Fixed Drug Eruption

Diagnosis: Fixed Drug Eruption

Widespread ovoid patches and plaques have the characteristic dusky hue of a fixed drug eruption.

Clinical Presentation

Widespread ovoid patches and plaques have the characteristic dusky hue of a fixed drug eruption.

Clinical History

Submitted by Alaa Saad. Originally posted October 13, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Herpes simplex • Erythema multiforme • Insect bite reaction • Burns • Bullous pemphigoid • Contact dermatitis

Key Learnings

• Recurs at the EXACT same site upon re-exposure to the causative drug • Classic: well-demarcated, round, dusky red to violaceous plaque that heals with hyperpigmentation • Most common culprits: NSAIDs, sulfonamides, tetracyclines, barbiturates, pseudoephedrine • Lips and genitalia are classic locations • Generalized bullous FDE can mimic SJS/TEN • Residual hyperpigmentation at inactive sites is a crucial diagnostic clue • Oral provocation test is the gold standard for confirmation

Tags: fixed, drug, eruption, alaa saad