[A fixed drug eruption caused by paracetamol]

Area of Science:

• Dermatology
• Pharmacology
• Clinical Medicine

Background:

• Fixed drug eruption (FDE) is a distinct hypersensitivity skin reaction to medications.
• Lesions can manifest as solitary spots, maculopapular rashes, or severe conditions like Stevens-Johnson syndrome.
• While numerous drugs can trigger FDE, paracetamol accounts for approximately 1.5% of cases.

Observation:

• A 58-year-old male presented with a five-year history of widespread exanthema.
• A skin biopsy confirmed the diagnosis of fixed drug eruption.
• The patient reported near-daily paracetamol use for headache management over the preceding five years.

Findings:

• Discontinuation of paracetamol led to the gradual resolution of the patient's exanthema.
• This case highlights paracetamol as a potential cause of chronic fixed drug eruption.
• The clinical presentation of FDE can be variable, underscoring the need for thorough medication history.

Implications:

• Healthcare providers should inquire about all medication use, including over-the-counter drugs, in patients presenting with unexplained rashes.
• Paracetamol, despite its perceived safety profile, should be considered a potential culprit in FDE.
• Early identification and cessation of the offending drug are crucial for managing fixed drug eruptions.