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Fixed drug eruption

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Yu-Ju Chou
Yu-Ju Chou
Yu-Ju Chou
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Hua-Ching Chang
Hua-Ching Chang
Hua-Ching Chang
  • This person is not on ResearchGate, or hasn't claimed this research yet.
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E1036 CMAJ | August 2, 2022 | Volume 194 | Issue 29 © 2022 CMA Impact Inc. or its licensors
A 31-year-old woman presented to the dermatology
department with an asymptomatic erythematous
patch on the dorsum of her right foot (Figure 1A). She
had taken 1dose of doxycycline (100mg) the previous
day as empirical treatment after picosecond laser
treatment for acne scars. She had had a similar epi-
sode the previous year on the same site, aer taking
the same dose of doxycycline aer laser treatment
(Figure 1B). She had no notable medical history, and
no other local or systemic symptoms, including fever.
The erythematous patch was well demarcated,
with a central dusky zone. There was no tenderness,
heat or discharge. We diagnosed a fixed drug erup-
tion and prescribed clobetasol propionate. After
1 week of treatment, the lesion had resolved.
Although patch testing was negative, an oral rechal-
lenge with 100 mg doxycycline was positive.
Fixed drug eruptions are common,1,2 and consti-
tute 14%–22% of cutaneous drug reactions among
children.3 They are type IV hypersensitivity reac-
tions that appear within 1 week aer initial drug
exposure, but may occur within minutes upon re-exposure.1,2
Fixed drug eruptions are characterized by well-circumscribed,
round or oval, erythematous patches, plaques or, less frequently,
bullae with a dusky-grey centre. They occur most commonly aer
exposure to acetaminophen, nonsteroidal anti-inflammatory
drugs, anticonvulsants and antibiotics.1,2 The lips, the anogenital
area and previous trauma areas are the most common sites.2
The diagnosis is clinical, but skin biopsy, topical patch test, lym-
phocyte transformation test or systemic rechallenge may help identify
the causative drug.1,2 Dierential diagnoses include erythema multi-
forme, contact dermatitis, cellulitis and herpes simplex infection.2 Sys-
temic antihistamines and topical corticosteroids may be required for
symptomatic relief.1 The condition is usually self-limiting; however,
hyperpigmentation may remain.2 Patients should avoid re-exposure
to the causative drug; local recurrence commonly occurs, although
extensive lesional blistering has been reported.
References
1. Lee AY. Fixed drug eruptions. Incidence, recognition, and avoidance. Am J Clin
Dermatol 2000;1:277-85.
2. Patel S, John AM, Handler MZ, et al. Fixed drug eruptions: an update, empha-
sizing the potentially lethal generalized bullous fixed drug eruption. Am J Clin
Dermatol 2020;21:393-9.
3. Nguyen E, Gabel CK, Yu J. Pediatric drug eruptions. Clin Dermatol 2020;
38:629-40.
Practice | Clinical images
Fixed drug eruption
Yu-Ju Chou MD, Hua-Ching Chang MD MS
n Cite as: CMAJ 2022 August 2;194:E1036. doi: 10.1503/cmaj.220049
Figure 1: Photographs of the feet of a 31-year-old woman with fixed drug eruptions from
doxycycline. (A) A well-demarcated, asymptomatic, erythematous patch with a central
dusky zone over the dorsum of the right foot. (B) A similar lesion at the same site, a year
before the current episode.
Competing interests: None declared.
This article has been peer reviewed.
The authors have obtained patient consent.
Ailiations: Department of Dermatology (Chou, Chang), Taipei Medical
University Hospital, Taipei, Taiwan; Department of Dermatology,
School of Medicine, College of Medicine (Chang), Taipei Medical Univer-
sity, Taipei, Taiwan
Content licence: This is an Open Access article distributed in accordance
with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0)
licence, which permits use, distribution and reproduction in any medium,
provided that the original publication is properly cited, the use is noncom-
mercial (i.e., research or educational use), and no modifications or adapta-
tions are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/
Acknowledgement: The authors thank Yu-Ting Hsu for assistance
during the case.
Correspondence to: Hua-Ching Chang, b101095089@tmu.edu.tw
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resolution images must be accompanied by a figure caption. A brief
explanation (300 words maximum) of the educational importance of
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