Bullous Fixed Drug Eruption Research Articles

Fixed drug eruption and generalized bullous fixed drug eruption: Insights from an analysis of the FDA Adverse Event Reporting System

Fixed drug eruption and generalized bullous fixed drug eruption: Insights from an analysis of the FDA Adverse Event Reporting System

Mefenamic acid-related generalised bullous fixed drug eruption

Mefenamic acid-related generalised bullous fixed drug eruption

A case of generalized bullous fixed drug eruptions induced by ceftriaxone

A case of generalized bullous fixed drug eruptions induced by ceftriaxone

Pseudoephedrine-induced Fixed Drug Eruption in a Scuba Diver With Recurrent Palmoplantar Exfoliation.

This report presents a case of pseudoephedrine-induced nonpigmented bullous fixed drug eruption (NBFDE) manifesting as recurrent palmoplantar exfoliation in a scuba diver. It emphasizes the importance of considering drug allergies in the differential diagnosis when divers present with peeling hands and soles. A 38-year-old female scuba diver experiencing recurrent palmoplantar exfoliation underwent a clinical evaluation, patch testing, an interferon-gamma enzyme-linked immunospot (ELISpot) assay, and graded drug challenges with pseudoephedrine and phenylephrine. Patch testing yielded negative results; however, the ELISpot assay indicated a strong immune response to pseudoephedrine. A graded challenge involving pseudoephedrine successfully reproduced the symptoms, confirming a diagnosis of pseudoephedrine-induced NBFDE. Subsequently, a challenge with phenylephrine elicited a milder reaction, suggesting it as a potential alternative medication for the patient. This case highlights NBFDE as a potential cause of skin peeling in scuba divers who are allergic to pseudoephedrine. It emphasizes the importance of considering drug allergies when diagnosing palmoplantar exfoliation in divers and underscores the need for a thorough evaluation of medication use in this group. Alternative medications and management strategies should be considered for divers with a pseudoephedrine allergy to prevent ear barotrauma while minimizing the risk of adverse skin reactions.

Bullous fixed drug eruption due to azithromycin: A rare case report

Abstract: Fixed drug eruption (FDE) is a common type of cutaneous adverse drug reaction. It is a delayed type of hypersensitivity reaction that occurs and recurs as lesions at the same skin site due to repeated intake of an offending drug. Drugs such as ciprofloxacin, acetaminophen, fluconazole, nimesulide, sulfonamides, tetracyclines, and metronidazole have been reported to cause the bullous form of FDE. FDE due to azithromycin have been reported, but the bullous variant is extremely rare. We present a case of azithromycin-induced bullous FDE in a 32-year-old male. Data were collected through a patient history and clinical examination during consultation. The patient developed a tense bullous lesion on the lower lip after taking azithromycin for an upper respiratory tract infection. This case highlights the importance of recognizing rare adverse reactions to commonly prescribed antibiotics like azithromycin.

Drug induced bullous fixed drug eruption: a case report

Bullous fixed drug eruption, which is a cutaneous adverse drug reaction, is commonly seen with antimicrobials and analgesics. Bullous drug eruptions are infrequent, but because they pose a challenge both to affected patients and to treating physicians, they are considered to be the most severe cutaneous adverse reactions (SCAR). It is important to recognize these conditions and to differentiate them from other clinical entities involving blister formation. There may be early signs and symptoms that indicate a severe bullous drug eruption even before blisters and erosions of the skin and mucous membranes become obvious. Once the diagnosis is suspected, appropriate diagnostic procedures and adequate management must be initiated. The latter includes identification of the potentially inducing drug, although it should be taken into account that not all cases of bullous eruptions are drug-induced. In cases with drug causality the potentially culprit agent must be withdrawn, while in cases with other aetiology the underlying condition, e.g. an infection, must be treated appropriately. In addition to best supportive care, immunomodulating therapy may be considered. Here we report 64-year-old male with bullous fixed drug eruptions due to doxycycline administration.

Severe cutaneous adverse reactions.

