Not uncommon but often under-recognized: case report of fixed drug eruption in a child

Kaysha-Lin Lexminarayana; Ming Lee Chin; Su Yuen Ng

doi:10.18203/2349-3291.ijcp20232594

Authors

Kaysha-Lin Lexminarayana Department of Pediatrics, Raja Permaisuri Bainun Hospital, Ipoh, Malaysia
Ming Lee Chin Department of Pediatrics, Raja Permaisuri Bainun Hospital, Ipoh, Malaysia
Su Yuen Ng Department of Pediatrics, Raja Permaisuri Bainun Hospital, Ipoh, Malaysia

DOI:

https://doi.org/10.18203/2349-3291.ijcp20232594

Keywords:

Fixed drug eruption, Pediatric, Adverse drug reaction

Abstract

When re-exposed to the offending drug, fixed drug eruptions (FDEs), a distinctive type of mucocutaneous drug reaction, typically recur in the same places. Often, these eruptions are benign in nature, however the recurrence and appearance of these lesions may be a cause of worry to patients, and in the pediatric population, to their caretakers as well. Lack of awareness among clinicians coupled with suboptimal history taking pertaining to drug usage are the key factors leading to delayed and under-diagnosis of FDEs. We discuss the case of a child whose fixed drug eruption was misdiagnosed as an insect bite for more than a year. This led to parental anxiety, as well as trial of multiple avenues of treatment to no avail. This article aims to raise awareness of the importance of prompt recognition of FDEs, as identification and discontinuation of the offending drug will alleviate the eruptions and prevent recurrence of the condition.

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References

Khaled A, Kharfi M, Ben Hamida M, El Fekih N, El Aidli S, Zeglaoui F, et al. Cutaneous adverse drug reactions in children. A series of 90 cases. La Tunisie medicale. 2012;90(1):45-50.

Sharma VK, Dhar S. Clinical pattern of cutaneous drug eruption among children and adolescents in north India. Pediatric dermatology. 1995;12(2):178-83.

Shaker G, Mehendale T, De La Rosa C. Fixed Drug Eruption: An Underrecognized Cutaneous Manifestation of a Drug Reaction in the Primary Care Setting. Cureus. 2022;14(8):e28299.

Shiohara T, Mizukawa Y. Fixed drug eruption: a disease mediated by self-inflicted responses of intraepidermal T cells. Eur J Dermatol. 2007;17(3):201-8.

Shiohara T. Fixed drug eruption: pathogenesis and diagnostic tests. Curr Opin Allergy Clin Immunol. 2009;9(4):316-21.

Korkij W, Soltani K. Fixed drug eruption. A brief review. Arch Dermatol. 1984;120(4):520-4.

Lipowicz S, Sekula P, Ingen-Housz-Oro S, Liss Y, Sassolas B, Dunant A, et al. Prognosis of generalized bullous fixed drug eruption: comparison with Stevens-Johnson syndrome and toxic epidermal necrolysis. Br J Dermatol. 2013;168(4):726-32.

Brahimi N, Routier E, Raison-Peyron N, Tronquoy AF, Pouget-Jasson C, Amarger S, et al. A three-year-analysis of fixed drug eruptions in hospital settings in France. Eur J Dermatol. 2010;20(4):461-4.

Montazer F, Jahani Amiri K, Mofarrah R, Ahmadi A, Nouripour B, Mofarrah R. A first case of fixed drug eruption due to Tamsulosin. Journal of cosmetic dermatology. 2020;19(5);1143-5.

Heelan K, Shear NH. Cutaneous drug reactions in children: an update. Paediatr Drugs. 2013;15(6):493-503.

Mahboob A, Haroon TS. Drugs causing fixed eruptions: a study of 450 cases. International journal of dermatology. 1998;37(11):833-8.

Lee AY. Fixed drug eruptions. Incidence, recognition, and avoidance. Am J Clin Dermatol. 2000;1(5):277-85.

Kidon M, Blanca-Lopez N, Gomes E, Terreehorst I, Tanno L, Ponvert C, et al. EAACI/ENDA Position Paper: Diagnosis and management of hypersensitivity reactions to non-steroidal anti- inflammatory drugs (NSAIDs) in children and adolescents. Pediatr Allergy Immunol. 2018;29(5):469-80.

Miah MA, Ahmed SS, Chowdhury SA, Begum F, Rahman SH. Fixed drug eruptions due to cotrimoxazole. Mymensingh Med J. 2008;17(2):S1-5.

McClatchy J, Yap T, Nirenberg A, Scardamaglia L. Fixed drug eruptions - the common and novel culprits since 2000. J Dtsch Dermatol Ges. 2022;20(10):1289-1302.

Anderson HJ, Lee JB. A Review of Fixed Drug Eruption with a Special Focus on Generalized Bullous Fixed Drug Eruption. Medicina. 2021;57:925.

Jhaj R, Asati DP, Chaudhary D. Fixed drug eruption due to levocetirizine. J Pharmacol Pharmacother. 2016;7(2):109-11.

Zambonino MA, Torres MJ, Muñoz C, Requena G, Mayorga C, Posadas T, et al. Drug provocation tests in the diagnosis of hypersensitivity reactions to non-steroidal anti-inflammatory drugs in children. Pediatr Allergy Immunol. 2013;24(2):151-9.

Khaled A, Kharfi M, Ben Hamida M, El Fekih N, El Aidli S, Zeglaoui F, et al. Cutaneous adverse drug reactions in children. A series of 90 cases. Tunis Med. 2012;90(1):45-50.