1
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Sakamoto K, Fujihiro M, Sakamoto A, Yamada C, Nagao K, Honda T. A case of nonpigmented fixed-drug eruption with eosinophilic intraepidermal vesicle formation. J Dermatol 2024; 51:e120-e122. [PMID: 37950416 PMCID: PMC10987267 DOI: 10.1111/1346-8138.17022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Keiko Sakamoto
- Department of Dermatology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Cutaneous Leukocyte Biology Section, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, 20852, USA
| | - Mayu Fujihiro
- Department of Pathology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Atsushi Sakamoto
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Chika Yamada
- Yamada hihuka, 537-1 Aritamaminami-cho, Higashi-ku, Hamamatsu, Shizuoka, 431-3122, Japan
| | - Keisuke Nagao
- Cutaneous Leukocyte Biology Section, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, 20852, USA
| | - Tetsuya Honda
- Department of Dermatology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
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2
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Yadav P, Bhatia R, Vasisht S, Sethi J. Patch test with multiple antipyretics in a case of fixed drug eruption in a child. Contact Dermatitis 2024; 90:422-423. [PMID: 38146069 DOI: 10.1111/cod.14487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 10/31/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Affiliation(s)
- Piyush Yadav
- Department of Dermatology, Venereology, and Leprosy, All India Institute of Medical Sciences, Rishikesh, India
| | - Riti Bhatia
- Department of Dermatology, Venereology, and Leprosy, All India Institute of Medical Sciences, Rishikesh, India
| | - Shivani Vasisht
- Department of Dermatology, Venereology, and Leprosy, All India Institute of Medical Sciences, Rishikesh, India
| | - Jyoti Sethi
- Department of Dermatology, Venereology, and Leprosy, All India Institute of Medical Sciences, Rishikesh, India
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3
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Mathieu A, de Grandmont M, Fernandes CL, Kechichian E. Triggers, clinical manifestations and assessment of paediatric fixed drug eruptions: A systematic review of the literature. Contact Dermatitis 2024; 90:343-349. [PMID: 38234071 DOI: 10.1111/cod.14500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/10/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
Fixed drug eruption (FDE) is a cutaneous drug reaction characterised by recurrent skin lesions occurring at the same site after each exposure to a causative agent. There is currently limited evidence in the paediatric population. The objective of this systematic review is to investigate the clinical features, causative agents and management of paediatric FDE. A systematic search of the English and French literature on paediatric FDE was conducted using the Medline and Embase databases. After full-text article review, 92 articles were included, representing a total of 233 patients. Antibiotics were the most frequent triggering agents, mainly sulfonamides (65.0% of antibiotics). Systemic symptoms were rare, and most patients only received supportive therapy. One hundred and six patients (106) performed a test to confirm the causative agent. Of these, 72.6% had oral provocation tests (OPTs) and 28.3% had patch tests. The patient's age, presence of bullous lesions and mucosal lesions were similar between tested and untested patients. It did not seem to influence the decision to perform OPTs. Paediatric FDE is a non-severe skin drug reaction. Antibiotics were the most reported triggering agents. Drug testing, including oral provocation test, was safely performed in the paediatric population.
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Affiliation(s)
- Audrey Mathieu
- Department of Dermatology, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Department of Dermatology, Université Laval, Québec, Québec, Canada
| | | | | | - Elio Kechichian
- Department of Dermatology, Université de Sherbrooke, Sherbrooke, Québec, Canada
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4
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Shaker N, Sangueza OP, Shaker N, Arthur M, Pradhan D. Erythema Multiforme-Like Fixed Drug Eruption During Azathioprine and Hydroxychloroquine Treatment for Systemic Lupus Erythematosus Mimicking Rowell Syndrome: A Rare and Challenging Clinical Scenario. Int J Surg Pathol 2024:10668969241234316. [PMID: 38494929 DOI: 10.1177/10668969241234316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background. Fixed drug eruption and Rowell syndrome stand as intriguing entities with overlapping clinical and pathological features. Case Presentation. A 32-year-old female patient presented with a tender and pruritic rash on the left upper chest for 3 days. Clinical examination revealed a flaring rash on the chest, under her left eye, tongue, and lips. The patient had a significant past medical history of systemic lupus erythematous with positive (ANA, Sm, dsDNA, ribosomalP, RNP) antibodies, hypocomplementemia, inflammatory arthritis, discoid lupus, leukopenia, thrombocytopenia, and immune thrombocytopenic purpura, and avascular necrosis affecting both hips and her right knee. At the time of presentation, the patient was on azathioprine 150 mg daily and hydroxychloroquine 200 mg twice daily. Skin biopsy of the left upper chest revealed interface dermatitis with necrotic keratinocytes at the dermal-epidermal junction. Superficial and, in some areas, deep perivascular and peri adnexal lymphocytic infiltrates were observed, accompanied by eosinophils. CD123 staining highlighted 16% of the inflammatory cells. Direct Immunofluorescence for IgG, IgA, IgM, C3, and fibrinogen revealed positive linear basement membrane staining for IgG and fibrinogen, with no significant staining for the remaining immunoreactants. Considering the patient's history of medicine usage, and negative SS-A and SS-B antibody, a fixed drug eruption was favored. Discussion. This article discusses the clinical presentations, pathophysiological mechanisms, and diagnostic criteria for fixed drug eruption and Rowell syndrome. Conclusion. Awareness of the distinct clinical and histopathologic features of fixed drug eruption and Rowell syndrome, particularly when sharing cutaneous manifestations, underscores the importance of a comprehensive diagnostic approach and laboratory testing.
