| Generalized bullous fixed drug eruption | |
|---|---|
| Other names | Bullous drug eruption, [1] multilocular bullous fixed drug eruption [2]: 554 |
 | |
| Drug eruption: Bullous dermatitis medicamentosa caused by sulfathiazole. | |
| Specialty | Dermatology |
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
- ^ 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.
- ^ a b Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
- ^ a b James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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
- Cho, Yung-Tsu; Lin, Jheng-Wei; Chen, Yi-Chun; Chang, Chia-Ying; Hsiao, Cheng-Hsiang; Chung, Wen-Hung; Chu, Chia-Yu (2014). "Generalized bullous fixed drug eruption is distinct from Stevens-Johnson syndrome/toxic epidermal necrolysis by immunohistopathological features". Journal of the American Academy of Dermatology. 70 (3). Elsevier BV: 539–548. doi: 10.1016/j.jaad.2013.11.015. ISSN 0190-9622. PMID 24388722.
- Byrd, Rachel Chikowski; Mournighan, Kimberly J.; Baca-Atlas, Michael; Helton, Margaret R.; Sun, Natalie Z.; Siegel, Marni B. (2018). "Generalized bullous fixed-drug eruption secondary to the influenza vaccine". JAAD Case Reports. 4 (9). Elsevier BV: 953–955. doi: 10.1016/j.jdcr.2018.07.013. ISSN 2352-5126. PMC 6197945. PMID 30364778.