Clinical features, culprit drugs, and allergology workup in 41 cases of fixed drug eruption

Fixed drug eruption (FDE) represents a drug-related cutaneous reaction. Many drugs been associated with this clinical entity, with continually evolving documentation of implicated agents and clinical presentations. A bullous form can occur although it is rare.

To assess the epidemiological and clinical characteristics of FDE.

We retrospectively analysed all FDE cases who presented to the Clinical Pharmacology Department at the University Hospital, Monastir, Tunisia, for allergy workup.

The mean age of the 41 confirmed FDE cases was 43.8 ± 15.5 years. The time between first lesion onset and FDE diagnosis was less than 1 month for 13 patients (31.7%). Fifteen patients had bullous lesions. The upper limbs were the most common location (65.9% of cases). The patch tests were positive in 27 cases; a provocation test yielded a positive response in the four cases tested. Nonsteroidal anti-inflammatory drugs (NSAIDs) were involved in 51.2%, antibiotics in 24.4%, and other analgesics in 19.5%. The most common offending drug was mefenamic acid in 24.4% of cases. Bullous lesions were significantly associated with paracetamol intake (P = .014; odds ratio 16.7; 95% confidence interval: 1.76-158).

NSAIDs and antibiotics were the most implicated in inducing FDE; paracetamol was associated with bullous lesions.