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Eosinophilic pustular eruption associated with transdermal fentanyl
G Mancuso1, R M Berdondini, B Passarini
1Department of Dermatology of Municipal Hospital of Lugo, Ravenna, Italy.
Summary
A 70-year-old man experienced a sterile pustular eruption after applying a fentanyl transdermal therapeutic system (fentanyl-TTS) patch. Symptoms resolved rapidly after discontinuing the fentanyl-TTS patch, suggesting a drug-induced reaction.
Area of Science:
- Dermatology
- Pharmacology
Background:
- Transdermal drug delivery systems offer continuous medication release.
- Fentanyl transdermal therapeutic systems (fentanyl-TTS) are used for persistent pain management.
Observation:
- A 70-year-old male presented with a widespread, sterile pustular skin eruption.
- The eruption appeared two days post-application of a fentanyl-TTS patch, primarily on the trunk, face, and limbs.
- No fever accompanied the pustular eruption.
Findings:
- Histopathology revealed intraepidermal pustules predominantly filled with eosinophils.
- Discontinuation of the fentanyl-TTS patch resulted in rapid, complete, and sustained regression of the pustules within approximately 10 days.
- A similar, temporally related pustular reaction occurred weeks prior to the current episode.
Implications:
- This case suggests a potential hypersensitivity reaction to fentanyl-TTS manifesting as sterile, eosinophilic pustulosis.
- Clinicians should consider fentanyl-TTS as a potential cause of sterile pustular eruptions, especially with recurrent episodes.
- Prompt recognition and discontinuation of the offending agent are crucial for managing this adverse dermatological reaction.