BAGIAN ILMU KESEHATAN KULIT DAN KELAMIN

FAKULTAS KEDOKTERAN

UNIVERSITAS MUSLIM INDONESIA JULI 2016

REFERAT

FIXED DRUG ERUPTION

Dibawakan Oleh :

SITI HARDIYANTI BAHARUDDIN

111 2015 2 196

PEMBIMBING :

Dr. dr. Nurelly N. Waspodo, Sp.KK

DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK

BAGIAN KULIT DAN KELAMIN

UNIVERSITAS MUSLIM INDONESIA

MAKASSAR

2016
 Definition

Fixed Drug Eruption (FDE) or erythema

fixum are a distinctive variant of drug
induced dermatosis with characteristic
recurrence at the same skin and or
mucosal sites after repeated
administration of the same drug.
Sites of predilection include :
Lips
Extremities
Genitalia
 Epidemiology
The age range of the patients was 17 to 60 years.
The time interval between drug exposure and the
development of genital FDE ranged from 1 day to 7 days.
11 patients (30,6%) had a history of the same lesions in the
past
18 patients (50%) had erythema in the genital area
18 patients (50%) had erythema and erosion in the genital
area
 Etiology
The list of offending agents is extensive. The Following list includes the more
common offenders, but is not all-inclusive.
Medications :
Acetaminophen
Barbiturates
Paracetamol
Phenolphthalein
Pyrazolon derivatives
Sulfonamides
Tetracyclines
Foods :
Red wine
Fresh grapes
Raisins
Strawberries
Cheese crips
saccharin
 Patofisilogy

A hypothetical model for the evolution of intraepidermal CD8+ T cells.

Virus-specific memory CD8+ T cells are primed during viral infections and
retained in the epidermis as a stable population of effector memory T
cells.
Once they are cross-reacted with the drug antigen, they become major
effectors of epidermal damage. Thus, intraepidermal T cells originally
evolved to protect epidermal integrity from pathogens exert an opposite
action on surrounding keratinocytes.
 Clinical Signs
FDE usually appears as a solitary or a small number of
pruritic
well circumscribed
erythematous macules that evolve into edematous plaques
these lesions typically resolve after discontinuation of the
offending drug
leaving hyperpigmentation at the site of lesions
Post- Fixed drug eruption: round
inflammatory erythematous plaque with
reaction due central dusky red to grayish
to fixed dose hyperpigmentation;
combination

Bullous lesion generalized bullous fixed drug

eruption: large areas
in the instep of faccid blisters or erosions
of left foot involving the abdomen, thighs,
and glans penis.

Erythema fixum on the elbow

Bullous
lesions
in the
right
dorsal
toe
 Penile lesion of erythema fixum

Muc Mucosal patch of fixed erythema

 Diagnostic
Anamnesis / History Taking
Dermatologic Physical Exam
Primary Lesions
1. A sharply demarcated macule or plaque, colour initially pink but rapidly becoming
dusky violet or violet-brown
2. Surface vesicles or bullae. Bullae may be so large as to obscure the underlying
inflammatory macule or plaque
Secondary Lesions
1. Moist erosions as bullae separate.
2. Deep dusky brown or gray-brown hyperpigmentation that persists
Differential Diagnostic
Discoid Lupus
Acute Urticaria Erythematosus

Dermatologic Manifestations of

Bullous Stevens-Johnson Syndrome and

Pemphigoid Toxic Epidermal Necrolysis

Drug Eruptions
Cellulitis
 Drug-Induced Bullous Disorders Erythema Annulare
Cetrifugum

Drug-Induced Pemphigus Erythema

Dyschromicum Perstans

Eczema Erythema Multiforme

 Herpes Simplex
Melasma

Insect Bites Postinflammatory

Pemphigus
Hyperpigmentation
Vulgaris

Lichen
Planus
Psoriasis

Lichen Planus Pityriasis Rosea

Actinicus
 Assessment
The first line treatment for FDE is prevention of
attacks and recurrences, which is done simply by
avoiding the offended drug if possible.
Discontinuation of the drug itself is usually the
only necessary treatment; in addition, topical
corticosteroids might as well be effective in lesion
regression.
 Additional Examination
Biopsy Specimen
Patch test
Oral provocation test
 Complications
Hyperpigmentation
(the potential forinfection exists in the setting of multiple,
eroded lesions)
 Prognosis
Dubia ad Bonam
 Patient Education

Patients should be counseled on medication

avoidance and possible cross-reaction of
similar medications.
Patients should notify their physicians of all
drug allergies they have experienced
Thank You