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Affiliation(s)
- Nada Shaker
- Pathology and Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Omar P Sangueza
- Departments of Dermatology and Dermatopathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nuha Shaker
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
| | - Megan Arthur
- University of Nebraska Medical Center, Omaha, NE, USA
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5
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Taboada Paz L, Iriarte Soter P, Vicente Basanta E, Ojea Varona S, López Caamaño AS, López Solache L, Monteagudo Sanchez B. Multiple widespread fixed drug eruption caused by in a transdermal therapeutic system. Contact Dermatitis 2024. [PMID: 38494171 DOI: 10.1111/cod.14542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/27/2024] [Accepted: 03/02/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Laura Taboada Paz
- Dermatology Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Pilar Iriarte Soter
- Allergology Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Elena Vicente Basanta
- Dermatology Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Silvia Ojea Varona
- Dermatology Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | | | - Laura López Solache
- Pathology Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
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6
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Zhang JS, Aggarwal I, Bain M. A case of bullous fixed drug eruption caused by tadalafil. JAAD Case Rep 2024; 45:44-46. [PMID: 38379872 PMCID: PMC10876462 DOI: 10.1016/j.jdcr.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Affiliation(s)
- Jane Sun Zhang
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
| | - Ishita Aggarwal
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
| | - Michelle Bain
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
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7
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Mota D, Miranda J, Carneiro-Leão L, Cernadas J. Fixed drug eruption caused by iodinated contrast media: An unusual hypersensitivity reaction. Contact Dermatitis 2024; 90:199-200. [PMID: 38010162 DOI: 10.1111/cod.14466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Diogo Mota
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Joana Miranda
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Leonor Carneiro-Leão
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Josefina Cernadas
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
- Hospital Lusíadas Porto, Porto, Portugal
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8
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Chindhalore CA, Gupta AV, Dakhale GN, Srivastava A. Analysis of Cutaneous Adverse Drug Reactions (ADR) Reported at an ADR Monitoring Center of a Tertiary Care Teaching Institute in Central India. Cureus 2024; 16:e53706. [PMID: 38455795 PMCID: PMC10918304 DOI: 10.7759/cureus.53706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Background Cutaneous adverse drug reactions (ADRs) are among the most frequent ADRs. Knowledge of the pattern of cutaneous ADRs (CADRs) and causal drugs helps prevent and reduce the incidence of CADR, which in turn reduces the incidence of hospitalization and expenses for the patient. Objectives To analyze CADR according to demographic profile, morphological pattern, causative drugs, severity, and outcome in patients suffering from CADRs. Materials and methods Retrospective data analysis was conducted in the Adverse Drug Reaction Monitoring Centre (AMC) of the tertiary care teaching institute between February 2020 and September 2023 under the Pharmacovigilance Program of India (PvPI). All ADRs reported were analyzed based on the following parameters: total number of ADRs reported, number of CADRs, information related to demographic parameters, the clinical presentation of CADRs, and suspected medication. Causality assessment was done using the World Health Organisation-Uppsala Monitoring Centre (WHO-UMC) scale. Severity was assessed using a modified Hartwig and Seigel scale. Results A total of 125 CADRs were analyzed. Considering the gender-wise distribution, 65 females and 60 males suffered from CADR. The most common drug category responsible for CADRs was antimicrobials (63.2%), followed by topical agents (12.8%). Maculopapular rash (33.6%) was the most common presenting symptom, followed by itching (27.2%). Few patients suffered from serious CADRs such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Conclusion A wide clinical spectrum of CADRs ranging from maculopapular rash to fixed-drug eruption to serious SJS was observed in our study. The most common causative agents for CADRs were antimicrobials, followed by topical agents and NSAIDs. For early diagnosis and management of CADRs, it is critical to have data on the potential cutaneous adverse effects of commonly used drugs, to educate the patients regarding common early symptoms of drug reactions (e.g., erythematous rash, edema, urticaria, mucosal erosions, itching, burning of skin, etc.), and to monitor the patient, especially during the start of therapy. To ease the burden of CADRs, a therapeutic plan of anticipating, avoiding, recognizing, and responding to ADRs should be implemented.
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Affiliation(s)
| | - Ashish V Gupta
- Pharmacology, Nandkumar Singh Chauhan Government Medical College, Khandwa, Khandawa, IND
| | - Ganesh N Dakhale
- Pharmacology, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Ankita Srivastava
- Dermatology, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
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9
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Sinha S, Kar C, Das S, Dutta A, De A. A Clinico-Epidemiological Study of Cutaneous Adverse Drug Reactions in a Tertiary Care Centre of Eastern India. Indian J Dermatol 2024; 69:106. [PMID: 38572036 PMCID: PMC10986873 DOI: 10.4103/ijd.ijd_944_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Background Adverse drug reactions (ADRs) are major problems in the drug therapy. Cutaneous adverse drug reactions (CADRs) are the most common ADRs. The pattern of CADRs differs among various drugs. Aims To record various morphological patterns of CADRs and their causal relationships among patients attending in a tertiary care centre. Materials and Methods An observational, cross-sectional, clinical study was conducted for a duration of one and a half years in a tertiary care centre in eastern India. Patients presenting with suspected CADRs were included if drug identity could be ascertained. Clinical profiling and drug history were recorded, and causality assessment was carried out as per the Naranjo scale. Result The commonest CADR in our study was fixed drug eruption (FDE) 48.61%, followed by SJS-TEN spectrum 16.66%, maculopapular rash 11.11% and so on. Severe cutaneous adverse drug reactions (SCARs) such as SJS, TEN, SJS-TEN Overlap, AGEP and DRESS accounted for 18 cases (25%). The most common culprit drugs were antimicrobials (54.16%), followed by nonsteroidal anti-inflammatory drugs (15.27%) and anticonvulsants (12.5%). Most of the CADRs were in probable category. Conclusion The pattern of CADRs and the drugs causing them in our study population are similar to some previous studies but somewhat different from most of the previous Indian studies. The incidence of SCARs was significantly higher than in previous other studies in India and abroad.
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Affiliation(s)
- Sujata Sinha
- From the Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Chinamy Kar
- From the Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Sudip Das
- From the Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Arnab Dutta
- From the Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Abhishek De
- From the Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
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10
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Youh J, Yamaguchi Y, Kawamura T, Hoshina D. Dose-dependent, non-pigmenting fixed drug eruption with eczematous lesions induced by bosutinib: case report. Pan Afr Med J 2023; 46:95. [PMID: 38405098 PMCID: PMC10891373 DOI: 10.11604/pamj.2023.46.95.42208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 11/25/2023] [Indexed: 02/27/2024] Open
Abstract
Bosutinib, widely used as a primary treatment for chronic myeloid leukemia (CML), is known to frequently cause cutaneous drug eruptions. Fixed Drug Eruption (FDE) is common, typically presenting as recurrent lesions that heal with residual hyperpigmentation. Diagnosing FDE, especially Non-Pigmenting Fixed Drug Eruption (NPFDE), is often challenging. A correlation exists between the dosage of certain medications, such as levetiracetam, and the emergence of drug eruptions. This report details a unique case of dose-dependent NPFDE caused by bosutinib. In managing cutaneous drug eruptions, particularly when the causative drug is crucial for treatment, a strategy of tapering the dosage should be considered.
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Affiliation(s)
- Joohyung Youh
- Department of Dermatology, Hakodate Central General Hospital, Hakodate, Japan
| | - Yasuyuki Yamaguchi
- Department of Dermatology, Hakodate Central General Hospital, Hakodate, Japan
- Sapporo Dermatology Clinic, Sapporo, Japan
| | - Tsugumichi Kawamura
- Department of Internal Medicine, Hakodate Central General Hospital, Hakodate, Japan
| | - Daichi Hoshina
- Department of Dermatology, Hakodate Central General Hospital, Hakodate, Japan
- Department of Dermatology, Otaru General Hospital, Otaru, Japan
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11
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Theroux Z, Gardner J, Ortiz E, Kosik G, Junkins-Hopkins J. Neutrophilic fixed drug eruption, a histopathologic variant or an expected finding?-A report of two cases and review of the literature. J Cutan Pathol 2023; 50:884-889. [PMID: 37403191 DOI: 10.1111/cup.14487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/10/2023] [Accepted: 06/13/2023] [Indexed: 07/06/2023]
Abstract
Fixed drug eruption (FDE) is an adverse drug reaction characterized by recurrent circumscribed lesions at the same location upon re-exposure to the culprit medication, resulting in distinct postinflammatory hyperpigmentation. Histopathologically, FDE demonstrates a predominantly lymphocytic interface or lichenoid infiltrate with basal cell vacuolar changes and keratinocyte dyskeratosis/apoptosis. The term "neutrophilic fixed drug eruption" has been used to describe cases in which the inflammatory infiltrate is predominantly neutrophilic. The infiltrate can extend deeper in the dermis, potentially mimicking a neutrophilic dermatosis such as Sweet syndrome. We present two cases and review the literature to discuss the possibility that a neutrophilic inflammatory infiltrate may be an expected finding in FDE, rather than a histopathologic variant.
