Generalized Bullous Fixed Drug Eruption: A Systematic Review.

Area of Science:

• Dermatology
• Pharmacovigilance
• Internal Medicine

Background:

• Generalized Bullous Fixed Drug Eruption (GBFDE) is a severe cutaneous adverse reaction (SCAR) with potential life-threatening implications.
• Despite similarities to Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN), comprehensive characterization of GBFDE is lacking.

Purpose of the Study:

• To systematically review the epidemiology, causative agents, clinical features, histology, outcomes, and management of GBFDE.
• To provide a comprehensive overview of GBFDE based on existing literature.

Main Methods:

• Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
• Searched PubMed and Embase databases (1985–October 2024) for original observational cases of GBFDE with quantitative data.
• Assessed study quality using the Newcastle-Ottawa Scale and performed descriptive and comparative analyses.

Main Results:

• Included 83 studies with 430 GBFDE cases; median age 56 years.
• Common triggers: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs, 48.7%) and antibiotics (30.9%); median latency 24 hours.
• Mortality was 15.2%, significantly associated with age; median resolution time 11 days; post-inflammatory hyperpigmentation common (54.3%).

Conclusions:

• GBFDE exhibits short latency, with NSAIDs and antibiotics as frequent triggers.
• Systemic involvement is less common than in SJS/TEN, but morbidity and mortality are significant, particularly in the elderly.
• The accessibility of over-the-counter NSAIDs represents a potential public health risk for GBFDE.