Fixed drug eruption in Adult
See also in: Cellulitis DDx,Anogenital,Oral Mucosal LesionAlerts and Notices
Synopsis
FDE is most commonly solitary, but some individuals may develop multiple patches. There may be an increasing number of patches seen with each exposure. Healing with postinflammatory hyperpigmentation is common. Atypical variants include nonpigmenting and generalized blistering forms.
Numerous drugs have been implicated in causing FDE. The most commonly associated drug classes include antibiotics (in particular sulfonamides, trimethoprim, fluoroquinolones, and tetracyclines), NSAIDs (including naproxen, ibuprofen, and celecoxib), and barbiturates. Other specifically implicated drugs include amoxicillin, erythromycin, metronidazole, fluconazole, paracetamol (acetaminophen), cetirizine, hydroxyzine, methylphenidate, oral contraceptives, quinine, and phenolphthalein. Biologic agents including ustekinumab, adalimumab, and abatacept have been reported to cause fixed drug eruptions. A nonpigmenting variant is seen with pseudoephedrine.
Codes
ICD10CM:L27.1 – Localized skin eruption due to drugs and medicaments taken internally
SNOMEDCT:
73692007 – Fixed drug eruption
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Erythema multiforme
- Contact dermatitis
- Acute febrile neutrophilic dermatosis (Sweet syndrome)
- Cellulitis or erysipelas
- Stevens-Johnson syndrome / toxic epidermal necrolysis – Generalized bullous variant of FDE can be distinguished from SJS/TEN as the former has a rapid onset (within 1 day) instead of weeks from exposure, and minimal to no mucosal or systemic involvement.
- Insect bite reaction
- Postinflammatory hyperpigmentation
- Lichen planus
- Bullous impetigo
- Tinea infection (see tinea capitis, tinea corporis, tinea manuum, tinea pedis)
- Kerion
- Erythema migrans
- Recurrent herpes simplex virus (HSV) infection
- Pseudolymphoma
- Bullosis diabeticorum
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:02/02/2021
Last Updated:02/02/2021
Last Updated:02/02/2021
Patient Information for Fixed drug eruption in Adult
Overview
A fixed drug eruption, also known as a drug rash or drug reaction, is a skin condition caused by a medication. In a fixed drug eruption, red or brown patches appear at the same body site every time the individual is exposed to the reaction-causing drug. Sometimes, the rash will itch, burn, or blister.Who’s At Risk
Drug rashes can appear on people of all ages, all races, and of both sexes.Any medication can cause a drug rash. The most common types of medications that trigger a fixed drug eruption include:
- Antibiotics
- Anti-inflammatories
- Barbiturates
- Oral contraceptives
- Quinine
- Phenolphthalein (sometimes found in laxatives)
Signs & Symptoms
Fixed drug eruptions can appear as red or brown patches. Drug rashes may involve the entire skin surface, or they may be limited to one or a few body parts.Itching is common in many drug rashes. However, if fever is present, the skin is tender, or the rash is on the membranes inside the mouth or genitals, a more serious skin condition may be present.
Self-Care Guidelines
To relieve the itching of a mild drug rash:- Take cool showers or rest cold washcloths on the rash.
- Apply calamine lotion.
- Take an over-the-counter antihistamine.
When to Seek Medical Care
For a widespread or severe drug rash, call your health care provider or 911, depending upon the severity of your symptoms.Whenever you are started on a new medication and develop a rash, immediately tell the doctor who prescribed the medicine.
If you have difficulty breathing, rapid heart rate, or swelling of your tongue, lips, throat, or face, you need emergency care.
Treatments
Your doctor may want to perform blood work to look for signs of an allergic reaction. He or she may want to examine a tissue sample of your skin to rule out other skin diseases.The best treatment for a drug rash is to stop the medication that is causing it. It may then take 5-10 days to see an improvement in the skin and up to 3 weeks for the rash to disappear.
Note: Stopping a prescription medication should be done only with a doctor's guidance.
Prescription treatments that may be helpful include:
- Oral antihistamine pills for itching.
- Topical corticosteroid (cortisone) creams or lotions.
Fixed drug eruption in Adult
See also in: Cellulitis DDx,Anogenital,Oral Mucosal Lesion