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Affiliation(s)
- Zachary Theroux
- Dermatopathology Department, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Jerad Gardner
- Dermatopathology Department, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Eduardo Ortiz
- Dermatology Department, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Grace Kosik
- Dermatology Department, Geisinger Medical Center, Danville, Pennsylvania, USA
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12
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Choi S, Kim SH, Hwang JH, Jang HW, Oh SH, Kim DY, Kim TG. Rapidly progressing generalized bullous fixed drug eruption after the first dose of COVID-19 messenger RNA vaccination. J Dermatol 2023; 50:1190-1193. [PMID: 37102209 DOI: 10.1111/1346-8138.16808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/01/2023] [Accepted: 04/05/2023] [Indexed: 04/28/2023]
Abstract
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.
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Affiliation(s)
- Sooyeon Choi
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Hee Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji-Hye Hwang
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Woo Jang
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Ho Oh
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Do-Young Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Gyun Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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13
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Sarawgi D, Rudra O. Tadalafil-Induced Generalized Bullous Fixed Drug Eruption: A Rare Side Effect of a Common Drug. Cureus 2023; 15:e39649. [PMID: 37388586 PMCID: PMC10306314 DOI: 10.7759/cureus.39649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
Tadalafil is a phosphodiesterase-5 (PDE-5) inhibitor, an FDA-approved treatment for erectile dysfunction (ED), pulmonary arterial hypertension (PAH), benign prostate hyperplasia, etc. It is also widely used by otherwise healthy individuals for recreational purposes. Fixed drug eruption (FDE) is a distinctive type of adverse drug reaction in which every exposure to the offending medication leads to the appearance of lesions at the same 'fixed' sites. A sharply defined erythematous patch or plaque with a violaceous hue is typically seen. A clinical variant featuring classic FDE lesions along with blistering in at least three out of six anatomical sites or involving at least 10% of body surface area is known as generalized bullous fixed drug eruption (GBFDE). Tadalafil-induced FDE is in itself an uncommon phenomenon, with only a handful of documented cases, none of which seem to have reported GBFDE-type presentation post-tadalafil intake. Here, we present a case of GBFDE following tadalafil administration.
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Affiliation(s)
- Devansi Sarawgi
- Dermatology, Institute of Post Graduate Medical Education & Research, Kolkata, IND
| | - Olympia Rudra
- Dermatology, Institute of Post Graduate Medical Education & Research, Kolkata, IND
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14
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Pereira AS, Flor D, Gonçalo M. A case of fixed drug eruption from cetirizine with cross-reaction to levocetirizine and hydroxyzine. Contact Dermatitis 2023; 88:318-319. [PMID: 36562721 DOI: 10.1111/cod.14270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Ana Sofia Pereira
- Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal
| | - Duarte Flor
- Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal
| | - Margarida Gonçalo
- Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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15
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Ashifha S, Vijayashree J, Vudayana K, Chintada D, P P, G P, Unnikrishnan P. A Study of Cutaneous Adverse Drug Reactions at a Tertiary Care Center in Andhra Pradesh, India. Cureus 2023; 15:e37596. [PMID: 37197134 PMCID: PMC10184741 DOI: 10.7759/cureus.37596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION Practically all physicians encounter a diverse range of suspected cutaneous adverse drug reactions (CADRs) in their daily clinical practice. The skin and mucosa are the most often encountered areas for the early presentation of numerous adverse drug reactions. Cutaneous adverse drug reactions are classified as benign or severe. The clinical manifestations of drug eruptions can range from mild maculopapular exanthema to severe cutaneous adverse drug reactions (SCARs). OBJECTIVE To determine the varied clinical and morphological presentations of CADRs and to identify the culprit drug and common drugs causing CADRs. MATERIALS AND METHODS Patients with clinical features suspected of CADRs presenting to the outpatient department (OPD) of dermatology, venereology, and leprosy (DVL) between December 2021 to November 2022 at Great Eastern Medical School and Hospital (GEMS), Srikakulam, Andhra Pradesh, India, were considered for the study. This was a cross-sectional, observational study. The patient's clinical history was taken in detail. This included chief complaints (symptoms, site of onset, duration, drug history, latency time between drug administration and the appearance of cutaneous lesions), family history, associated diseases, the morphology of lesions, and mucosal examination. Upon drug discontinuation, improvement in cutaneous lesions and systemic features were noted. A complete general examination, systemic examination, dermatological tests, and mucosal examination were performed. RESULTS A total of 102 patients were involved in the study, of whom 55 were males and 47 were females. The male-to-female ratio was 1.17:1, with a slight male majority. The most common age group was 31 to 40 years for both males and females. Itching was the predominant complaint in 56 patients (54.9%). The mean latency period was shortest in urticaria (2.13+/- 0.99 hours) and longest in lichenoid drug eruption (4.33+/- 3.93 months). Most patients developed symptoms after a week of taking the drug (53.92%). A history of similar complaints was present in 38.23% of patients. Analgesics and antipyretics (39.2%) were the most common culprit drugs followed by antimicrobials (29.4%). Among analgesics and antipyretics, aceclofenac (24.5%) was the commonest culprit drug. Benign CADRs were observed in 89 patients (87.25%), and severe cutaneous adverse reactions (SCARs) were observed in 13 patients (12.74%). The common CADRs presented were drug-induced exanthem (27.4%). Imatinib-induced psoriasis vulgaris and lithium-induced scalp psoriasis were observed in one patient each. Severe cutaneous adverse reactions were observed in 13 patients (12.74%). Anticonvulsants, nonsteroidal anti-inflammatory drugs (NSAIDs), and antimicrobials were the culprit drugs for SCARs. Eosinophilia was present in three patients, deranged liver enzymes was present in nine patients, a deranged renal profile was present in seven patients, and death occurred in one patient with toxic epidermal necrolysis (TEN) of SCARs. CONCLUSION Before prescribing any drug to a patient, a detailed drug history and family history of drug reactions need to be obtained. Patients should be advised to avoid over-the-counter usage of medications and self-administration of drugs. If adverse drug reactions occur, it is advised to avoid readministration of the culprit drug. Drug cards must be prepared and given to the patient, mentioning the culprit drug as well as the cross-reacting drugs.
