Fixed drug eruption treatment

Fixed drug eruption treatment

What is fixed drug eruption?

Fixed drug eruption (FDE) is a form of cutaneous drug reaction that typically recurs in the same spots when the offending drug is reintroduced. Acute FDE usually starts with a single or a few dusky red or violaceous plaques that fade away, leaving postinflammatory hyperpigmentation (picture 1A-C). Multiple, nonpigmen FDE variants are rare severe unusual variations of FDE. Stevens-Johnson syndrome/toxic epidermal necrolysis shares clinical symptoms with rare severe atypical variations of FDE, such as numerous, nonpigmenting, and generalized bullous types.

What does a drug eruption look like?

Drug rashes can take the form of pink to red pimples, hives, blisters, red patches, pus-filled lumps (pustules), or skin sensitivity to sunlight. Drug rashes can affect the full surface of the skin or only one or a few body regions. In many medication rashes, itching is frequent.


 fixed drug eruption

Who is the victim of a fixed drug eruption?

Fixed drug eruption can afflict both men and women, however it is more prevalent in adults than in youngsters. Some HLA-associations have been linked to fixed drug eruptions caused by specific medicines, such as HLA-A30 and cotrimoxazole-induced fixed drug eruption.

Factors that predispose an individual to developing a drug rash include:

  • Due to an underlying sickness or medication, the immune system is weakened.
  • Infection beneath the surface
  • Taking more than three medications per day

Although any medication can induce a drug rash, the following are the most prevalent types of medications that cause a rash:

  • Penicillin and sulfa medicines are examples of antibiotics.
  • Ibuprofen, naproxen, or indomethacin are anti-inflammatory medications.
  • Codeine or morphine, for example, are pain relievers.
  • Anti-convulsant drugs, such as phenytoin or carbamazepine, are used to treat seizures.
  • Agents used in chemotherapy
  • Medications for psychiatric disorders (psychotropic medications)
  • Diuretics
  • Iodine, particularly the kind used in X-ray contrast dye

What causes fixed drug eruption?

A delayed type IV hypersensitivity reaction is a fixed drug eruption. When memory CD8+ T-cells at the dermo-epidermal interface are triggered by the medicine antigen, they release interferon-gamma, which damages the epidermal basal layer. T-cells and neutrophils that have been recruited cause harm to melanocytes and keratinocytes. Dermal macrophages gather melanin during the resolution phase, resulting in the usual post-inflammatory hyperpigmentation. Interleukin-15 is released by regenerating basal keratinocytes, resulting in the development of resident memory CD8+ T-cells, which stay dormant but primed to respond to the chemical antigen again.

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Oral pharmaceuticals are the most common cause of fixed drug eruption, with antimicrobials and non-steroidal anti-inflammatory drugs (NSAIDs) being the most common causes. Topical or intravaginal medication exposures are less prevalent. Antibiotics, flavoring or coloring additives, or preservatives in the food may cause fixed food eruptions. Herbal supplements have also been linked to the problem.

What are the symptoms of a fixed medication eruption?

Clinical morphology can be used to classify fixed drug eruptions. The localised pigmenting variety is the most prevalent; other forms include bullous (localised or widespread), mucosal, non-pigmenting, or generalised.

A single (or limited number of) well-defined, round or oval red or violaceous patch or plaque, which may blister or ulcerate, is typical of a fixed drug eruption. It’s normally asymptomatic, but it might itch or hurt. The skin may become scaly or crusty before peeling, and the color fades to reveal brown post-inflammatory hyperpigmentation over the next few days or weeks. In skin of color, post-inflammatory hyperpigmentation is more noticeable.

Unlike many other medication eruptions, the patient’s systemic health is unaffected.

Common places include the hands and feet, eyelids, and anogenital areas. Lips, tongue, and hard palate lesions are the most common oral mucosa lesions. A fixed drug eruption can happen when there has been previous skin trauma, such as a burn, an insect bite, or a venepuncture.

The eruption may appear after weeks to years of regular administration of the medication on the initial time, but subsequent episodes appear within minutes to hours of resuming the involved drug. Even with re-exposure, a patch of fixed drug eruption indicates a refractory period during which it will not flare. The original patch may grow in size and other patches may develop in subsequent episodes.

Fixed drug eruption clinical variations

Fixed drug eruption on the mucosa

  • Lips, tongue, hard palate, and vaginal mucosa are all affected.
  • Blisters and erosions are a regular occurrence.
  • It might be isolated or localized, or it can be associated with cutaneous lesions.
  • Cotrimoxazole and naproxen often cause oral mucosal ulcers.
  • Cotrimoxazole is used to treat genital mucosal lesions in the glans penis, and NSAIDs are used to treat vulva mucosal lesions.

Fixed drug eruption that is non-pigmenting

  • Lesions that are usually symmetrical.
  • Resolves without hyperpigmentation after the inflammatory process.
  • Piroxicam and pseudoephedrine are two drugs that have been linked to this.

Generalised fixed drug eruption

  • Multiple lesions are seen.
  • Targetoid lesions, similar to erythema multiforme, are possible.

Generalised bullous fixed drug eruption

  • Variant that is rare
  • Recurrent bouts that begin within 24 hours after exposure to the substance
  • With normal skin, there are several big blisters and erosions that normally impact 10% of the skin surface.
  • Mucosal surfaces are relatively spared.
  • Lesions are not targetoid in nature.
  • Fever, malaise, and arthralgia are all possible symptoms.
  • Post-inflammatory hyperpigmentation resolves the condition.

Complications of fixed drug eruption

  • Erosion and blisters
  • Hyperpigmentation after an inflammatory reaction
  • Recurrence
  • Other drugs may cause a cross-reaction.
  • Fluid loss, electrolyte imbalance, and subsequent infection can all aggravate a generalised bullous fixed drug eruption.