Severe cutaneous adverse reactions (SCARs), which include Stevens-Johnson syndrome and toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (also known as drug-induced hypersensitivity syndrome), acute generalized exanthematous pustulosis, and generalized bullous fixed drug eruption, are life-threatening conditions. The pathogenesis of SCARs involves T cell receptors recognizing drug antigens presented by human leukocyte antigens, triggering the activation of distinct T cell subsets. These cells interact with keratinocytes and various immune cells, orchestrating cutaneous lesions and systemic manifestations. Genetic predisposition, impaired drug metabolism, viral reactivation or infections, and heterologous immunity influence SCAR development and clinical presentation. Specific genetic associations with distinct SCAR phenotypes have been identified, leading to the implementation of genetic screening before prescription in various countries to prevent SCARs. Whilst systemic corticosteroids and conventional immunomodulators have been the primary therapeutic agents, evolving strategies, including biologics and small molecules targeting tumour necrosis factor, different cytokines, or Janus kinase signalling pathways, signify a shift towards a precision management paradigm that considers individual clinical presentations.

A Case of Generalized Bullous Fixed Drug Eruption Caused by Acetaminophen

A Case of Generalized Bullous Fixed Drug Eruption Caused by Acetaminophen

Rapidly progressing generalized bullous fixed drug eruption after the first dose of COVID-19 messenger RNA vaccination.

Generalized bullous fixed drug eruption (GBFDE) is a rare type of life-threatening severe cutaneous adverse reaction that is considered a medical emergency because of its potential lethality. Currently, only a few cases of bullous adverse reactions have been reported after coronavirus disease 2019 (COVID-19) vaccination. We describe a patient with distinct clinical, histopathological, and immunological findings that are consistent with severe GBFDE, after Pfizer messenger RNA COVID-19 vaccination. An 83-year-old man presented with a fever and well-demarcated multiple erythematous patches that occurred only 4 h after receiving the first dose of COVID-19 Pfizer vaccination. Over the next few days, the patches became generalized and turned into blisters covering approximately 30% of the body surface. The patient was started on intravenous methylprednisolone and oral cyclosporine. There were no additional blistering lesions after 10 days of treatment, prompting a gradual dose reduction. Our case suggests that a stepwise vaccination adhering to the standard dosing schedule should be warranted with close monitoring for possible significant side effects.

Generalized Bullous Fixed Drug Eruption.

Dermatitis®Ahead of Print Images in DermatitisGeneralized Bullous Fixed Drug EruptionLi Chai and Ze-Hu LiuLi Chaihttps://orcid.org/0000-0003-1197-3468From the Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China.Search for more papers by this author and Ze-Hu LiuAddress reprint requests to Ze-Hu Liu, Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, West Lake Rd 38, Hangzhou, 310009, China, E-mail Address: zehuliu@yahoo.comFrom the Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China.Search for more papers by this authorPublished Online:28 Mar 2023https://doi.org/10.1089/derm.2022.0088AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Generalized Bullous Fixed Drug Eruption." Dermatitis®, , pp. –FiguresReferencesRelatedDetails Volume 0Issue 0 Information© 2023 American Contact Dermatitis Society. All Rights Reserved.To cite this article:Li Chai and Ze-Hu Liu.Generalized Bullous Fixed Drug Eruption.Dermatitis®.ahead of printhttp://doi.org/10.1089/derm.2022.0088Online Ahead of Print:March 28, 2023PDF download

MRNA COVID-19 VACCINE-ASSOCIATED BULLOUS FIXED DRUG ERUPTION

<h3>Introduction</h3> Fixed drug eruptions are unique cutaneous drug reactions that recur in the same location upon re-exposure to the offending agent. We report a dilemma of how to proceed with the vaccination after a rare complication of the mRNA covid-19 vaccine. <h3>Case Description</h3> A 47-year-old female referred to us after developing a rash to the mRNA covid-19 vaccine for evaluation of safety and plan on how to proceed with the booster vaccine. After the 1^st dose on her left deltoid, she developed persistent right arm pruritus from mid-forearm to wrist that gradually became well-demarcated and erythematous by day four. Rash improved within seven days of using hydrocortisone but left hyperpigmentation of the skin. Two weeks after receiving her 2^nd dose on her left deltoid, the same location on her right forearm flared up with more pronounced pruritus, erythema and a few bullous lesions. Rash improved after a week of using hydrocortisone leaving behind hyperpigmentation. The patient denied using any prior medications and had no other skin or mucosal involvement. We decided to proceed with another brand of mRNA covid-19 vaccine instead and prophylactically apply clobetasol twice daily to the affected area for 7-days post-vaccine. She tolerated the vaccine without any flare-up of the rash. <h3>Discussion</h3> Fixed drug eruptions more frequently occur with drugs including antimicrobials, NSAIDs, acetaminophen and anti-convulsants. Very rarely has it been reported in association with the administration of the Covid-19 vaccines. This case illustrates a unique predicament after an unusual complication of bullous fixed drug eruption after mRNA covid-19 vaccine administration.