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Affiliation(s)
- Shaik Ashifha
- Dermatology, Venereology and Leprosy, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Jami Vijayashree
- Dermatology, Venereology and Leprosy, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Kirankanth Vudayana
- Dermatology, Venereology and Leprosy, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Dilipchandra Chintada
- Dermatology, Venereology and Leprosy, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Pavani P
- Dermatology, Venereology and Leprosy, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Pallavi G
- Dermatology, Venereology and Leprosy, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Pooja Unnikrishnan
- Dermatology, Venereology and Leprosy, Great Eastern Medical School and Hospital, Srikakulam, IND
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Ammar H, Ben Fredj N, Ben Romdhane H, Chaabane A, Chadli Z, Ben Fadhel N, Aouam K. Cross-reactivity between nonsteroidal anti-inflammatory drugs in fixed drug eruption: Two unusual cases and a literature review. Br J Clin Pharmacol 2023; 89:561-573. [PMID: 36223303 DOI: 10.1111/bcp.15565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/22/2022] [Accepted: 10/05/2022] [Indexed: 01/18/2023] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the main causes of fixed drug eruption (FDE). Cross-sensitivity between chemically unrelated NSAIDs has been rarely described in FDE. We report herein two cases of NSAID-induced FDE confirmed by oral provocation test (OPT) with a literature review. Case 1 is a 49-year-old woman who took mefenamic, naproxen and acetaminophen for lumbago. On the second day, she noticed three erythematous plaques, located in the upper lip, chin and the right hand, which faded spontaneously, leaving residual patches. Three months later, she took mefenamic acid with reactivation of the same plaques. She received naproxen. On the same day, she exhibited a reactivation of lesions with the development of a new one. These lesions have disappeared leaving hyperpigmented sequelae. After negative patch test to naproxen, an OPT was performed with positive reaction, observed on the third day. To establish the cross-reactivity, she underwent OPTs, which gave positive results to indomethacin, ketoprofen and tiaprofenic acid. Case 2 is a 52-year-old woman who presented painful dusky-red macules, located in the right and left wrists, 24 hours after taking mefenamic acid. She described two similar events that occurred in the past with an undefined drug and piroxicam. Patch tests to lysine acetylsalicylate, mefenamic acid, piroxicam, naproxen and celecoxib were negative. OPTs to the same NSAIDs gave positive results to lysine acetylsalicylate, piroxicam and mefenamic acid. Thirteen case reports, seven case series and one retrospective analysis, including cases with confirmed cross-reactivity between NSAIDs, were reported in literature. Clinicians should be aware of such phenomenon.
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Affiliation(s)
- Helmi Ammar
- Department of Pharmacology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Nadia Ben Fredj
- Department of Pharmacology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Haifa Ben Romdhane
- Department of Pharmacology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Amel Chaabane
- Department of Pharmacology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Zohra Chadli
- Department of Pharmacology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Najah Ben Fadhel
- Department of Pharmacology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Karim Aouam
- Department of Pharmacology, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
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17
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Mital R, Cartron AM, Trinidad JC, Spaccarelli N, Gibbons-Fideler IS, Kaffenberger BH, Chung CG. Novel cutaneous eruptions in the setting of programmed cell death protein 1 inhibitor therapy. JAAD Case Rep 2022; 31:124-127. [PMID: 36583144 PMCID: PMC9792734 DOI: 10.1016/j.jdcr.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Rohan Mital
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alexander M. Cartron
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - John C. Trinidad
- Department of Dermatology, Massachusetts General Hospital, Cambridge, Massachusetts
| | - Natalie Spaccarelli
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | | | - Catherine G. Chung
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio,Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio,Correspondence to: Catherine G. Chung, MD, 2050 Kenny Rd MMT 930, Columbus, OH 43221.
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18
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Romero-Sánchez L, Méndez-Brea P. Fixed drug eruption due to clindamycin with tolerance to lincomycin. Contact Dermatitis 2022; 87:369-370. [PMID: 35608453 DOI: 10.1111/cod.14164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/03/2022] [Accepted: 05/20/2022] [Indexed: 12/01/2022]
Affiliation(s)
| | - Paula Méndez-Brea
- Department of Allergy, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
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19
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Sun Y, Lan CCE, Yang TT, Chiu SH. Common pitfalls and bias learned from the COVID-19 pandemic: Keeping a clear mind of judgment. JAAD Case Rep 2022; 27:1-2. [PMID: 35812080 PMCID: PMC9249663 DOI: 10.1016/j.jdcr.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yng Sun
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Che E Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ting-Ting Yang
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Hao Chiu
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Dermatology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
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20
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Calvão J, Figueiredo C, Gonçalo M. Patch testing in fixed drug eruptions: a 12-year retrospective study. J Eur Acad Dermatol Venereol 2022; 36:e770-e772. [PMID: 35656639 DOI: 10.1111/jdv.18290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- J Calvão
- Dermatovenereology Department of Coimbra University Hospital, Coimbra, Portugal
| | - C Figueiredo
- Dermatovenereology Department of Coimbra University Hospital, Coimbra, Portugal
| | - M Gonçalo
- Dermatovenereology Department of Coimbra University Hospital, Coimbra, Portugal.,Faculty of Medicine of Coimbra University Hospital
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21
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Ophélie B, Alia G, Brigitte M, Paola S, Stéphanie K, Ruben G, Anne-Sophie D. Ectasy-Induced Fixed Drug Eruption. Contact Dermatitis 2022; 87:280-281. [PMID: 35452150 PMCID: PMC9543104 DOI: 10.1111/cod.14132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Barbier Ophélie
- Department of Dermatology, Hôpital Saint André, CHU de Bordeaux, France
| | - Galadari Alia
- Department of Dermatology, Hôpital Saint André, CHU de Bordeaux, France
| | - Milpied Brigitte
- Department of Dermatology, Hôpital Saint André, CHU de Bordeaux, France
| | - Sanchez Paola
- Department of Pharmacoviligancy, Hôpital Pellegrin, CHU de Bordeaux, France
| | - Kassab Stéphanie
- Department of Dermatology, Hôpital Saint André, CHU de Bordeaux, France
| | - Goncalves Ruben
- Department of Pharmacotoxicology, Hôpital Pellegrin, CHU de Bordeaux, France
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22
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Zhang R, Geng H, Du J, Liu M. Fixed drug eruption in a patient of HLA-B*58:01 negative after allopurinol administration: A case report. J Clin Pharm Ther 2022; 47:841-843. [PMID: 35118681 DOI: 10.1111/jcpt.13616] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/21/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Allopurinol is widely used for hyperuricemia and gouty arthritis, but is associated with cutaneous adverse drug reactions (CADRs). HLA-B*58:01 is a highly specific and effective genetic marker for the detection of allopurinol-induced CADRs, especially for Asian descents. CASE SUMMARY A 60-year-old Chinese Han male patient took allopurinol for lowering uric acid after the negative result from HLA-B*58:01 testing. Then, he experienced episodes of well-demarcated pruritic erythematous patches on the whole body that developed into blisters and pustular eruption. Fixed drug eruption (FDE) was diagnosed by skin biopsy and improved with withdrawal and hormone treatments. WHAT IS NEW AND CONCLUSION It should be kept in mind that cutaneous drug eruption might occur after allopurinol administration in Asians of HLA-B*58:01 negative. Awareness among medical practitioners about FDE can lead to correct diagnosis, treatment and decreased damage as well as lower therapeutic costs.
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Affiliation(s)
- Ruiqi Zhang
- Department of Geriatrics, Peking University First Hospital, Beijing, China
| | - Hui Geng
- Department of Geriatrics, Peking University First Hospital, Beijing, China
| | - Jiali Du
- Department of Geriatrics, Peking University First Hospital, Beijing, China
| | - Meilin Liu
- Department of Geriatrics, Peking University First Hospital, Beijing, China
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23
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Ercan N. Mucosal fixed drug eruption to levetiracetam with early positive patch test on non-lesional skin. Pediatr Allergy Immunol 2022; 33:e13723. [PMID: 35212050 DOI: 10.1111/pai.13723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Nazli Ercan
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Gulhane Research and Training Hospital, University of Health Sciences Turkey, Ankara, Turkey
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24
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Kashfi S, Radparvar AA, Ventura Y, Sharma S, Sharma S. Bullous Erythema Multiforme Secondary to Trimethoprim-Sulfamethoxazole Use, Treated With Cyclosporine in a 91-Year-Old Male. Cureus 2021; 13:e18239. [PMID: 34712524 PMCID: PMC8542345 DOI: 10.7759/cureus.18239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
Erythema multiforme is an acute, immune-mediated, mucocutaneous condition in which 90% of cases are triggered by infection. The second most common cause is drug-induced. It classically presents with itchy, burning targetoid lesions on the skin and mucous membranes. The lesions may be mistaken for other conditions, and thus, rapid and correct diagnosis is crucial. It is most often treated with corticosteroids, though non-responders or those with weakened immune systems may require immunomodulatory therapy. We present the case of a 91-year-old male who developed bullous erythema multiforme after treatment with trimethoprim-sulfamethoxazole who was successfully treated with cyclosporine.
