A Review of Fixed Drug Eruption with a Special Focus on Generalized Bullous Fixed Drug Eruption

Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by the onset of rash at a fixed location on the body each time a specific medication is ingested. With each recurrence, the eruption can involve additional sites. Lesions can have overlying vesicles and/or bullae, and when they cover a significant percentage of body surface area, the eruption is referred to as generalized bullous fixed drug eruption (GBFDE). Due to the widespread skin denudation that can be seen in this condition, GBFDE may be confused clinically with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). While treatments described for GBFDE include supportive care, topical and/or systemic steroids, and, recently, cyclosporine, the mainstay of management involves identifying and discontinuing the causative drug. This review article will provide an overview of FDE with an emphasis on its generalized bullous variant.

A case of palmar hypopigmentation induced by capecitabine in a gastrointestinal cancer patient

Introduction Capecitabine is an antimetabolite antineoplastic agent widely used in the treatment gastrointestinal cancers. The common frequently reported cutaneous adverse drug reaction associated with capecitabin are a palmar-plantar erythrodysesthesia syndrome, rash and hyperpigmentation. This case reports a capecitabine-induced palmar hypopigmentation. Case report We report the case of a 74-years old patient with jejunum adenocarcinoma treated by capecitabine. The patient developed a pseudo-vitiligo after 2 cycles capecitabine and without history of cutaneous disorders. The skin lesions were characterized with skin hypopigmentation on both hands. Management and outcome: The hypopigmentation slowly recovered after capecitabine discontinuation. Conclusion This is the first described case of pseudo-vitiligo induced by capecitabine. This impressive but non-severe adverse effect should be known by oncologists and oncology pharmacists to reassure the patients in particular about the possible recovery after discontinuation of capecitabine.

A study and evaluation of cutaneous adverse drug reaction in the patients attending dermatology department of tertiary care teaching hospital in Eastern Uttar Pradesh

Background: Cutaneous adverse drug reactions (CADRs) are most frequently reported type of ADRs and can be caused by variety of drugs. The clinical patterns of adverse cutaneous drug reactions and the drug responsible for them is changing every year due to the emergence of newer molecules and changing trends in the use of drugs.Methods: This was a prospective, cross-sectional and observational study done for a period of 6 months to evaluate the clinical pattern of CADRs and their causative drugs in the tertiary health care.Results: Over all 55 patients were detected with cutaneous adverse drug reaction. The majority of CADRs were in the age group of 18-35 years (63.46%). Fixed drug eruptions (FDE) being the most common adverse cutaneous drug reaction (34.68%) followed by maculopapular rash (23%), NSAIDs being the most common, followed by antimicrobial agents.Conclusions: Knowledge of these drug eruptions, the causative drugs are essential for the clinicians and implementing the ADRs reporting and monitoring system, one can promote drug safety and better patients care, among health care professionals.

Fixed drug eruption associated with fixed combination of fluoroquinolone-nitroimidazole

Fixed drug eruptions (FDE) are cutaneous adverse drug reaction characterized by well demarcated erythematous plaques which on removal of the offending agent resolves with residual hyperpigmentation patches at the site. FDE to nitroimidazoles and fluoroquinolones have nevertheless been infrequently reported. Awareness about the adverse reaction to the fluoroquinolone-nitroimidazole combination drug and also the likelihood of recurrence with same or similar drugs and the possible cross reaction is eminent. Hereby we report one such case of FDE to ciprofloxacin/tinidazole combination.

Massive clonal expansion of polycytotoxic skin and blood CD8+ T cells in patients with toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN) is a life-threatening cutaneous adverse drug reaction. To better understand why skin symptoms are so severe, we conducted a prospective immunophenotyping study on skin and blood. Mass cytometry results confirmed that effector memory polycytotoxic CD8+ T cells (CTLs) are the main leucocytes in TEN blisters at the acute phase. Deep T cell receptor (TCR) repertoire sequencing identified massive expansion of unique CDR3 clonotypes in blister cells. The same clones were highly expanded in patient’s blood, and the degree of their expansion showed significant correlation with disease severity. By transducing α and β chains of the expanded clonotypes into a TCR-defective cell line, we confirmed that those cells were drug specific. Collectively, these results suggest that the relative clonal expansion and phenotype of skin-recruited CTLs condition the clinical presentation of cutaneous adverse drug reactions.

Ofloxacin/ tinidazole induced fixed drug eruption- a case report

Introduction: An immunological cutaneous adverse drug reaction is distinguished as sharply defined lesions with red rashes and sharp borders, erythematous lesions with or without blisters developing within an hour or in a few cases within a week after drug administration is termed as fixed drug eruptions (FDE). FDE is one of the major forms of drug-induced dermatosis. Various class of drugs that are causative agents for FDE includes antibiotics, anticonvulsants, antivirals, and Non-steroidal anti-inflammatory drugs (NSAID). FDE is easily recognized and differentiated from other drug eruptions since it does not occur voluntarily or during infection. Case report: This case report is to spotlight the case of a 52-year-old male patient who was undergoing treatment for acute gastroenteritis and suffered from FDE due to administration of IV Ofloxacin.

Ethambutol Induced Lichenoid Drug Eruption: a case report

Background: A rare type of cutaneous adverse drug reaction (CADR), lichenoid drug eruption (LDE), can be associated with ethambutol. Case Report: A 60-year-old woman with spinal tuberculosis received multiple anti-TB medications and developed rashes after 3 months of the treatments. A skin biopsy from the posterior auricular area confirmed lichenoid dermatitis and the Naranjo causality assessment indicated ethambutol as a probable cause of LDE in the patient. The rashes slowly improved after discontinuation of ethambutol . Unfortunately, the residual of brown hyperpigmentation on the body has still persisted for over 16 months. Results and Conclusion: The medications were reduced to isoniazid 300 mg/day and rifampicin 450 mg /day as planned for another 3 months. This case report points out the essentials of early recognition of ethambutol LDE by health care professionals.