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Fixed drug eruption in Adult
See also in: Cellulitis DDx,Anogenital,Oral Mucosal Lesion
Other Resources UpToDate PubMed

Fixed drug eruption in Adult

See also in: Cellulitis DDx,Anogenital,Oral Mucosal Lesion
Contributors: Rajini Murthy MD, Elizabeth B. Wallace MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed


Fixed drug eruption (FDE) is a cutaneous adverse drug reaction that recurs at the same body site each time the individual is re-exposed to the culprit drug. One or more sharply demarcated, red or violaceous patches that are typically round develop within minutes to hours of exposure to the inciting drug. These may vary from 0.5 to several centimeters in size. They are usually asymptomatic, although burning, pain, or pruritus may occur. While any cutaneous surface may be affected, the oral and anogenital mucosa are most frequently involved.

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.


L27.1 – Localized skin eruption due to drugs and medicaments taken internally

73692007 – Fixed drug eruption

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Erythema multiforme
  • Allergic 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.
  • Arthropod bite or sting
  • Postinflammatory hyperpigmentation
  • Lichen planus
  • Bullous impetigo
  • Tinea infection (see Tinea capitis, Tinea corporis, Tinea manus, Tinea pedis)
  • Kerion
  • Lyme disease
  • Recurrent Herpes simplex virus
  • Pseudolymphoma
  • Bullosis diabeticorum

Best Tests

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Management Pearls

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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.

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Last Reviewed:02/02/2021
Last Updated:02/02/2021
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Patient Information for Fixed drug eruption in Adult
Contributors: Medical staff writer
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Fixed drug eruption in Adult
See also in: Cellulitis DDx,Anogenital,Oral Mucosal Lesion
A medical illustration showing key findings of Fixed drug eruption : Lips, Tongue, Feet, Hands
Clinical image of Fixed drug eruption - imageId=1453376. Click to open in gallery.  caption: 'A close-up of a round bright red plaque with a central darker color.'
A close-up of a round bright red plaque with a central darker color.
Copyright © 2024 VisualDx®. All rights reserved.