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Affiliation(s)
- Simon Kashfi
- Internal Medicine, CUNY School of Medicine, New York, USA
| | | | | | - Sapna Sharma
- Internal Medicine, Mahatma Gandhi Mission Institute of Health Sciences, Navi Mumbai, IND
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25
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Al Masri D, Fleifel M, Hirbli K. Fixed Drug Eruption Secondary to Four Anti-diabetic Medications: An Unusual Case of Polysensitivity. Cureus 2021; 13:e18599. [PMID: 34786218 PMCID: PMC8577818 DOI: 10.7759/cureus.18599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
Abstract
We report a case of fixed drug eruption in a 58-year-old lady treated for diabetes with four pharmacologically different anti-diabetic agents that were used at separate times of therapy. Skin manifestations, including erythema, blisters, and ulcers, developed over the right leg each time after the initiation of metformin, gliclazide, vildagliptin, and empagliflozin; and disappeared following the discontinuation of the drugs. Magnesium stearate was the common excipient identified in the four agents. This is an extremely rare case of fixed drug eruption caused by structurally dissimilar drugs.
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Affiliation(s)
- Dana Al Masri
- Endocrinology, Diabetes, and Metabolism, Lebanese American University Medical Center, Beirut, LBN
| | - Mohamad Fleifel
- Internal Medicine, Lebanese American University Medical Center, Beirut, LBN
| | - Kamal Hirbli
- Endocrinology, Diabetes, and Metabolism, Lebanese American University Medical Center, Beirut, LBN
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26
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Almukhadeb E. A Case of Recurrent Fixed Drug Eruption Secondary to Desloratadine. Cureus 2021; 13:e16762. [PMID: 34476136 PMCID: PMC8403490 DOI: 10.7759/cureus.16762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 11/26/2022] Open
Abstract
Desloratadine is a second-generation H1-type antihistamine that is widely prescribed for multiple indications including allergic rhinitis and urticaria. It is well-tolerated and is not known to cause cutaneous side effects including fixed drug eruption (FDE). In this report, a case of recurrent fixed drug eruption induced by desloratadine is reported.
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Affiliation(s)
- Eman Almukhadeb
- Dermatology, College of Medicine, King Saud University, Riyadh, SAU
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27
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Anderson HJ, Lee JB. A Review of Fixed Drug Eruption with a Special Focus on Generalized Bullous Fixed Drug Eruption. Medicina (Kaunas) 2021; 57:925. [PMID: 34577848 DOI: 10.3390/medicina57090925] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/28/2021] [Accepted: 08/29/2021] [Indexed: 11/24/2022]
Abstract
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.
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28
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Schunkert EM, Shah PN, Divito SJ. Skin Resident Memory T Cells May Play Critical Role in Delayed-Type Drug Hypersensitivity Reactions. Front Immunol 2021; 12:654190. [PMID: 34497600 PMCID: PMC8419326 DOI: 10.3389/fimmu.2021.654190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/06/2021] [Indexed: 12/31/2022] Open
Abstract
Delayed-type drug hypersensitivity reactions (dtDHR) are immune-mediated reactions with skin and visceral manifestations ranging from mild to severe. Clinical care is negatively impacted by a limited understanding of disease pathogenesis. Though T cells are believed to orchestrate disease, the type of T cell and the location and mechanism of T cell activation remain unknown. Resident memory T cells (TRM) are a unique T cell population potentially well situated to act as key mediators in disease pathogenesis, but significant obstacles to defining, identifying, and testing TRM in dtDHR preclude definitive conclusions at this time. Deeper mechanistic interrogation to address these unanswered questions is necessary, as involvement of TRM in disease has significant implications for prediction, diagnosis, and treatment of disease.
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29
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Perron E, Viarnaud A, Marciano L, Karkouche R, Wechsler J, De Prost N, Chosidow O, Wolkenstein P, Ingen-Housz-Oro S, Ortonne N. Clinical and histological features of fixed drug eruption: a single-centre series of 73 cases with comparison between bullous and non-bullous forms. Eur J Dermatol 2021; 31:372-80. [PMID: 34309522 DOI: 10.1684/ejd.2021.4051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The clinical and pathological aspects of fixed drug eruption (FDE) have been described based on a few case series. To compare bullous FDE (BFDE) and non-bullous FDE (NBFDE) and to determine whether BFDE can be histologically distinguished from other dermatoses presenting with an apoptotic pan-epidermolysis. In this retrospective monocentre study (2005-2016), FDE was classified as BFDE or NBFDE and localized (one anatomical site) or generalized (≥ two sites; GBFDE). Clinical data were extracted from charts, and images were reviewed. Skin biopsies were analysed and compared to the clinical presentation. Three dermatopathologists, blinded to the final clinical diagnosis, evaluated a subset of BFDE cases (n = 8) and 25 biopsies of other bullous diseases known to have an epidermal necrolysis (EN)-like pattern. In total, 73 patients were included in the study. Patients with BFDE (n = 58; GBFDE n = 48) were significantly older (p < 0.001). All patients with GBFDE were hospitalized; 25 had a complication (infectious; n = 19), and eight died (median age: 80). Histology revealed spongiotic (6.7%), interface dermatitis (48.3%) and EN-like (66.3%) patterns. The EN-like pattern was more frequent in BFDE than NBFDE (74% vs 27%; p = 0.008). Melanophages (100% vs 66%; p = 0.02) and massive dermal melanosis (40% vs 4%; p = 0.0005) were more prominent in NBFDE than BFDE. BFDE could not be reliably distinguished from other bullous diseases with EN-like patterns. BFDE belongs to the spectrum of skin conditions with an EN pattern, for which the concept of acute syndrome of apoptotic pan-epidermolysis (ASAP) was previously introduced. Clinical-pathological correlation is mandatory for a diagnosis of BFDE.
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30
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Long CY, Wong N, Burns A. Fixed Drug Eruption to Trimethoprim-Sulfamethoxazole and Doxycycline. Cureus 2021; 13:e14502. [PMID: 34007755 PMCID: PMC8121196 DOI: 10.7759/cureus.14502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Fixed drug eruption (FDE) is a common cutaneous drug eruption. We are the first to report a case of polysensitive FDE to both trimethoprim-sulfamethoxazole (TMP-SMX) and doxycycline. Diagnosis of FDE is largely clinical, and it is important to establish a good medication history to identify the causative agent. Treatment depends on avoidance of the implicated drug.
