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

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

Synopsis

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 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 post-inflammatory hyperpigmentation is common.

Numerous drugs have been implicated in causing FDE. The most commonly associated drug classes include antibiotics (in particular sulfonamides, trimethoprim, fluoroquinolones, and tetracyclines), nonsteroidal anti-inflammatory medications (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. A nonpigmenting variant is seen with pseudoephedrine.

FDE can be differentiated from cellulitis based on a temporal relationship to taking a commonly offending medication and lack of warmth or spreading.

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

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: 06/30/2017
Last Updated: 07/18/2017
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Fixed drug eruption - Cellulitis DDx
See also in: Overview,Anogenital,Oral Mucosal Lesion
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Fixed drug eruption : Leg, Penis, Round configuration, Scattered few, Tongue, Brown patch, Blanching patch
Clinical image of Fixed drug eruption
A close-up of a round bright red plaque with a central darker color.
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