Bullous Fixed Drug Eruption Associated With Atenolol: A Rare Dermatological Reaction With Mucosal Involvement

Area of Science:

• Dermatology
• Pharmacology
• Internal Medicine

Background:

• Bullous fixed drug eruption (BFDE) is characterized by recurrent, site-specific bullous eruptions triggered by medications.
• While NSAIDs, analgesics, and antibiotics are common culprits, rare drug associations require investigation.

Purpose of the Study:

• To report a rare case of bullous fixed drug eruption (BFDE) associated with atenolol.
• To discuss the clinical presentation, diagnosis, and management of BFDE.
• To review the dermatopathology of fixed drug eruptions and their bullous variants.

Main Methods:

• Case report of an elderly woman presenting with disseminated bullous and erythematous-violaceous plaques and oral ulcers.
• Clinical assessment, skin biopsy for histopathological examination, and medication review.
• Diagnostic process involving sequential drug withdrawal and therapeutic trials.

Main Results:

• The patient presented with symptoms consistent with BFDE while on atenolol, analgesics, and NSAIDs.
• Discontinuation of NSAIDs and analgesics provided no relief.
• Improvement was observed only after atenolol was substituted, strongly implicating it as the causative agent.

Conclusions:

• Atenolol, a selective β-1 blocker, can rarely cause bullous skin reactions, including BFDE.
• This case underscores the importance of considering less common medications in the differential diagnosis of BFDE.
• Further investigation into the dermatopathology of FDE and its bullous variants is warranted.