Fixed drug eruption in Adult
See also in: Cellulitis DDx,Anogenital,Oral Mucosal LesionAlerts and Notices
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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 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.
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
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
- 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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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:02/02/2021
Last Updated:02/02/2021

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