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Fixed drug eruption - Anogenital in
See also in: Overview,Cellulitis DDx,Oral Mucosal Lesion
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Fixed drug eruption - Anogenital in

See also in: Overview,Cellulitis DDx,Oral Mucosal Lesion
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Contributors: Rajini Murthy MD, Elizabeth B. Wallace MD, Belinda Tan MD, PhD, Susan Burgin MD
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Synopsis

Fixed drug eruption : Lips, Tongue, Feet, Hands
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. In the anogenital region in men, the patches of FDE most commonly affect the glans penis. Additional possible sites of involvement include the prepuce, coronal sulcus, shaft of the penis, and scrotum. Bullous FDE more frequently involves the genital region in men.

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.

Numerous drugs have been implicated in causing FDE. The most commonly associated drug classes for FDE in the anogenital region are also the most frequently seen culprit medications for FDE in general. These medication classes include antibiotics, in particular sulfonamides, trimethoprim, and tetracyclines, and NSAIDs, including naproxen, ibuprofen, and celecoxib. Other drugs implicated in FDE 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

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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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.

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References

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Last Reviewed:02/02/2021
Last Updated:02/16/2022
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Fixed drug eruption - Anogenital in
See also in: Overview,Cellulitis DDx,Oral Mucosal Lesion
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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.

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