Naproxen-induced generalized bullous fixed drug eruption

A fixed drug eruption (FDE) is a cutaneous reaction to an ingested drug that recurs at the same site each time the offending drug is taken. Clinical diagnosis may be difficult as patients often do not consider over-the-counter medications or supplements as part of their reported medication list. In addition, patients may take the offending medication so infrequently that the eruption does not occur often enough to easily allow them to deduce the association. The most common offending agents include anti-microbials, non-steroidal anti-inflammatory drugs (NSAIDs), and anti-epileptics. Fixed drug eruptions classically present as a single, sharply demarcated, round erythematous patch or plaque, occasionally with localized bullae. Generalized bullous FDEs, however, are relatively rare and can be confused with Stevens-Johnson Syndrome. We present a case of naproxen-induced generalized bullous FDE in a 50-year-old woman.