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fixed drug eruption

Red to red-brown macules that appear on a certain area of the patient's skin secondary to a drug. Etiology: 1) antibiotics, especially sulfonamides most commonly implicated 2) phenolphthalein 3) barbiturates 4) NSAIDs, salicylates 5) oral contraceptives 6) pseudoephedrine Pathology: - excessive activation of effector memory T cells [3] - presence of CD8+ intra-epidermal T-cells [3] Clinical manifestations: 1) red to red-brown macules localized to a certain area - painful purple patch [2] - blisters common [2] 2) can be anywhere on the body - lips, face, genitals & hands commonly involved [2] - lesions commonly bilateral or symmetric 3) most commonly characterized by a solitary, round to oval violaceous patch on the skin or mucosa [4] - multiple patches may rarely occur [4] - patches sharply demarcated 4) no pruritus 5) occasional fever 6) resolution often with postinflammatory hyperpigmentation 7) if offending agent is administered again, rash will often recur at the same localization [4] - re-exposure may result in new lesion(s) in addition to the original lesion [2] * images [5] Management: - discontinuation of offending agent - reassurance: cosmetic only, no serious sequelae - lesions resolve over days to weeks

General

drug eruption; drug rash

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 30-31, 170
  2. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  3. Mizukawa Y, Shiohara T Fixed drug eruption: a prototypic disorder mediated by effector memory T cells. Curr Allergy Asthma Rep. 2009 Jan;9(1):71-7 PMID: 19063828
  4. NEJM Knowledge+ Question of the Week. Nov 8, 2016 http://knowledgeplus.nejm.org/question-of-week/1452/
  5. Elston CA, Elston DM Identifying Lesions on Skin of Color. Medscape. October 25, 2022 https://reference.medscape.com/slideshow/identifying-lesions-6007985