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Affiliation(s)
- Clara Y Long
- Faculty of Medicine, Dalhousie University, Halifax, CAN
| | - Noelle Wong
- Department of Dermatology, Queen Elizabeth II Health Sciences Center, Halifax, CAN
| | - Ariel Burns
- Department of Dermatology, Queen Elizabeth II Health Sciences Center, Halifax, CAN
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31
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Kawall T, Seecheran R, Seecheran V, Persad S, Seecheran NA. Suspected Ticagrelor-Induced Bullous Fixed Drug Eruption. Cureus 2021; 13:e13890. [PMID: 33880246 PMCID: PMC8045002 DOI: 10.7759/cureus.13890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We describe a case of a suspected cutaneous hypersensitivity reaction to ticagrelor. The patient displayed a localized bullous fixed drug eruption after being loaded with ticagrelor, which resolved with oral antihistamines and topical steroids after one week. Clopidogrel and rivaroxaban were successfully administered as alternative antithrombotic therapy without any apparent further hypersensitivity skin reaction.
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Affiliation(s)
- Tiffany Kawall
- Internal Medicine, Eric Williams Medical Sciences Complex, Champ Fleurs, TTO
| | - Rajeev Seecheran
- Internal Medicine, Eric Williams Medical Sciences Complex, Champs Fleurs, TTO
| | - Valmiki Seecheran
- Internal Medicine, Eric Williams Medical Sciences Complex, Champs Fleurs, TTO
| | - Sangeeta Persad
- Internal Medicine, Eric Williams Medical Sciences Complex, Champs Fleurs, TTO
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Affiliation(s)
- Skylar Klager
- University of Central Florida College of Medicine, Orlando, Florida
| | | | - Kenneth Shulman
- Department of Dermatology, New York Medical College, Valhalla, New York
| | - Naveed Sami
- UCF Health, Orlando, Florida.,Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida
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Tokura Y, Phadungsaksawasdi P, Kurihara K, Fujiyama T, Honda T. Pathophysiology of Skin Resident Memory T Cells. Front Immunol 2021; 11:618897. [PMID: 33633737 PMCID: PMC7901930 DOI: 10.3389/fimmu.2020.618897] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022] Open
Abstract
Tissue resident memory T (TRM) cells reside in peripheral, non-lymphoid tissues such as the skin, where they act as alarm-sensor cells or cytotoxic cells. Physiologically, skin TRM cells persist for a long term and can be reactivated upon reinfection with the same antigen, thus serving as peripheral sentinels in the immune surveillance network. CD8+CD69+CD103+ TRM cells are the well-characterized subtype that develops in the epidermis. The local mediators such as interleukin (IL)-15 and transforming growth factor (TGF)-β are required for the formation of long-lived TRM cell population in skin. Skin TRM cells engage virus-infected cells, proliferate in situ in response to local antigens and do not migrate out of the epidermis. Secondary TRM cell populations are derived from pre-existing TRM cells and newly recruited TRM precursors from the circulation. In addition to microbial pathogens, topical application of chemical allergen to skin causes delayed-type hypersensitivity and amplifies the number of antigen-specific CD8+ TRM cells at challenged site. Skin TRM cells are also involved in the pathological conditions, including vitiligo, psoriasis, fixed drug eruption and cutaneous T-cell lymphoma (CTCL). The functions of these TRM cells seem to be different, depending on each pathology. Psoriasis plaques are seen in a recurrent manner especially at the originally affected sites. Upon stimulation of the skin of psoriasis patients, the CD8+CD103+CD49a- TRM cells in the epidermis seem to be reactivated and initiate IL-17A production. Meanwhile, autoreactive CD8+CD103+CD49a+ TRM cells secreting interferon-γ are present in lesional vitiligo skin. Fixed drug eruption is another disease where skin TRM cells evoke its characteristic clinical appearance upon administration of a causative drug. Intraepidermal CD8+ TRM cells with an effector-memory phenotype resident in the skin lesions of fixed drug eruption play a major contributing role in the development of localized tissue damage. CTCL develops primarily in the skin by a clonal expansion of a transformed TRM cells. CD8+ CTCL with the pagetoid epidermotropic histology is considered to originate from epidermal CD8+ TRM cells. This review will discuss the current understanding of skin TRM biology and their contribution to skin homeostasis and diseases.
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Affiliation(s)
- Yoshiki Tokura
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Cellular & Molecular Anatomy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Kazuo Kurihara
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiharu Fujiyama
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tetsuya Honda
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Jadhav A, Patil S, Manchanda I, Hasija R, Patil A. Cutaneous Adverse Drug Reactions in a Tertiary Teaching Hospital: A Prospective, Observational Study. Indian J Dermatol 2021; 66:573. [PMID: 35068528 PMCID: PMC8751732 DOI: 10.4103/ijd.ijd_874_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe clinical patterns, identify associated drugs, and perform causality assessment of cutaneous adverse drug reactions. MATERIALS AND METHODS In this prospective, observational study, patients with signs of cutaneous drug reaction from the department of dermatology of a tertiary teaching hospital were included. Patients with viral exanthemas were excluded. The patterns of cutaneous drug reactions, and associated drugs were noted. Naranjo scale was used for causality assessment of adverse drug reactions. RESULTS Sixty-five patients (mean age 38.1 years) were included. Skin lesions were seen after 2 days of drug consumption in 25 (38.5%) patients. Pigmentation, fixed drug eruption, and maculo-papular rashes were seen in 13 (20%), 22 (33.8%), and 12 (18.5%) patients, respectively. Thirty-five (53.85%) patients had other associated symptoms. Fever was seen in 22 (33.8%) patients. Thirty-two (49.2%) cases had exposure to antibacterial agents. Most commonly associated drugs with reactions were nonsteroidal anti-inflammatory agents 14 (21.5%) followed by beta-lactam antibiotics 12 (18.5%), and fluroquinolones 7 (10.8%). Fifty-seven (87.7%) adverse drugs reactions had "probable" association with the drug." CONCLUSION Fixed drug eruption is the commonest presentation of cutaneous adverse drug reactions and antimicrobial agents are most commonly associated with it. According to the Naranjo scale, the majority of the cutaneous drug reactions have a "probable" association with the offending drugs.
