fixed drug eruption

Introduction

Red to red-brown macules that appear on a certain area of the patient's skin secondary to a drug.

Etiology

• antibiotics, especially sulfonamides most commonly implicated
• phenolphthalein
• barbiturates
• NSAIDs, salicylates
• oral contraceptives
• pseudoephedrine

Pathology

• excessive activation of effector memory T cells
• presence of CD8+ intra-epidermal T-cells

Clinical manifestations

• red to red-brown macules localized to a certain area
  • painful purple patch
  • blisters common
• can be anywhere on the body
  • lips, face, genitals & hands commonly involved
  • lesions commonly bilateral or symmetric
• most commonly characterized by a solitary, round to oval violaceous patch on the skin or mucosa
  • multiple patches may rarely occur
  • patches sharply demarcated
• no pruritus
• occasional fever
• resolution often with postinflammatory hyperpigmentation
• if offending agent is administered again, rash will often recur at the same localization
  • re-exposure may result in new lesion(s) in addition to the original lesion

* images

Management

• discontinuation of offending agent
• reassurance: cosmetic only, no serious sequelae
• lesions resolve over days to weeks

More general terms

• drug eruption; drug rash