Diagnosis of fixed drug eruption

Fixed drug eruption (FDE) is a type of drug eruption that is distinguished by its morphology, which is characterized by a round form. Pruritus, burning, or discomfort may occur at the affected locations. In periurethral instances, dysuria is possible. Fever and malaise have been recorded, but systemic symptoms are uncommon.

Antimicrobials, analgesics, anticonvulsants, and sedatives are the most prevalent drugs recalled by patients. It’s also possible that new meals or recent radiographic contrast media injection are variables.

On the basis of the history and examination, a fixed drug eruption should be considered, but this can be difficult on the first visit. A detailed history of oral intake in the preceding 24 hours may pinpoint the perpetrator in subsequent instances.

Investigations may involve the following:

  • Skin biopsy – Skin biopsy reveals an early lesion with scattered apoptotic keratinocytes, vacuolar degeneration, dermal oedema, and a superficial perivascular lympho-eosinophilic infiltration, as well as an interface dermatitis. If blisters are present, they are subepidermal. Upper dermal melanophages are seen in a late lesion.
  • Oral challenge test – with a tiny amount of the suspected drug, albeit the patch is usually resistant for a period of time during which it does not flare. In individuals with generalized bullous fixed drug eruption, this is contraindicated.
  • Patch test – In 50% of instances, a patch test utilizing the suspected drug in soft paraffin applied to the lesion site is positive. On normal skin, prick tests and patch testing are frequently negative.

When to Seek Medical Care

If you get a rash after starting a new drug, you should contact the doctor who recommended it right away. If the rash is accompanied by trouble breathing, a high heart rate, or swelling of your tongue, lips, neck, or face, you should seek emergency medical attention.

Make a list of all of your prescriptions for the doctor, including prescription and over-the-counter tablets, topical creams, vitamins, and herbal or homeopathic therapies. Make careful to mention any medications that you only use once in a while. If at all feasible, keep track of when you first started taking each medicine. Also, make sure you’re aware of any previous drug or food responses you may have experienced.

Treatment of fixed drug eruption

The fundamental goal of treatment is to identify and prevent the causal agent. Otherwise, treatment for fixed drug eruptions (FDEs) is symptomatic. It’s possible that systemic antihistamines and topical corticosteroids are all that’s needed. Antibiotics and adequate wound care are recommended in cases where infection is suspected. Desensitization to drugs has been documented, however it should be avoided unless no other options are available. Cyclosporine has been used in extreme situations.

Treatments are

  • Suspected medicine should be stopped.
  • Indefinitely avoiding the implicated medication
  • Systemic corticosteroids vs. topical steroids
  • A generalised bullous fixed drug eruption necessitates immediate medical attention or admission to a burns center.

What happens if a fixed medication eruption occurs?

A benign self-resolving drug eruption that recurs on re-exposure, leaving post-inflammatory hyperpigmentation, is known as a fixed drug eruption. Flares that follow can be more severe.

Generalised bullous fixed drug eruption can be fatal, with a 20 percent death risk.

A summary of some of the possible causes of a fixed drug eruption


  • Antibiotics — co-trimoxazole, tetracyclines, penicillins, metronidazole, rifampicin, erythromycin, quinolones, dapsone
  • Antimalarials — quinine
  • Antifungals — systemic azoles eg, fluconazole [see Oral antifungal medication]


  • Paracetamol (acetaminophen)
  • Non-steroidal anti-inflammatory drugs (NSAID) — aspirin, ibuprofen, naproxen, piroxicam, mefenamic acid

Sedatives and anticonvulsants

  • Carbamazepine, barbiturates, and benzodiazepines


  • Calcium-channel blockers
  • Angiotensin-converting enzyme inhibitors

Other drugs

    • Cetirizine, omeprazole, pseudoephedrine, sulphasalazine, vaccinations

Complimentary medicines

  • Including traditional herbal medications and supplements


  • Asparagus, cashew nuts, kiwi fruit, lentil, palm wine, peanut, propolis, quinine (tonic water), seafood, strawberry, tartrazine (yellow rice, cheese crisps)

What is the average time it takes for a fixed drug eruption to subside?

Following drug ingestion, large tender well-circumscribed edematous and erythematous plaques that may be symmetrical appear and fade within 2 to 3 weeks.

What is the main goal of treatment for fixed drug eruptions (FDE)?

The main goal of treatment is to identify and prevent the causal agent. Otherwise, treatment for fixed drug eruptions (FDEs) is symptomatic. It’s possible that systemic antihistamines and topical corticosteroids are all that’s needed. Antibiotics and adequate wound care are recommended in cases where infection is suspected. Desensitization to drugs has been documented, however it should be avoided unless no other options are available. Cyclosporine has been used in extreme situations.

Can vitamins cause fixed drug eruption?

Drug interactions with multivitamins are uncommon, with only a few occurrences reported. This is a story about a young woman who acquired a bullous fixed medication eruption after taking multivitamins. Over-the-counter multivitamins come in a variety of combinations.

Is fixed drug eruption an allergic reaction?

A fixed drug eruption is a type of cutaneous allergic reaction that occurs at the same location(s) every time the medicine or other chemical agent is re-exposed.

Guidelines for Self-Care

Self-care is not advised in the case of a widespread or severe medication rash. Depending on the severity of your symptoms, call your doctor.

You can try the following measures if you have a moderate or restricted medication rash:

  • Shower in cool water or use cool compresses.
  • Apply calamine lotion to the affected area.
  • Take a diphenhydramine-type antihistamine.


Fixed drug eruption treatment

Fixed drug eruption treatment

Fixed drug eruption treatment

Fixed drug eruption treatment