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Affiliation(s)
- Anuja Jadhav
- From the Consultant Dermatologist, Dermastudio Skincare and Aesthetic Clinic, Mumbai, Maharashtra, India
| | - Sharmila Patil
- Department of Dermatology, Dr DY Patil Medical College, Navi Mumbai, Maharashtra, India
| | - Isheeta Manchanda
- Department of Dermatology, Dr DY Patil Medical College, Navi Mumbai, Maharashtra, India
| | - Ruchita Hasija
- Department of Dermatology, Dr DY Patil Medical College, Navi Mumbai, Maharashtra, India
| | - Anant Patil
- Department of Pharmacology, Dr DY Patil Medical College, Navi Mumbai, Maharashtra, India,Address for correspondence: Dr. Anant Patil, Department of Pharmacology, Dr. DY Patil Medical College, Nerul, Navi Mumbai, Maharashtra - 400706, India. E-mail:
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35
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Tan KL, Bisconti I, Leck C, Billahalli T, Barnett S, Rajakulasingam K, Watts TJ. Bullous fixed drug eruption induced by fluconazole: Importance of multi-site lesional patch testing. Contact Dermatitis 2020; 84:350-352. [PMID: 33210283 DOI: 10.1111/cod.13745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/13/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Ky Lyn Tan
- Department of Respiratory Medicine & Allergy, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Ilaria Bisconti
- Department of Respiratory Medicine & Allergy, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Claire Leck
- Department of Respiratory Medicine & Allergy, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Thippeswamy Billahalli
- Department of Respiratory Medicine & Allergy, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Sheena Barnett
- Department of Respiratory Medicine & Allergy, Homerton University Hospital NHS Foundation Trust, London, UK.,Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Karalasingam Rajakulasingam
- Department of Respiratory Medicine & Allergy, Homerton University Hospital NHS Foundation Trust, London, UK.,Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Timothy J Watts
- Department of Respiratory Medicine & Allergy, Homerton University Hospital NHS Foundation Trust, London, UK.,National Heart & Lung Institute, Imperial College London, London, UK
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Hafez DM, Alshehri N, Alshehri H, Al-Dawsari NA. Ustekinumab-induced fixed drug eruption. JAAD Case Rep 2020; 6:1234-1235. [PMID: 33294551 PMCID: PMC7701007 DOI: 10.1016/j.jdcr.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Kutlu Ö, Demirbaş A, Elmas ÖF, Güvenç U, Metin A. Fixed drug eruption: A new side effect of bromelain. Contact Dermatitis 2020; 84:51-52. [PMID: 32648609 DOI: 10.1111/cod.13658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ömer Kutlu
- Department of Dermatology and Venereology, Uşak University, School of Medicine, Uşak, Turkey
| | - Abdullah Demirbaş
- Deparment of Dermatology and Venereology, Konya Numune Hospital, Konya, Turkey
| | - Ömer F Elmas
- Deparment of Dermatology and Venereology, Kırşehir Ahi Ervan University, School of Medicine, Kırşehir, Turkey
| | - Ulaş Güvenç
- Deparment of Dermatology and Venereology, Mersin Tarsus Medicalpark Hospital, Mersin, Turkey
| | - Ahmet Metin
- Department of Dermatology and Venereology, Uşak University, School of Medicine, Uşak, Turkey
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38
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Trautmann A, Brockow K, Stoevesandt J. Metamizole-induced reactions as a paradigm of drug hypersensitivity: Non-allergic reactions, anaphylaxis, and delayed-type allergy. Clin Exp Allergy 2020; 50:1103-1106. [PMID: 32564452 DOI: 10.1111/cea.13689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/09/2020] [Accepted: 06/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Axel Trautmann
- Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany
| | - Knut Brockow
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Johanna Stoevesandt
- Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany
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39
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Gutiérrez González A, Juaristi SA, Pellón LF. Might your gin tonic make you sick? Fixed drug eruption likely due to quinine in gin tonic. Contact Dermatitis 2020; 83:320-321. [PMID: 32383255 DOI: 10.1111/cod.13595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 04/28/2020] [Accepted: 05/03/2020] [Indexed: 11/30/2022]
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40
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Salloum A, Nasr D, Maalouf D. Esomeprazole fixed drug eruption. Contact Dermatitis 2020; 82:334-335. [PMID: 31967328 DOI: 10.1111/cod.13479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Antoine Salloum
- Department of Dermatology, Saint Georges Hospital University Medical Center, Beirut, Lebanon
| | - Dayana Nasr
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Diane Maalouf
- Department of Dermatology, Saint Georges Hospital University Medical Center, Beirut, Lebanon
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Sahu K, Sirka CS, Pradhan S, Rout AN. Co-occurrence of Symmetrical Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) and Pigmented Fixed Drug Eruption (FDE) in a Single Patient Due to Doxycycline: A Case Report. Indian Dermatol Online J 2020; 11:62-64. [PMID: 32055511 PMCID: PMC7001400 DOI: 10.4103/idoj.idoj_104_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), and fixed drug eruption (FDE) are adverse cutaneous drug reactions. SDRIFE is most commonly associated with the use of beta-lactam antibiotics. There is only one case report describing SDRIFE due to intake of doxycycline in literature. Previously reported case describes the characteristic morphology of well-defined macular erythema over the flexural and intertriginous area. We here in report a 38-year-old male presented with unusual morphology of SDRIFE, and well circumscribed erythematous patches suggestive of FDE on the thigh and back after doxycycline intake. Histopathology was consistent with SDRIFE and FDE respectively. The skin lesions improved with 5 days of 40 mg oral prednisolone. After 6 weeks, drug provocation with doxycycline was done following which patient developed itching and erythema over the older sites. Though there is a single published report of SDRIFE due to doxycycline, our case had additional findings of having pigmented FDE lesions along with flexural lesions of SDRIFE.
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Affiliation(s)
- Kananbala Sahu
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Chandra S Sirka
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Swetalina Pradhan
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Arpita N Rout
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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42
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Deno R, Nakagawa Y, Itoi-Ochi S, Kotobuki Y, Kiyohara E, Wataya-Kaneda M, Fujimoto M. Fixed drug eruption caused by allylisopropylacetylurea mimicking contact dermatitis of the face. Contact Dermatitis 2020; 82:56-57. [PMID: 31400018 DOI: 10.1111/cod.13382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Rikako Deno
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yukinobu Nakagawa
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Saori Itoi-Ochi
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yorihisa Kotobuki
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Eiji Kiyohara
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mari Wataya-Kaneda
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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43
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Combemale L, Ben Saïd B, Dupire G. Generalized bullous fixed drug eruption: Trazodone as a new culprit. Contact Dermatitis 2019; 82:192-193. [PMID: 31742734 DOI: 10.1111/cod.13436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Benoit Ben Saïd
- Centre de Référence national dermatoses bulleuses toxiques, Lyon, France
| | - Gwendy Dupire
- Department of Immuno-allergology, CHU Brugmann, Brussels, Belgium
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44
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Kawaguchi K, Kinoshita S, Ishikawa M, Sakura H. Tranexamic acid-induced fixed drug eruption confirmed by the drug lymphocyte transformation test. Clin Case Rep 2019; 7:2074-2075. [PMID: 31788254 PMCID: PMC6878053 DOI: 10.1002/ccr3.2442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 11/23/2022] Open
Abstract
We present the first case of multiple fixed drug eruption caused by tranexamic acid, which was confirmed by the LTT. This case was difficult to diagnose because the drug-induced aseptic meningitis by loxoprofen was occurred simultaneously.
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Affiliation(s)
- Kenji Kawaguchi
- Postgraduate Clinical Training CenterTokyo Women's medical University Medical Center EastTokyoJapan
| | - Shotaro Kinoshita
- Postgraduate Clinical Training CenterTokyo Women's medical University Medical Center EastTokyoJapan
| | - Motonao Ishikawa
- Department of MedicineTokyo Women's medical University Medical Center EastTokyoJapan
| | - Hiroshi Sakura
- Department of MedicineTokyo Women's medical University Medical Center EastTokyoJapan
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45
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Affiliation(s)
- Hidetsugu Fukuda
- Department of Dermatology, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan.
