Fixed eruptions

Although described more than 90 years ago, fixed drug eruptions are little known outside the world of dermatology. Whereas other allergic drug rashes exhibit a 

Carbromal (Adalin) Bromvalurea (Bromural) Acetylcarbromal (Abasin) Meprobamate Sodium bromide 

The essential characteristic of the disease is that on renewed exposure to the allergen the rash reappears at the same sites as before, though usually the number of lesions increases with each recurrence. 

The causes of fixed eruptions are manifold. Drugs come first, but foodstuffs, spices and alcoholic drinks have also been mentioned. Compilations by Engelhard (1960), Welsh (1961 a, b) and Kleine-Natrop (1966), who reviewed the older literature, list more than 60 different drugs. In terms of frequency the following head the list  

In our own series of patients, which has been reviewed by Louis (1972), the drugs responsible were pyrazolone analgesics in 22 cases, barbiturates in 19, sulfonamides in five, phenolphthalein in three, tetracyclines in two, benzodiazepines in two, and a hydantoin derivative in one case. Other causes of fixed eruptions have been observed by Loveman (1943), Brehm and Brehm (1963), and Post and Dougherty (1964). 

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Delayed reactions with radiocontrast media occur in 1% to 3% of patients.21 Although reactions occasionally are severe, most are mild and manifest as maculopapular rashes, fixed eruptions, erythema multiforme, and urticarial eruptions. 

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. 

Fixed eruptions are eruptions that recur at the same site, often circumoral, with each administration of the drug e.g. phenolphthalein (laxative self-medication), sulphonamides, quinine (in tonic water), tetracycline, barbiturates, naproxen, nifedipine. 

Kanwar AJ, BeUiaj MS, Bharija SC, Mohammed M. Drugs causing fixed eruptions. J Dermatol 1984 ll(4) 383-5. 

This report shows that non-ionic contrast media can cause multiple fixed eruptions and that repeated administration of the causative agent can be associated with a more severe eruption. 

Pareek SS. Nystatin-induced fixed eruption. Br J Dermatol 1980 103(6) 679-80. 

Kauppinen K, Stubb S. Fixed eruptions causative drugs and challenge tests. Br J Dermatol 1985 112(5) 575-8. 

Pasricha JS. Drugs causing fixed eruptions. Br J Dermatol 1979 100(2) 183-5. 

A fixed eruption with pruritus was observed in a 27-year-old man treated for Entamoeba histolytica with tinidazole 500 mg, four tablets in a single dose for 3 days. 

Mahboob A, Haroon TS. Drugs causing fixed eruptions a study of 450 cases. Int J Dermatol 1998 37(ll) 833-8. 

Madnani N, Mumbai, India (from Internet) (observation) Fixed eruption... 

Hernandez-Salazar A+, Arch Med Res 37(7), 899 (1999) Cesaro S +, Support Care Cancer 7, 284 Exfoliative dermatitis Fixed eruption Pigmentation Pruritus... 

Erythema multiforme Exanthems Facial edema Fixed eruption... 

Alanko K+, Acta Derm Venereol (Stockh) 69, 223 (1988) Kohl PK+, Aktuel Dermatol 14, 104 Exfoliative dermatitis Fixed eruption... 

Bellet JS+, Curr Opin Infect Dis 18(2), 97 Fixed eruption... 

Haerslev T+, Cutis 52, 45 (linear and symmetrical) (1980) Lincke-Plewig H, Hautarzt (German) 31,616 Fixed eruption... 

Lindner K+, Dermatol Monatsschr (German) 176, 483 Fixed eruption Hypersensitivity Lichenoid eruption Perioral dermatitis... 

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