33379 Melanophages save the day: A case of generalized bullous fixed drug eruption

A 29-year-old female was seen via inpatient dermatology consultation for acute erosive stomatitis. Upon admission for sickle cell crisis, the patient had an incidental urinary tract infection and was treated with trimethoprim-sulfamethoxazole for 3 days. On physical examination, she had painful superficial erosions of the upper and lower mucosal lips extending onto the vermillion as well as the distal and ventral tongue. Five large dusky violaceous plaques with overlying superficial erosions were seen on the bilateral proximal medial thighs, arms and on the left lateral abdomen. Punch biopsy of the violaceous plaques revealed a vacuolar interface dermatitis with full thickness necrosis overlying an inflammatory infiltrate with occasional interstitial eosinophils and many melanophages at the level of the superficial vascular plexus. While the pathologic differential diagnosis included EM as well as SJS/TEN, the melanophages, eosinophils and clinical findings favored a diagnosis of generalized bullous fixed drug eruption (GBFDE) secondary to trimethoprim-sulfamethoxazole. GBFDE is a particularly severe variant of FDE which often includes mucosal erosions. Differentiation from SJS/TEN may sometimes be clinically and histologically difficult, and patients may suffer high morbidity and mortality. In our patient, we treated aggressively and cautiously with IV methylprednisolone followed by oral prednisone with no disease progression and eventual complete resolution. The clinical findings suggestive of FDE along with dermal melanophages and eosinophils allowed a cautious but confident diagnosis of GBFDE without need for transferring our patient to a burn unit.

Study protocol: Australasian Registry of Severe Cutaneous Adverse Reactions (AUS-SCAR)

IntroductionSevere cutaneous adverse reactions (SCAR) are a group of T cell-mediated hypersensitivities associated with significant morbidity, mortality and hospital costs. Clinical phenotypes include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN),...

L’érythème pigmenté fixe bulleux généralisé au vaccin de la grippe : à propos d’un cas

IntroductionGeneralized bullous fixed drug eruption is a variant of fixed drug eruption occurring in rare cases. It is a severe drug-induced eruption requiring special management. Few cases of generalized bullous fixed drug eruption occurring after the influenza vaccine have been described in the literature, we report a new case of generalized bullous fixed drug eruption occurring after the influenza vaccine. ObservationThe patient is a 58-year-old female patient with generalized bullous fixed drug eruption occurring three days after the influenza shot. The patient did not receive any treatment that could potentially cause the clinical symptomatology. Skin biopsy showed apoptotic keratinocytes in the epidermis with the onset of subepidermal cleavage. DiscussionFixed drug eruption is a common drug eruption characterized by single or multiple rounded erythematous plaques giving way to scarring hyperpigmented macules. It recurs on the same cutaneous or mucosal sites, with the possibility of the appearance of other plaques, each time the incriminated agent is taken. The most commonly incriminated drugs are non-steroidal anti-inflammatory drugs, antibiotics and anti-epileptic drugs. Generalized bullous fixed drug eruption is a rare variant of fixed drug eruption, with only a few cases reported following the annual flu vaccine. The differential diagnosis includes Stevens-Johnson syndrome and toxic epidermal necrolysis in which lesions appear within 1 to 4 weeks of drug administration and almost always involve mucous membranes with marked systemic involvement. Although generalized bullous fixed drug eruption is less severe than these syndromes, it can be potentially fatal, especially in elderly subjects. ConclusionGeneralized bullous fixed drug eruption is a rare entity of fixed drug eruption, often confused with bullous dermatoses and severe drug eruptions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. The drugs involved are numerous, but few cases of generalized bullous fixed drug eruption following the influenza vaccination have been reported.

Generalized Bullous Fixed Drug Eruption to Iodinated Contrast Media in Skin of Color

A 69-year-old Malay woman presented with a widespread painful blistering rash, which had first begun over her neck and trunk, a few hours after a computed tomography scan performed with 90 mL of iohexol contrast for surveillance of sigmoid adenocarcinoma. Examination was notable for multiple circular hyperpigmented patches with inlying blisters and well-demarcated erosions involving her upper lip, neck, abdomen, and lower extremities (Figures 1 and 2). The total area of detachable epidermis was approximately 25%.