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46
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Erden F, Agis ER, Gunduzoz M, Yilmaz OH. Fixed drug eruption due To 2,3-dimercapto-1-propanesulfonic acid (DMPS) treatment for mercury poisoning: a rare adverse effect. Acta Clin Belg 2019; 74:200-202. [PMID: 29912651 DOI: 10.1080/17843286.2018.1484983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Fixed drug eruptions (FDE) are characterized by recurrent, usually solitary erythematous or dark red macular, plaque or bullous lesions, all at the same site. Among the first choices for antidotal treatment in mercury exposure, 2,3-dimercapto-1-propanesulfonic acid (DMPS) is generally a drug with a low incidence of side effects. FDE due to DMPS was not detected in our literature research and so we aimed to present this rare case. CASE REPORT Forty-eight-year-old male patient, gunpowder and explosives factory worker, was admitted to our hospital because of mercury exposure and we started DMPS treatment. On the second day of chelation treatment, swelling and felting on lips and complaints of wound formation in genital areas started. Annular, purple color plaque on penis with no angioedema was observed. Case was regarded as FDE. Systemic and topical steroid therapy was started after termination of chelation therapy and lesions regressed with steroids. DISCUSSION Drug eruptions are substantially common dermatological problems and can be seen in about 2.2% of inpatients. The most common unexpected effects of DMPS are allergic skin reactions. The clinical state regress rapidly after the cessation of chelation therapy.
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Affiliation(s)
- Fatma Erden
- Department of Dermatology and Venereology, Ankara Occupational Diseases Hospital, Ankara, Turkey
| | - Erol Rauf Agis
- Clinic of Pharmacology, Ankara Occupational Diseases Hospital, Ankara, Turkey
| | - Meside Gunduzoz
- Clinic of Family Medicine, Ankara Occupational Diseases Hospital, Ankara, Turkey
| | - Omer Hinc Yilmaz
- Department of Public Health, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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47
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Phillips EJ, Bigliardi P, Bircher AJ, Broyles A, Chang YS, Chung WH, Lehloenya R, Mockenhaupt M, Peter J, Pirmohamed M, Roujeau JC, Shear NH, Tanno LK, Trubiano J, Valluzzi R, Barbaud A. Controversies in drug allergy: Testing for delayed reactions. J Allergy Clin Immunol 2018; 143:66-73. [PMID: 30573342 DOI: 10.1016/j.jaci.2018.10.030] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/27/2018] [Accepted: 10/30/2018] [Indexed: 01/11/2023]
Abstract
Controversies exist with regard to in vivo approaches to delayed immunologically mediated adverse drug reactions, such as exanthem (maculopapular eruption), drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome/toxic epidermal necrolysis, and fixed drug eruptions. In particular, widespread differences exist between regions and practice on the availability and use of intradermal and patch testing, the standard drug concentrations used, the use of additional drugs in intradermal and patch testing to help determine cross-reactivity, the timing of testing in relation to the occurrence of the adverse drug reaction, the use of testing in specific phenotypes, and the use of oral challenge in conjunction with delayed intradermal and patch testing to ascertain drug tolerance. It was noted that there have been advances in the science of delayed T cell-mediated reactions that have shed light on immunopathogenesis and provided a mechanism of preprescription screening in the case of HLA-B*57:01 and abacavir hypersensitivity and HLA-B*15:02 and carbamazepine Stevens-Johnson syndrome/toxic epidermal necrolysis in Southeast Asian subjects. Future directions should include the collaboration of large international networks to develop and standardize in vivo diagnostic approaches, such as skin testing and patch testing, combined with ex vivo and in vitro laboratory approaches.
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Affiliation(s)
- Elizabeth J Phillips
- Vanderbilt University Medical Center, Nashville, Tenn; Institute for Immunology and Infectious Diseases, Murdoch, Australia.
| | - Paul Bigliardi
- Department of Dermatology, Dermato-Allergy Division, University of Minnesota, Minneapolis, Minn
| | - Andreas J Bircher
- Department of Dermatology, Allergy Unit, University Hospital, University of Basel, Basel, Switzerland
| | - Ana Broyles
- Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Linkou and Keelung, Taiwan
| | - Rannakoe Lehloenya
- Division of Dermatology and Combined Drug Allergy Clinic, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Maja Mockenhaupt
- Department of Dermatology, Dokumentationszentrum schwerer Hautreaktionen (dZh), Medical Center and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Jonny Peter
- Division of Dermatology and Combined Drug Allergy Clinic, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Munir Pirmohamed
- Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | | | - Neil H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Luciana Kase Tanno
- University Hospital of Montpellier, Montpellier, and Sorbonne Université, INSERM, Paris, France; Hospital Sírio Libanês, São Paulo, Brazil
| | - Jason Trubiano
- Department of Infectious Diseases and Centre for Antibiotic Allergy and Research, Austin Health, University of Melbourne, Heidelberg, Australia; National Centre for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Australia
| | - Rocco Valluzzi
- Allergy Department, Pediatric Hospital Bambino Gesù, Rome, Vatican City, Italy
| | - Annick Barbaud
- Dermatology and Allergy Department, Tenon Hospital, Medecine Sorbonne University, Paris, France; Assistance publique-hopitaux de Paris, Paris, France
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Broche C, Pralong P, Gil H, Yahiaoui N, Mousseau M, Chatain C, Jacquier JP, Charles J, Leccia MT. Fixed drug eruption caused by fulvestrant confirmed by skin tests: First case. Contact Dermatitis 2018; 80:184-186. [PMID: 30461027 DOI: 10.1111/cod.13161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Clémentine Broche
- Dermatology, Allergology and Photobiology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Pauline Pralong
- Dermatology, Allergology and Photobiology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Hugo Gil
- Anatomopathology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Nassima Yahiaoui
- Regional Pharmacovigilance, Addictovigilance Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Mireille Mousseau
- Oncology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Catharina Chatain
- Dermatology, Allergology and Photobiology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Jean-Pierre Jacquier
- Dermatology, Allergology and Photobiology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Julie Charles
- Dermatology, Allergology and Photobiology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Marie-Thérèse Leccia
- Dermatology, Allergology and Photobiology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
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49
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Jacobsen E, Tarabadkar ES, Shinohara MM. Generalized fixed drug eruption mimicking CD8+ cutaneous T-cell lymphoma in HIV. J Cutan Pathol 2018; 46:134-137. [PMID: 30328131 DOI: 10.1111/cup.13376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/03/2018] [Accepted: 10/08/2018] [Indexed: 11/27/2022]
Abstract
We present a case of a widespread fixed drug eruption histologically mimicking CD8 positive cutaneous T-cell lymphoma (CTCL). CTCL has several potential histological and clinical mimics, and accurate diagnosis relies on a combination of clinicopathological correlation and molecular studies. We add generalized fixed drug eruption to the list of possible CTCL mimics.
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Affiliation(s)
- Emilie Jacobsen
- University of Washington School of Medicine, Seattle, Washington
| | | | - Michi M Shinohara
- University of Washington Division of Dermatology, Seattle, Washington.,University of Washington Division of Dermatopathology, Seattle, Washington
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Quint T, Wöhrl S, Kinaciyan T. Fixed drug eruption caused by fluconazole-An underdiagnosed but recurrent problem. Contact Dermatitis 2018; 80:172-173. [PMID: 30417394 PMCID: PMC6587866 DOI: 10.1111/cod.13149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 09/26/2018] [Indexed: 12/02/2022]
Affiliation(s)
- Tamara Quint
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Stefan Wöhrl
- Floridsdorf Allergy Centre (FAZ), Vienna, Austria
| | - Tamar Kinaciyan
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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