Fixed drug eruptions

The differential diagnosis for PIH includes the following fixed drug eruption, systemic drug-induced hyperpigmentation, macular amyloid, ashy dermatosis, melasma, and tinea versicolor. Medications such as tetracyclines, antimalarial drugs, arsenic, bleomycin, and doxorubicin can result in hyperpigmentation of the skin. 

NSAIDs can induce a number of other adverse reactions, including bleeding disorders, anemia, thrombocytopenia, erythema nodosum, erythema multiforme, fixed drug eruptions, toxic epidermal necrolysis, Stevens-Johnson syndrome, leukocytocla-sitc vasculitis, recurrent fever with exanthema and, of course, the well-known gastric cytotoxicity. 

The word dermatitis denotes an inflammatory erythematous rash. The disorders discussed in this chapter include contact dermatitis, seborrheic dermatitis, diaper dermatitis, and atopic dermatitis. Drug-induced skin disorders have been associated with most commonly used medications and may present as maculopapular eruptions, fixed-drug eruptions, and photosensitivity reactions. 

Frank SB, Cohen HJ. 1961. Fixed drug eruption due to paradichlorobenzene. N Y State J Med 61 4079. 

Dermafo/og/c. Alopecia, balanitis, erythema multiforme, erythema nodosum, fixed drug eruptions, hyperpigmentation of the nails, injection site erythema and injection site pain, maculopapular and erythematous rashes, photosensitivity, pruritus, skin and mucus membrane pigmentation, Stevens-Johnson syndrome, toxic epidermal necrolysis, vasculitis. 

Adverse effects include vomiting, nausea, fixed drug eruptions, skin rash. It is contraindicated in spastic constipation, electrolyte imbalance, intestinal obstruction, lactation. 

A 42-year-old woman developed a nonpigmented fixed drug eruption after skin testing and an intra-articular injection of triamcinolone acetonide, which has not been previously reported (178). 

Ozanguc N. Nonpigmenting solitary fixed drug eruption after skin testing and intra-articular injection of triamcino- 195. lone acetonide. Ann Allergy Asthma Immunol... 

Bardazzi F, Placucci F, Neri I, D Antuono A, Patrizi A. Fixed drug eruption due to melatonin. Acta Derm Venereol 1998 78(l) 69-70. 

Hypersensitivity reactions, such as urticaria and angio-edema, are relatively common in subjects with aspirin hypersensitivity. Purpura, hemorrhagic vasculitis, erythema multiforme, Stevens-Johnson syndrome, and Lyell s syndrome have also been reported, but much less often. Fixed drug eruptions, probably hypersensitive in origin, are periodically described. In some patients they do not recur on rechallenge, that is the sensitivity disappears (74). 

Because aldesleukin stimulates T cells, it has been suggested to have favored the development of successive episodes of multifocal fixed drug eruption in response to chemically unrelated drugs (paracetamol, ondansetron, and tropisetron) in a 43-year-old patient (107). 

Bernand S, Scheidegger EP, Dummer R, Burg G. Multifocal fixed drug eruption to paracetamol, tropisetron and ondansetron induced by interleukin 2. Dermatology 2000 201(2) 148-50. 

An allopurinol-induced fixed drug eruption was successfully treated by desensitization (SEDA-21,108). Allopurinol can uncover latent lichen planus (15). 

Valproate, clonazepam, or clobazam may be safer alternatives in patients who have had a rash from aromatic anticonvulsants. However, in a 41-year-old man a fixed drug eruption that occurred after phenytoin and carbamazepine also occurred after valproate (SEDA-22, 83). 

Baran R, Perrin C. Fixed-drug eruption presenting as an acute paronychia. Br J Dermatol 1991 125(6) 592-5. 

A man taking cetirizine developed a multifocal fixed drug eruption (14). 

Kranke B, Kern T. Multilocalized fixed drug eruption to the antihistamine cetirizine. J Allergy Clin Immunol 2000 106(5) 988. 

Inamadar AC, Palit A, Athanikar SB, Sampagavi VV, Deshmukh NS. Multiple fixed drug eruptions due to cetirizine. Br J Dermatol 2002 147(5) 1025-6. 

Verbov J. Fixed drug eruption due to a drug combination but not to its constituents. Dermatologica 1985 171(1) 60-1. 

Ciprofloxacin can cause a fixed drug eruption (43,44), purpuric skin lesions (44,45), bullous pemphigoid (46), cutaneous vasculitis (45-47), and ultraviolet recall-like phenomenon (48). 

Rodriguez-Morales A, Llamazares AA, Benito RP, Cocera CM. Fixed drug eruption from quinolones with a positive lesional patch test to ciprofloxacin. Contact Dermatitis 2001 44(4) 255. 

Clarithromycin has been associated with fixed dmg emp-tions and hypersensitivity reactions (41,42). In one case a clarithromycin-induced fixed drug eruption was reproduced by oral provocation, whereas patch tests on both unaffected and residual pigmented skin were negative (43). 

Rosina P, Chieregato C, Schena D. Fixed drug eruption from clarithromycin. Contact Dermatitis 1998 38(2) 105. 

Hamamoto Y, Ohmura A, Kinoshita E, Muto M. Fixed drug eruption due to clarithromycin. Clin Exp Dermatol 2001 26(l) 48-9. 

Blood dyscrasias are associated with ecchymosis and purpura. Allergic skin changes are rare. Alopecia is common after acute intoxication and prolonged treatment (SEDA-5,109). A fixed drug eruption has been reported (SEDA-21, 109). 

Kaur C, Sarkar R, Kanwar AJ. Fixed drug eruption to rofecoxib with cross-reactivity to sulfonamides. Dermatology 2001 203(4) 351. 

On two occasions, a fixed drug eruption occurred on the arm of a 45-year-old woman after using dextromethorphan as an antitussive (SEDA-16, 79). Worsening of urticaria pigmentosa has been attributed to dextromethorphan (SEDA-21, 87). 

Diphenhydramine has been associated with a fixed drug eruption, but only three such cases have been published with dimenhydrinate. In one such case patch tests were conducted there was a positive response to the dimenhydrinate patch, but negative responses to separate patches containing either dimenhydrinate or 8-chlorotheophylline. 

Mori Y, Sugihara K, Noda T, Yudate T, Aragane Y, Tezuka T. A case of fixed drug eruption due to diphenylpyraline hydrochloride. Skin Res 1999 41 25-9. 

Fixed drug eruptions have been attributed to doxycycline (15). 

Alanko K. Topical provocation of fixed drug eruption. A study of 30 patients. Contact Dermatitis 1994 31(l) 25-7. 

Non-pigmenting fixed drug eruptions proven by oral rechallenge have been reported with pseudoephedrine in each of these cases the eiythematous lesions spontaneously remitted without residual pigmentation (23-25). 

Hindioglu U, Sahin S. Nonpigmenting solitary fixed drug eruption caused by pseudoephedrine hydrochloride. J Am Acad Dermatol 1998 38(3) 499-500. 

Vidal C, Prieto A, Perez-Carral C, Armisen M. Nonpigmenting fixed drug eruption due to pseudoephedrine. Ann Allergy Asthma Immunol 1998 80(4) 309-10. 

A fixed drug eruption due to erythromycin has been observed (53). In another case skin tests with erythromycin were positive for the immediate and or delayed types of hypersensitivity (54). 

Pigatto PD, Riboldi A, Riva F, Altomare GF. Fixed drug eruption to erythromycin. Acta Dermatol Venereol 1984 64(3) 272-3. 

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