Bullous Fixed Drug Eruption Caused by Doxycycline

Area of Science:

• Dermatology
• Pharmacology
• Pathology

Background:

• Fixed drug eruption (FDE) is a specific type of cutaneous drug reaction.
• Antibiotics, particularly doxycycline, are common culprits in FDE.
• Bullous variants of FDE can present with significant blistering.

Observation:

• A 50-year-old woman presented with acute onset of pruritic, erythematous, purplish annular patches with hemorrhagic bullae on her palms.
• Lesions appeared 24 hours after initiating doxycycline for acute bronchitis.
• The patient had no prior history of allergies or drug reactions.

Findings:

• Dermatologic examination revealed characteristic annular patches with bullae on the palms.
• Skin biopsy showed hydropic degeneration of the basal membrane, superficial perivascular infiltrate with lymphocytes and eosinophils, and dermal red blood cells.
• Laboratory tests were unremarkable.

Implications:

• This case highlights doxycycline as an important cause of bullous fixed drug eruption.
• Early recognition and diagnosis are crucial for managing FDE.
• Pharmacovigilance is essential for identifying drug-induced adverse events like FDE.