Mixed Zone between Drug-Induced Hyperpigmentation and Generalized Fixed Pigmented Erythema

Hanafi Tarik,Frikh Rachid,Essaoudi Amine,Hjira Naoufal,Titou Hicham,Boui Mohammed,Kerrouch Hasna

doi:10.23937/2378-3656/1410296

Hanafi Tarik, Frikh Rachid + Show 5 more

Open Access

https://doi.org/10.23937/2378-3656/1410296

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Abstract

We report a particular case of fixed drug eruption (FDE), in its erythematous and pigmented form, as a fixed pigmented erythema (FPE), which manifests in a generalized form, evolving for three years, and discuss the imputability to piroxicam and the Ramipril/Hydrochlorothiazide combination. Indeed, chronological, semiological, bibliographic criteria, were imprecise and non-discriminatory. We ended up retaining the diagnosis of fixed pigmented erythema (FPE) of particular diffuse presentation induced probably by piroxicam, based on clinical, histological and evolutive criteria. However, it remains a mixed zone between drug-induced hyperpigmentation and generalized fixed pigmented erythema with diffuse hypermelanosis.

Highlights

The first case of fixed pigmented erythema [FPE] described in the literature dates back to 1894 by Brocq, reporting a case of pigmented evolutionary erythema induced by antipyrine [1]
We report a particular case of fixed drug eruption (FDE), in its erythematous and pigmented form, as a fixed pigmented erythema (FPE), which manifests in a generalized form, evolving for three years, and discuss the imputability to piroxicam and the Ramipril/Hydrochlorothiazide combination
It remains a mixed zone between drug-induced hyperpigmentation and generalized fixed pigmented erythema with diffuse hypermelanosis

Summary

Introduction

The first case of fixed pigmented erythema [FPE] described in the literature dates back to 1894 by Brocq, reporting a case of pigmented evolutionary erythema induced by antipyrine [1]. We report a particular case of FPE, in a generalized and extensive form evolving for three years, and discuss the diagnostic balance between, hyperpigmentation as toxiderma and generalized fixed pigmented erythema presenting with diffuse hypermelanosis, we will discuss, the imputability compared to piroxicam and the Ramipril/Hydrochlorothiazide combination. He is a 56-year-old patient, followed for three years for high blood pressure under the combination of Ramipril/Hydrochlorothiazide 10 mg/25 mg and arthritis of the knee treated with Piroxicam 20 mg/d with prolonged self-medication without medical supervision. Despite stopping Piroxicam and a three-month topical depigmenting treatment, we have not noticed any improvement in hyperpigmentation

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