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Generalized bullous fixed drug eruption

Generalized bullous fixed drug eruption
Other namesBullous drug eruption,[1] multilocular bullous fixed drug eruption[2]: 554 
Drug eruption: Bullous dermatitis medicamentosa caused by sulfathiazole.
SpecialtyDermatology

Generalized bullous fixed drug eruption (GBFDE) most commonly refers to a drug reaction in the erythema multiforme group.[3]: 129  These are uncommon reactions to medications, with an incidence of 0.4 to 1.2 per million person-years for toxic epidermal necrolysis and 1.2 to 6.0 per million person-years for Stevens–Johnson syndrome.[3]: 129  The primary skin lesions are large erythemas (faintly discernible even after confluence), most often irregularly distributed and of a characteristic purplish-livid color, at times with flaccid blisters.[2]: 554 

Signs and symptoms

A rare and severe variation of fixed drug eruption, generalized bullous fixed drug eruption involves blisters and erosions involving at least 10% of the body's surface area, affecting three of the six anatomic sites: the head and neck, the anterior and posterior trunk, the upper and lower extremities, and the genitalia.[4]

Causes

Fixed drug eruptions are linked to anti-infective (ß-lactam antibiotics, tinidazole, and acyclovir), analgesics (acetaminophen (paracetamol), mefenamic acid, and metamizole), non-steroidal anti-inflammatory drugs (NSAIDs), anti-epileptic (carbamazepine), psychoactive (barbiturates, codeine, and others), and other miscellaneous medications (omeprazole, contrast media, loratadine, and allopurinol).[4]

Diagnosis

In cases where the clinical presentation is unclear, a skin biopsy may be necessary to confirm the diagnosis of GBFDE. A subepidermal blister or denuded epidermis, vacuolar alterations at the dermo-epidermal junction, and a variable number of necrotic keratinocytes within the lesional intact epidermis are characteristic histopathologic findings of GBFDE.[5]

Treatment

Antihistamines and topical steroids are used in symptomatic therapy. Antibiotics should be given if an infection is thought to be present.[6] It is also important to counsel the patient to stay away from the offending medication.[7]

See also

References

  1. ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. p. 470. ISBN 978-1-4160-2999-1.
  2. ^ a b Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
  3. ^ a b James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
  4. ^ a b Paulmann, Maren; Reinkemeier, Felix; Lehnhardt, Marcus; Mockenhaupt, Maja (August 14, 2023). "Case report: Generalized bullous fixed drug eruption mimicking epidermal necrolysis". Frontiers in Medicine. 10. Frontiers Media SA. doi:10.3389/fmed.2023.1125754. ISSN 2296-858X. PMC 10461315. PMID 37644986.
  5. ^ Anderson, Hannah J.; Lee, Jason B. (September 1, 2021). "A Review of Fixed Drug Eruption with a Special Focus on Generalized Bullous Fixed Drug Eruption". Medicina. 57 (9). MDPI AG: 925. doi:10.3390/medicina57090925. ISSN 1648-9144. PMC 8468217. PMID 34577848.
  6. ^ Girisha, BanavasiShanmukha; Noronha, TonitaMariola; Alva, AkshataCharan; Menon, Ashok (2018). "Generalized bullous fixed drug eruption mimicking toxic epidermal necrolysis caused by paracetamol". Clinical Dermatology Review. 2 (1). Medknow: 34. doi:10.4103/cdr.cdr_25_17. ISSN 2542-551X.
  7. ^ Das, Anupam; Podder, Indrashis; Chandra, Somodyuti; Gharami, RameshChandra (2016). "Doxycycline induced generalized bullous fixed drug eruption". Indian Journal of Dermatology. 61 (1). Medknow: 128. doi:10.4103/0019-5154.174197. ISSN 0019-5154. PMC 4763688. PMID 26955169.

Further reading
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