Fixed drug eruption in Adult
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
- 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)
- Erythema migrans
- Recurrent herpes simplex virus (HSV) infection
- Bullosis diabeticorum