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

Fundamentals: Bullous fixed drug eruption (BFDE) is defined by the recurrence of bullous eruptions caused by medications, with a predilection for the same site. We report a rare association of BFDE with atenolol, with only two cases described in the literature. Case Report: An elderly woman presented with bullous and erythematous-violaceous plaques disseminated across her body, along with painful ulcers in the oral cavity. She was using atenolol, analgesics, and anti-inflammatory drugs (NSAIDs). After a biopsy compatible with BFDE, NSAIDs and analgesics were discontinued, and topical corticosteroids were started, but without improvement. The condition only showed improvement after the substitution of atenolol, supporting the suspicion. Discussion: The main drugs involved in BFDE are NSAIDs, analgesics, and antibiotics. Atenolol is a selective β-1 blocker, widely used, which rarely causes bullous skin reactions, including drug-induced pemphigoid, erythema multiforme, and BFDE. We also discuss the classic dermatopathology of FDE and its bullous variant.