- Bullous fixed drug eruption (BFDE) – Can be single, multiple, or generalized. Generalized bullous fixed drug eruption (GBFDE) develops in 50% of affected patients. Due to widespread blistering, it can mimic Stevens-Johnson syndrome (SJS). GBFDE tends to occur more rapidly after drug exposure (48 hours versus 1-3 weeks), have more well-circumscribed individual lesions, and have less mucosal involvement than SJS, but can be life-threatening due to widespread denudation. Compared to localized BFDE, GBFDE tends to occur in older individuals, possibly due to repeated culprit drug exposure. More than 100 medications have been implicated. Vaccinations have also been reported to be triggers. Foods can cause a similar eruption called fixed food eruption (FFE).
- SJS / toxic epidermal necrolysis (TEN) – A rare, severe, and sometimes life-threatening drug eruption.
- Drug-induced autoimmune blistering diseases (eg, linear IgA bullous dermatosis [LABD], drug-induced bullous pemphigoid, drug-induced pemphigus) – Autoimmune blistering disease that may be drug-induced. Penicillamine and captopril have been implicated in the causation of pemphigus vulgaris; vancomycin, lithium, angiotensin converting enzyme (ACE) inhibitors, and diclofenac have been implicated in LABD; and there are a host of less-well-studied drug associations for bullous pemphigoid.
- Drug-induced pseudoporphyria – Photoexposed skin fragility and blistering that resembles porphyria cutanea tarda and is usually drug-induced.
- Acute generalized exanthematous pustulosis (AGEP) – Characterized by tiny pustules on a background of erythema, AGEP may rarely have bullae and resemble SJS/TEN.
Bullous drug eruption in Adult
L27.1 – Localized skin eruption due to drugs and medicaments taken internally
402750008 – Bullous dermatosis precipitated by drug treatment
Differential Diagnosis & Pitfalls
- Bullous pemphigoid
- Bullous impetigo
- Pemphigus vulgaris
- Linear IgA disease
- Inherited or acquired epidermolysis bullosa acquisita
- Flea bites
- Arthropod bites
- Acute allergic contact dermatitis (eg poison ivy dermatitis)
- Severe irritant dermatitis
- Erythropoietic protoporphyria
- Porphyria cutanea tarda
- Phototoxic drug eruptions
Drug Reaction Data