Fixed drug eruptions /exanthema

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. 

Morbilliform exanthema, fixed drug eruptions, and erythrodermia are thought to result from a cell-mediated reaction, i.e., T-lymphocytes as in contact sensitivity. However, the histologic pictures of both reactions differ in a number of features. Moreover, basophil infiltration, which is rather important in contact sensitivity, is often negligible in the tuberculin reaction. In spite of several differences between... 

Morphine and opiates decrease propulsive contractions and have long been used to arrest diarrhea. They are now often replaced by diphenoxylate and difenoxine, often in combination with atropine. Allergic side effects are unusual. Fixed drug eruption can occur from opium (Welsh 1961) but it is rare. In Sweden a few cases of urticaria, angioedema, exanthema, and purpura have been reported. A preparation containing diphenoxylate and atropine (Retardin) caused urticaria and angioedema in three patients and exanthema in one. 

Cutaneous side effects reported are urticaria, fixed drug eruption, maculopapular exanthemas and pigmentary purpura Uses water-soluble prodrug for intravenous administration resulting in the liberation of paracetamol. ABCD A... 

Non-immediate reactions to quinolones occur but they are not encountered as often as immediate reactions and in-depth studies are so far few. Some of the more often-seen delayed reactions are fixed drug eruptions and maculopapular exanthemas where a T cell mechanism has been demonstrated. Specific T cell clones were identified from patients with ciprofloxacin-induced maculopapular exanthems and about half of the clones proved cross-reactive with related drugs. Reexposure studies in patients with exanthems revealed that cross-reactivity is in fact lower than this. Cellular tests such as lymphocyte transformation tests were judged to be not very useful. However, the lymphocyte transformation test was said to have confirmed the involvement of T cells when peripheral blood... 

Apart from immediate or so-called type I reactions, nonimmediate or so-called type IV reactions may occur after ICM administration. The latter allergy subgroup manifests either with maculopapular exanthema, fixed drug eruption or other very rare conditions such as Stevens-Johnson syndrome [13-15]. 

Fixed eruptions (drug exanthemas) with mostly few demarcated, painful lesions, usually located in intertriginous skin regions (genital area, mucous membranes). With repeated exposure, these typically recur at the same sites. 

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