Cutaneous fixed drug eruption to fluconazole

Area of Science:

• Dermatology
• Pharmacology

Background:

• Fixed drug eruption (FDE) is an uncommon cutaneous adverse drug reaction.
• It is characterized by recurrent lesions at the same site upon re-exposure to the causative agent.
• FDE to fluconazole is rarely documented.

Observation:

• A 64-year-old woman presented with recurrent, hyperpigmented patches on her arms, palms, and lower legs.
• The lesions reappeared in identical locations over six months, with the causative drug initially unidentified.

Findings:

• Clinicopathologic diagnosis strongly suggested FDE.
• Oral rechallenge confirmed fluconazole as the culprit medication, despite previous uneventful use and short treatment courses.
• This represents a rare instance of fluconazole-induced FDE.

Implications:

• Clinicians should consider FDE in patients with recurrent, site-specific cutaneous reactions.
• Thorough drug history and diagnostic challenges in FDE, particularly with less commonly implicated drugs like fluconazole, are highlighted.
• Awareness of rare drug-induced eruptions is crucial for accurate diagnosis and patient management.