Fixed drug eruption: A case series, clinical presentation and management strategies

Abstract

Fixed drug eruption (FDE) is a unique immunological cutaneous reaction characterized by the recurrence of sharply demarcated lesions at the same site upon re-exposure to the offending drug. This delayed Type IV hypersensitivity reaction most commonly involves antimicrobials, nonsteroidal anti-inflammatory drugs (NSAIDs) and anticonvulsants. The lesions, ranging from macules to bullae, typically heal with residual post-inflammatory hyperpigmentation. This case series presents ten detailed cases of FDE, each induced by different medications, including metronidazole, levofloxacin, cefotaxime and others. Diagnosis was primarily based on clinical history, recurrence of lesions and in some instances, histopathological findings. Management involved the discontinuation of the offending drug, along with corticosteroid and antihistamine therapy. The study underscores the importance of patient education, including the provision of drug allergy cards, to prevent recurrence. Studies suggest an association between human leukocyte antigen (HLA) class I and FDE. Patients often experience multiple recurrences over an extended period before a definitive diagnosis is made. The genitalia, perianal regions and lip mucosa are among the thin-skinned areas that are most frequently affected. Emphasis is placed on pharmacovigilance and rational prescribing practices as key strategies for minimizing the risks associated with FDE. The findings highlight the critical need for early diagnosis and intervention to mitigate complications and improve patient outcomes.