Fixed Drug Eruptions: Presentation, Diagnosis, and Management

Hal Flowers, BA; Robert Brodell, MD; Melissa Brents, MD; Julie Porter Wyatt, MD

Disclosures

South Med J. 2014;107(11):724-727. 

In This Article

Abstract and Introduction

Abstract

Fixed drug eruption (FDE) is a well-defined, circular, hyperpigmenting plaque that recurs as one or a few lesions always in fixed locations upon ingestion of a drug. FDE commonly occurs on the genitals, lips, trunk, and hands. Although the lesions are distinctive, the diagnosis of FDE often is missed because it shares none of the characteristics of more common morbilliform drug rashes. The diagnosis can be confirmed by histopathologic examination of a small punch biopsy specimen. Drug avoidance is the mainstay of treatment, and antihistamines can reduce associated pruritus. Raising awareness of this condition will increase the likelihood of prompt diagnosis leading to resolution within days to weeks after the offending drug is discontinued.

Introduction

As many as 2% to 3% of patients taking medications will develop a cutaneous drug reaction.[1] Behind exanthematous (morbilliform) reactions, fixed drug eruptions (FDEs) are the most common type of cutaneous drug reaction. Estimates vary depending on the population in question, but between 0.67% and 22% of patients taking certain medications will develop FDEs.[1] The clinical characteristics of FDEs are so unusual that many primary care physicians fail to recognize this entityVa critical error, because elimination of the offending drug is the most important aspect of treatment. This article reviews the clinical features, offending agents, differential diagnosis, course, and treatment involved in FDEs.

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