Cause Of Fixed Drug Eruption Research Articles

In Situ Patch Test and Repeated Open Application Test for Fixed Drug Eruption: A Multicenter Study

Few studies have evaluated allergy workup in fixed drug eruption (FDE) in a large population. To evaluate the sensitivity of a standardized allergy workup for diagnosing the cause of FDE, with a focus on in situ repeated open application tests (ROATs). In a retrospective multicenter study, we analyzed the practice of conducting a complete allergy workup for the etiological diagnosis of FDE. It consisted of 3 steps: in situ patch tests (PTs) for all cases except pure mucosal involvement, followed by in situ ROAT if in situ PT results were negative, and finally a drug challenge (DC). The in situ ROAT involved daily application of the suspected drug on a previously affected FDE site for 7 days. Of 98 suspected FDE cases, 61 patients (median age 61 y; male-to-female ratio 1.8) with a complete allergy workup were included. In 4 cases, even the DC yielded negative results. Among the remaining 57 patients with a positive workup, implicated drugs included paracetamol (12 cases), β-lactams (11 cases), imidazoles (9 cases, including 5 with metronidazole), nonsteroidal anti-inflammatory drugs (8 cases), iodinated contrast media (4 cases), cotrimoxazole (3 cases), and various other drugs in 10 patients. The diagnosis was confirmed by in situ PT in 17 of 54 cases (31.5%), in situ ROAT in 14 of 40 cases (35%) (with 4 cases showing remote reactivation of FDE sites), and DC in 26 cases. The sequential allergy workup involving successively in situ PT, in situ ROAT, and DC is a reliable and safe method for diagnosing the cause of FDE. In situ tests exhibited a sensitivity of over 50%.

A Study of Drugs Causing Fixed Drug Eruptions

Fixed drug eruption (FDE) is a distinctive type of cutaneous drug reaction that characteristically recurs in the same site or sites each time a particular drug is taken. FDEs are among the most frequent problems encountered by the dermatologists. The present study was carried out to recognize offending drugs, to educate the patients and to avoid self-administration of drugs and re-administration of the offending drugs. The study was conducted in Skin & VD outpatient department of Rajshahi Medical College Hospital, Rajshahi over a period of one year. One hundred ten cases with established FDE were evaluated clinically. The causative drugs were identified and confirmed by provocation tests. Cotrimoxazole (25%) was the most common cause of FDE. Other drugs incriminated were NSAID (21.8%), Tetracycline (15.4%), Ciprofloxacin (10%), Amoxicillin (7.2%), Metronidazole (5.4%), Griseofulvin (2.7%) and Fluconazole (1.8%). The lesions were found to be distributed on the oro-genital mucosa, trunk and the acral regions.The main presentation of FDE was circularhyperpigmented lesion.TAJ 2014; 27(1): 29-33

A case of fixed drug eruption secondary to quinine in tonic water presenting to a sexual health clinic

Fixed drug eruption (FDE) is a cutaneous drug reaction which occurs repeatedly at a given mucocutaneous site after exposure to the causative agent. Lesions typically occur on extremities, oral mucosa...

Fixed drug eruption: topical provocation and subsequent phenomena.

