Disusun :

A.Asriwahyuni Lestari 1519 777 14 371

Fidya Novita Sari 15 19 777 14 361
Pembimbing : dr. SyahrianiSyahrir, M.Kes,Sp.KK
 Indtroduction

 Fixed drug eruption is an unusual and rare drug

reaction. A fixed drug eruption reaction is actually
a type of delayed hypersensitivity reaction, that
occurs as lesions recurring at the same skin site
due to repeated intake of an offending drug.
 Fixed drug eruption is a very adverse drug
reaction are very common. Thay range In severity
and type. In the general population drug related
problems occur in about 5% and in hospitalized
patients this figure rises to 20%. The most
commonly involved organ by drug reactions is the
skin.
 A typical sign of fixed drug eruption is to
occur in the same place every time the drug
that causes fixed drug eruption is consumed

Fixed drug eruption is usually solitary in the

initial attack, but with each subsequent
exposure, the number of involved sites may
increase and pre-existing ones may increase in
size.
 A systematic review of the medical literature,
encompassing nine studies, concluded that cutaneous
raction rates varied from 0% to 8% and were highest for
antibiotics.

FDE usually appears as solitary, erythematous or

dusky red macules that may evolve into an edematous
plaque.
 Definisi

Fixed-drug eruption (FDE) is an unusual and rare

adverse drug reaction. This type of reaction is actually
a delayed type of hypersensitivity reaction that occurs
as lesions recurring at the same skin site due to
repeated intake of an offending drug. Here

Sumber : Bihari RSM, Bhuvan J, Saad A. Fixed drug eruptions with

intraoral Presentation. IndiantJ Dent 2015; 2 ; 103-06
 Epidemilogi :

A systematic review of the medical literature,

encompassing nine studies, concluded that cutaneous
reaction rates varied from 0% to 8% and were highest for
antibiotics.2 Outpatient studies of cutaneous adverse drug
reactions (ADRs) estimate that 2.5% of children who are
treated with a drug, and up to 12% of children treated with
an antibiotic, will experience a cutaneous reaction.

Sumber Shear NH, Knowles SR. Cutaneous Reactions to drugs.

Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffel DJ, Wolff
K ed. Fitzpatrick’s Dermatology In General Medicine 8th Ed. MC
Graw Hill 2012; P 449 -57
 Etiologi :

The most common offending medications include

nonsteroidal anti-inflammatory drugs, antimicrobials,
and antiepileptics; the incidence associated with any
particular medication varies geographically and
historically owing to the frequency of its use

Sumber : Shear NH, Knowles SR. Cutaneous Reactions to drugs.

Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffel DJ, Wolff K ed.
Fitzpatrick’s Dermatology In General Medicine 8th Ed. MC Graw Hill 2012; P 449-57
 Patogenesis :
PATOGENESIS
Type I :

• Immediate-type reactions mediated by

immunoglobulin E (IgE) antibodies
Type II :
• Cytotoxic reactions mediated by immunoglobulin G (IgG)
or immunoglobulin M (IgM) antibodies

Type III :
• Immune-complex reactions

Type IV
• Delayed-type hypersensitivity reactions mediated by
cellular immune mechanisms, such as the recruitment
and activation of T cells.

Sumber : Bihari RSM, Bhuvan J, Saad A.

Fixed drug eruptions with intraoral Presentation.
IndiantJ Dent 2015; 2 ; 103-06
 Clinical Features
 FDEs usually appear as solitary, erythematous,
bright red or dusky red macules that may evolve into
an edematous plaque; bullous-type lesions may be
present, widespread lesions may be difficult to
differentiate from TEN. FDEs are commonly found
on the genitalia and in the perianal area, although
they can occur anywhere on the skin surface
 patients may complain of burning or stinging, and
others may have fever, malaise, and abdominal
symptoms. FDE can develop from 30 minutes to 8–
16 hours after ingestion of the medication. After the
initial acute phase lasting days to weeks, residual
grayish or slatecolored hyperpigmentation develops.
On rechallenge, not only do the lesions recur in the
same location, but also new lesions often appear.

Sumber :Shear NH, Knowles SR. Cutaneous Reactions to drugs.

Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffel DJ, Wolff K ed.
Fitzpatrick’s Dermatology In General Medicine 8th Ed.
MC Graw Hill 2012; P 449-57
 Differential Diagnosis

 Erythema multiforme is an
acute, self-limited, and
sometimes recurring skin
condition considered to be a
hypersensitivity reaction
associated with certain
infections and medications

Sumber: MD Micheler RL, MD Marna RS, PHD W Teresa HSUMD.

Erythema Multiforme. Dermatol Clin 2003; 21; 196.
 Differential Diagnosis
-Syndrome Stevens Johnson
is a form mucocutaneous disease
with signs and severe systemic
symptoms such as lesions targets
with irregular shapes, accompanied
by macules, vesicles, bullae, and
Purpura are especially widespread
on the body frame, The exact
cause of the syndrome Stevens-
Johnson is currently not unknown
but several found things that trigger
the emergence of such drugs or
viral infections
 Management
1. systemic treatment
A. Corticosteroid
- prednisone 3 x 10 mg a day for adults, or
- oral prednisone 1 mg / kg body weight, reduced gradually over two
weeks

2. topical treatment
A. Lesions appear dry:
- Glucocorticoid ointment
- 2% salicylic powder
- Menthol ½-1% to reduce itching.

Sumber: Wolff K, Johnson RA, Fixed Drug Eruption.

Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology 6th Ed.
Dermatology and Internal Medicine 2009; P 566-80
B. Lesions appear wet
a) Salicylic acid 1% .

Prognosis

FDE resolves within a few weeks of withdrawing

the drug. Recurs within hours after ingestion of a single
dose of the drug.

Sumber: Wolff K, Johnson RA, Fixed Drug Eruption.

Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology 6th Ed.
Dermatology and Internal Medicine 2009; P 566-80
 Conclusion
 Fixed drug eruption is a disease caused by drug induction, with typical
symptoms in the same place on the skin or mucous membranes. The
etiological agents of drugs associated with fixed drug eruption are
sulfonamides, phenazones and tetracyclines.

 About nine studies conclude that reactions to fixed drug eruption vary
greatly from 0% to 8% due to antibiotic drugs. Outpatients who
experience fixed drug eruption are estimated to occur in children
around 2.5% to 12%
 Clinical features of fixed drug eruption usually appear as solitary,
erythematous, with bright red or black macules that can evolve into
edematous plaques, fixed drug eruption is most common in the
perianal region although it can occur anywhere on the surface of the
skin.

 Fixed drug eruption will be resolved within a few weeks after stopping
or withdrawing the drug. Fixed drug eruption recurs within a few
hours after the consumption of drugs that will cause fixed drug
eruption.
TERIMA KASIH