MULTIFOCAL FIXED DRUG ERUPTION IN AN ATOPIC PATIENT

Abstract

<h3>Introduction</h3> Fixed Drug Eruption (FDE) is a cutaneous reaction that usually occurs in the same locations with re-exposure of certain drugs. Acute episodes present with violaceous plaques following with post-inflammatory hyperpigmentation. This case highlights the challenge of diagnosing FDE when lesions are multifocal and do not recur in the exact same location. <h3>Case Description</h3> A 58 year old woman with a past medical history of aspirin exacerbated respiratory disease, multiple nasal polypectomies, atopic dermatitis, chronic urticaria, allergic rhinitis, and moderate persistent asthma on dupilumab presented to clinic for evaluation of skin hyperpigmentation. Possible triggers she recalled included NSAID use or pseudoephedrine use. Symptoms included hyperpigmentation following recurring episodes of erythematous, pruritic plaques since 2017 located on her face, chest, and groin. The plaques usually resolved after days to weeks. To treat her skin hyperpigmentation, the patient had tried sunscreen, hydroquinone, and tretinoin creams with no improvement. Physical examination showed skin hyperpigmentation on her forehead, cheeks, nose, periorbital area, chest, and hands with well demarcated violaceous patches. <h3>Discussion</h3> The patient's symptoms are likely associated with a multifocal FDE with post inflammatory hyperpigmentation. This patient's use of NSAIDs or pseudoephedrine are potential triggers. The patient had never had a biopsy during the presence of active lesions and could not report a medication history that clearly correlated with symptoms, which makes diagnosis difficult.