Fixed Drug Eruptions in Malagasy Children: Clinical Observations and Characteristics

Fixed drug eruption is a drug-induced hypersensitivity reaction characterized by recurrent erythematous-pigmented lesions at the same site after each exposure to the causative drug. The molecules most frequently implicated are sulfonamides, nonsteroidal anti-inflammatory drugs, anticonvulsants, and paracetamol. The first case involved a four-year-old boy with sickle cell disease who had presented with a recurrent hyperpigmented macule on the lip for 1 year. The second case involved a three-year-old girl with multiple pigmented, pruritic macules. The third case involved a ten-year-old boy presenting with pigmented plaques and flaccid bullae on his arm and left thigh. In all three cases, fixed drug eruption (including one bullous form) was diagnosed based on the patient history and recurrence. Management consisted of permanent withdrawing of the offending drug and providing symptomatic treatment with antihistamines and topical corticosteroids. There were favorable outcomes, but persistent residual pigmentation remained. These three cases illustrate the typical clinical presentation of fixed drug eruption in children in Madagascar. Recurrence of the same lesion at the same site is pathognomonic and requires discontinuation of the offending drug and reporting to pharmacovigilance.