Pharm
Fixed Drug Eruption
search
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
Sulfonamide
s (e.g.
Bactrim
) - most common
Tetracycline
- most common
Cephalosporin
s
Macrolide
s (e.g.
Erythromycin
,
Clarithromycin
)
Clindamycin
Fluoroquinolone
s
Penicillin
s (e.g.
Amoxicillin
)
Antifungal
s
Fluconazole
Ketoconazole
Griseofulvin
Miscellaneous
Antimalarials
Dapsone
Causes
Miscellaneous
Cardiovascular agents
Beta Blocker
s
ACE Inhibitor
s
Flecainide
Analgesic
s
Acetaminophen
NSAID
s or
Aspirin
(common)
Allopurinol
Colchicine
Opiate
s (e.g.
Codeine
)
Neuropsychiatric agents
Barbiturates
Gabapentin
Carbamazepine
Lamotrigine
Benzodiazepine
s
Lithium
Antihistamine
s
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 Lesion
s
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
Corticosteroid
s (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]
Type your search phrase here