To determine the usefulness of topical provocation in detecting the incriminated drug causing fixed eruption. Quasi-experimental study. Department of Dermatology, Shaikh Zayed FPGMI, Lahore, from November 2002 to December 2005. Three hundred and five, clinically diagnosed cases of Fixed Drug Eruption (FDE) of either gender and of any age were subjected to topical provocation with different drugs by using concentration of 1% (n=203), 2% (n=210) and 5% (n=235) in white soft paraffin. Drug ointment of one strength was applied one at a time on normal skin of flexor surface of right or left forearm. The effects of tests on involved and uninvolved skin were observed for 48 hours. The changes in lesions like erythema, hyperpigmentation, itching, burning or appearance of new lesion were considered a positive response. In case of no change, the patients (n=5) were subjected to oral provocation test, by giving half to full therapeutic dose of the suspected drug depending upon the severity of the initial attack. A patient who exhibited see-sawing phenomenon with 5% metamizole TPT was given oral challenge with same drug. Control topical tests were repeated in equal number of normal persons with various drug ointments and in patients of FDE with white soft paraffin on normal and affected skin. One hundred and thirty-seven patients were males and one hundred and sixty-eight patients were females. Maximum number of patients belonged to third decade. With 1% drug preparations 12 out of 316, with 2% drug preparations 28 out of 422 and with 5% drug preparations, 312 out of 523 TPTs were positive. The comparison revealed a highly significant association (Chi-square 448.1 and p < 0.000) among various strengths of preparations and positive response. Sulphamethoxazole was found to be the most commonly incriminated cause of FDE applied in 5% concentration yielded sensitivity rate of 91% compared to 4% with lower concentrations. Positive patch test was also observed with oxytetracycline. Five patients who were given oral provocation with different drugs were found to be positive to tinidazole, dapsone, propylphenazone, belladonna and phenobarbitone. Interesting phenomena like earlier reactivation of lesion situated distal to site of application of preparation, marching, see-sawing (with oral metamizole) and lightening observed, are not yet reported in literature. Topical provocation test with 5% drug concentration applied on normal skin of patient with FDE is a possible first line investigation in finding the incriminated drug.

Specific site involvement in fixed drug eruption

A total of 105 patients with established fixed drug eruption (FDE) by oral provocation were evaluated with regard to a drug-related site involvement. Cotrimoxazole was the leading causative agent (63.8%), followed by naproxen sodium (23.8%), dipyrone (5.7%), oxicams (4.8%) and other rare causes (1.9%). Cotrimoxazole most frequently induced lesions on genital mucosa; naproxen and oxicams on lips; and dipyrone on trunk and extremities. Isolated FDE on male genitalia (n = 16) was exclusively because of cotrimoxazole. A highly significant association could be established between naproxen and FDE on lips (chi-square = 28.3; corrected P = .000002). As this study represents the largest series of patients with naproxen-induced FDE, we would suggest that naproxen should be considered as an important potential cause of FDE on lips.

Drugs causing fixed eruptions: a study of 450 cases.

Drug eruptions are among the most common cutaneous disorders encountered by the dermatologist. Some drug eruptions, although trivial, may cause cosmetic embarrassment and fixed drug eruption (FDE) is one of them. The diagnostic hallmark is its recurrence at previously affected sites. We evaluated 450 FDE patients to determine the causative drugs. The ratio of men to women was 1:1.1. The main presentation of FDE was circular hyperpigmented lesion. Less commonly FDE presented as: nonpigmenting erythema, urticaria, dermatitis, periorbital or generalized hypermelanosis. Occasionally FDE mimicked lichen planus, erythema multiforme, Stevens-Johnson syndrome, paronychia, cheilitis, psoriasis, housewife's dermatitis, melasma, lichen planus actinicus, discoid lupus erythematosus, erythema annulare centrifugum, pemphigus vulgaris, chilblains, pityriasis rosea and vulval or perianal hypermelanosis. Cotrimoxazole was the most common cause of FDE. Other drugs incriminated were tetracycline, metamizole, phenylbutazone, paracetamol, acetylsalicylic acid, mefenamic acid, metronidazole, tinidazole, chlormezanone, amoxycillin, ampicillin, erythromycin, belladonna, griseofulvin, phenobarbitone, diclofenac sodium, indomethacin, ibuprofen, diflunisal, pyrantel pamoate, clindamycin, allopurinol, orphenadrine, and albendazole. Cotrimoxazole was the most common cause of FDE, whereas FDE with diclofenac sodium, pyrantel pamoate, clindamycin, and albendazole were reported for the first time. FDE may have multiform presentations.

Provocation Tests in a Chlormezanone-Induced Fixed Drug Eruption

Although as few as seven cases of fixed drug eruption (FDE) due to chlormezanone have been reported, it should not be overlooked as a cause of FDE. To identify the causative agent in FDEs, topical provocation tests are much safer and more convenient than systemic provocation tests. If results of topical provocation tests are reliable, they could become useful diagnostic as well as screening tests. Patch tests were performed in a suspected case of FDE due to chlormezanone on the patient's normal and prelesional skin with all ingested drugs whose concentrations were one and ten percent. The base was petrolatum. A positive reaction occurred only at the previously lesional site tested with chlormezanone, and was confirmed with oral provocation tests.