Otolaryngology Book


Fixed Drug Eruption

Aka: Fixed Drug Eruption, Morbilliform Drug Reaction, Exanthematous Drug Reaction
  1. See Also
    1. Adverse Drug Reaction
    2. Life-Threatening Drug-Induced Rashes
    3. Hypersensitivity Reaction
    4. Anaphylaxis
    5. Penicillin Allergy
    6. Gell and Coombs Classification
  2. Pathophysiology
    1. Delayed Type IV Hypersensitivity Reaction
    2. Antibody-dependent, cell-mediated cytotoxic response
  3. Epidemiology
    1. Of cutaneous drugs eruptions, Morbilliform rash accounts for 80% in adults and 35% in children
  4. Causes: Antimicrobials
    1. Antibiotics (most common)
      1. Sulfonamides (e.g. Bactrim) - most common
      2. Tetracycline - most common
      3. Cephalosporins
      4. Macrolides (e.g. Erythromycin, Clarithromycin)
      5. Clindamycin
      6. Fluoroquinolones
      7. Penicillins (e.g. Amoxicillin)
    2. Antifungals
      1. Fluconazole
      2. Ketoconazole
      3. Griseofulvin
    3. Miscellaneous
      1. Antimalarials
      2. Dapsone
  5. Causes: Miscellaneous
    1. Cardiovascular agents
      1. Beta Blockers
      2. ACE Inhibitors
      3. Flecainide
    2. Analgesics
      1. Acetaminophen
      2. NSAIDs or Aspirin (common)
      3. Allopurinol
      4. Colchicine
      5. Opiates (e.g. Codeine)
    3. Neuropsychiatric agents
      1. Barbiturates
      2. Gabapentin
      3. Carbamazepine
      4. Lamotrigine
      5. Benzodiazepines
      6. Lithium
    4. Antihistamines
      1. Hydroxyzine
      2. Laratodine
    5. Miscellaneous
      1. Finasteride
  6. Risk Factors
    1. Immunosuppression
    2. Childhood Viral Infections
  7. Symptoms
    1. Lesion with pruritic or burning pain
    2. Lesion timing after initial exposure
      1. Onset 4 to 21 days after starting medication
    3. Lesion timing after subsequent exposure
      1. Onset within 0.5 to 8 hours (up to 16 hours) after medication ingestion
      2. Lesions recur at same site on reexposure to drug
    4. Systemic Symptoms are rare
      1. Fever, malaise and Nausea may be seen with Drug-Induced Bullous Disease
  8. Signs
    1. Lesion onset on the trunk and spreads peripherally
    2. Lesion distribution
      1. Symmetric involvement on trunk and extremities (especially dependent, warm areas)
      2. Face or ears
      3. Genital region
      4. Sacral area
      5. Hands or feet
      6. Spares mucous membranes
    3. Lesion characteristics
      1. Coloration
        1. Pink to dark red
      2. Maculopapular Rash with Annular Lesions
        1. Round erythematous patch with sharp borders
      3. May also present as bullae or ulcers
      4. Hyperpigmentation may occur on healing after withdrawal of causative agent
  9. Management
    1. Withdraw suspected medication
    2. Consider Corticosteroids (topical or systemic)
    3. Consider Antihistamine for Pruritus
    4. Observe open lesions for secondary infection
  10. Course
    1. Resolves in 7-10 days after medication stopped
  11. Complications
    1. Postinflammatory Hyperpigmentation
  12. References
    1. Crowson (2003) Am J Clin Dermatol 4:407-28 [PubMed]
    2. Nelson (2022) Am Fam Physician 106(2): 193-4 [PubMed]
    3. Trayes (2018) Am Fam Physician 98(5): 283-91 [PubMed]

Fixed drug eruption (C0221242)

Definition (NCI) Round areas of red-purple reaction in the skin that result after drug exposure; these recur in the same location when the medication is readministered.(NICHD)
Concepts Pathologic Function (T046)
SnomedCT 73692007
Dutch fixed-drug eruption
French Eruption fixe d'origine médicamenteuse
German fixes Arzneiexanthem
Italian Eruzione fissa da farmaci
Portuguese Erupção medicamentosa fixa
Spanish Erupción fija medicamentosa, dermatitis medicamentosa fija (trastorno), dermatitis medicamentosa fija
Japanese 固定薬疹, コテイヤクシン
Czech Fixní lékový exantém
English fix drug eruption, drug eruptions fixed, drug eruption fixed, fixed drug eruptions, drugs eruption fixed, fixed drug eruption, Fixed Drug Eruption, Fixed drug eruption, FDE - Fixed drug eruption, Fixed drug eruption (disorder), Fixed drug eruption, NOS
Hungarian Fix gyógyszer-exanthema
Derived from the NIH UMLS (Unified Medical Language System)

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