
- Tetsuo Shiohara, MD, PhD
Tetsuo Shiohara, MD, PhD
- Professor and Chairman, Department of Dermatology
- Kyorin University School of Medicine
Fixed drug eruption (FDE) is a distinctive type of cutaneous drug reaction that characteristically recurs in the same locations upon reexposure 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). Rare severe atypical variants of FDE, including multiple, nonpigmenting, and generalized bullous variants, share clinical features with Stevens-Johnson syndrome/toxic epidermal necrolysis.
FDE will be discussed in this topic. Other types of drug eruptions are discussed separately. (See "Drug eruptions" and "Exanthematous (morbilliform) drug eruption" and "Lichenoid drug eruption (drug-induced lichen planus)" and "Stevens-Johnson syndrome and toxic epidermal necrolysis: Pathogenesis, clinical manifestations, and diagnosis".)
Cutaneous skin reactions occur in approximately 2 to 3 percent of patients taking drugs. FDEs are less common than exanthematous (morbilliform) eruptions, which are estimated to account for up to 95 percent of cutaneous drug reactions [1-3]. FDEs occur in both sexes and in all age groups; in children, FDEs account for 14 to 22 percent of cutaneous drug reactions [4,5].
ETIOLOGY AND PATHOGENESIS
Eliciting drugs — Many drugs may induce FDE. The frequency with which individual drugs cause FDE varies over time and from country to country, depending upon drug availability and rates of consumption. Drugs most frequently associated with FDE include [6-8]:
●Antibacterial agents (trimethoprim-sulfamethoxazole, tetracyclines, penicillins, quinolones, dapsone)
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- ETIOLOGY AND PATHOGENESIS
- Eliciting drugs
- Immunologic mechanisms
- CLINICAL MANIFESTATIONS
- CLINICAL VARIANTS
- Erythema multiforme-like FDE
- Generalized FDE
- Generalized bullous FDE
- Nonpigmenting FDE
- Other variants
- Provocation tests
- - Systemic provocation
- - Patch testing
- DIFFERENTIAL DIAGNOSIS
- Drug withdrawal and avoidance
- Symptomatic treatment
- SUMMARY AND RECOMMENDATIONS