Fixed drug eruption after Pfizer-BioNTech COVID-19 vaccine: A case report

Fixed drug eruption after Pfizer-BioNTech COVID-19 vaccine: A case report

Bullous fixed drug eruptions consequent to NSAID usage − a case series

Fixed drug eruption (FDE) is a distinct, delayed type-IV hypersensitivity manifesting as recurring cutaneous reaction (on skin or mucosa) in the same locations on re-exposure to the offending drug. This is most commonly due to oral medications, antimicrobials and NSAIDs being the most common culprits. Herein, we discuss six cases of bullous FDE due to diverse NSAIDs. The first case was Naproxen-induced bullous fixed drug eruption (BFDE), the second case was due to Etoricoxib, the third patient had Mefenamic acid-induced BFDE, the fourth was Ibuprofen-induced FDE, the fifth one was Diclofenac-induced BFDE, the sixth was Aceclofenac-induced BFDE, and the seventh was a case of paracetamol-induced BFDE. All these patients noticed skin reactions that were clinically diagnosed by the dermatologist as NSAID-induced BFDE. The mainstay of treatment adopted was to avoid the culprit drug. All the seven patients were treated with oral steroids, followed by antihistaminics for reducing FDE-associated pruritus, ointment soframycin, and topical steroids for hyperpigmented lesions. Prompt diagnosis of BFDE and drug withdrawal at the clinician side may help in rapid resolution of the reaction within days to delayed recovery within few weeks, thus preventing rise in morbidity and mortality.

Nicorandil-Induced Bullous Fixed Drug Eruption on the Glans Penis.

Nicorandil-Induced Bullous Fixed Drug Eruption on the Glans Penis.

EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS, CAUSATIVE DRUGS, AND DIAGNOSTIC CHALLENGES OF FIXED DRUG ERUPTION IN ELDERLY PATIENTS: IS BULLOUS TYPE A MORE COMMON CLINICAL PHENOTYPE?

Objective: The present study aimed to evaluate the epidemiological and clinical features, causative drugs, and diagnostic challenges of Fixed drug eruption (FDE) in elderly patients. Material and Methods: In this single-center, retrospective, cross-sectional study, we evaluated data of all consecutive adult patients (aged &gt;18 years) with an established diagnosis of FDE between 1996-2018 in our tertiary referral center in Turkey. Elderly patients who were aged ≥60 years at the time of diagnosis were allocated to the study. Results: Among 182 adult FDE patients, 14 (7.7%) patients (male/ female=1/1.8) were in the elderly group (mean age=66.1±6.9 years). Fix drug eruption was induced by intermittently taken drugs in all patients, 50% of whom had polypharmacy (concurrent use of ≥5 medications). Trimethoprim-sulfamethoxazole (42.9%) and non-steroidal anti-inflammatory drugs (35.7%) were the main causative drugs, while ornidazole was a remarkable novel FDE inducer since 2011. Fix drug eruption was mostly located on the trunk and extremities. Mucosal involvement was less frequent. Ten (71.4%) patients had bullous FDE (BFDE). There were no statistically significant differences between the gender and mean ages of the patients with and without BFDE. Conclusion: Our long-term experience demonstrated that FDE may also affect elderly patients. Most of the patients had BFDE&nbsp;raising the question of whether the bullous type is a more common clinical phenotype in these patients. Among the important diagnostic challenges of FDE in this age group, e.g., polypharmacy, multimorbidity, recall problems, cognitive disorders, frailty, and immunosenescence, BFDE should also be kept in mind as it may clinically mimic Stevens-Johnson syndrome/toxic epidermal necrolysis, and autoimmune bullous diseases.

A Review of Fixed Drug Eruption with a Special Focus on Generalized Bullous Fixed Drug Eruption.

Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by the onset of rash at a fixed location on the body each time a specific medication is ingested. With each recurrence, the eruption can involve additional sites. Lesions can have overlying vesicles and/or bullae, and when they cover a significant percentage of body surface area, the eruption is referred to as generalized bullous fixed drug eruption (GBFDE). Due to the widespread skin denudation that can be seen in this condition, GBFDE may be confused clinically with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). While treatments described for GBFDE include supportive care, topical and/or systemic steroids, and, recently, cyclosporine, the mainstay of management involves identifying and discontinuing the causative drug. This review article will provide an overview of FDE with an emphasis on its generalized bullous variant.