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Fixed Drug Eruption
Aka: Fixed Drug Eruption, Morbilliform Drug Reaction
- See Also
- Adverse Drug Reaction
- Life-Threatening Drug-Induced Rashes
- Hypersensitivity Reaction
- Anaphylaxis
- Penicillin Allergy
- Gell and Coombs Classification
- Pathophysiology
- Antibody-dependent, cell-mediated cytotoxic response
- Causes: Antimicrobials
- Antibiotics
- Sulfonamides (e.g. Bactrim) - most common
- Tetracycline - most common
- Cephalosporins
- Macrolides (e.g. Erythromycin, Clarithromycin)
- Clindamycin
- Fluoroquinolones
- Penicillins (e.g. Amoxicillin)
- Antifungals
- Fluconazole
- Ketoconazole
- Griseofulvin
- Miscellaneous
- Antimalarials
- Dapsone
- Causes: Miscellaneous
- Cardiovascular agents
- Beta Blockers
- ACE Inhibitors
- Flecainide
- Analgesics
- Acetaminophen
- NSAIDs or Aspirin (common)
- Allopurinol
- Colchicine
- Opiates (e.g. Codeine)
- Neuropsychiatric agents
- Barbiturates
- Gabapentin
- Carbamazepine
- Lamotrigine
- Benzodiazepines
- Lithium
- Antihistamines
- Hydroxyzine
- Laratodine
- Miscellaneous
- Finasteride
- Symptoms
- Lesion with pruritic or burning pain
- Lesion timing after initial exposure
- Onset within days to typically 1-2 weeks of medication use
- Lesion timing after subsequent exposure
- Onset within 0.5 to 8 hours (up to 16 hours) after medication ingestion
- Lesions recur at same site on reexposure to drug
- Signs
- Lesion distribution
- Symmetric involvement on trunk and extremities (especially dependent, warm areas)
- Face or ears
- Genital region
- Sacral area
- Hands or feet
- Spares mucous membranes
- Lesion characteristics
- Coloration
- Pink to dark red
- Annular Lesions
- Round erythematous patch with sharp borders
- May also present as bullae or ulcers
- Hyperpigmentation may occur on healing after withdrawal of causative agent
- Management
- Withdraw suspected medication
- Consider Corticosteroids (topical or systemic)
- Consider Antihistamine for Pruritus
- Observe open lesions for secondary infection
- Course
- Resolves in 7-10 days after medication stopped
- Complications
- Postinflammatory Hyperpigmentation
- References
- Crowson (2003) Am J Clin Dermatol 4:407-28 [PubMed]
- Trayes (2018) Am Fam Physician 98(5): 283-91 [PubMed]