Clinical features of fixed drug eruption at a tertiary hospital in Korea

Abstract

Purpose: Fixed drug eruption (FDE) is characterized by a well-defined erythematous patch, plaque, or bullous eruption that recurs at the same site as the result of systemic exposure to a causative drug, and resolves with or without hyperpigmentation. This study was carried out to identify the common causative drugs and clinical features of FDE in Korea.

Methods: We reviewed electronic medical records of all patients diagnosed with FDE from January 2000 to December 2010 at a tertiary hospital in Korea.

Results: A total of 134 cases were diagnosed as FDE. The mean age was 35.9 years (range, 0-82 years) and 69 (51.5%) of the patients were male. The mean duration from the first event to attending hospital was 1.9 years (range, 1-20 years). The mean number of recurrences was 2.6 (1-10), and 72.6% of patients sought medical care after experiencing symptoms twice or more. Four patients (3.1%) needed hospitalization. The most common sites were the upper extremities (47.7%), followed by the lower extremities, face, abdomen, chest, buttocks and perineum. Clear documentation on the causative drugs was available for 38 patients (28.4%), and among these, non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen accounted for 71.1% of cases, and antibiotics accounted for 15.8%. Eighty patients (59.7%) underwent active treatment for FDE, and topical steroids were most frequently prescribed (43.3%), with systemic steroids used in 11.2% of patients.

Conclusions: NSAIDs and acetaminophen were the main causative agents of FDE, however, the causative agents were not assessed in 25% of patients.

Keywords: Fixed drug eruption; non-steroidal anti-inflammatory drug.

Fig. 1

Involved sites of patients with fixed drug eruption. (A) Most commonly involved sites were the upper extremities, followed by the lower extremities, face, abdomen, chest, buttocks, and perineum. (B) FDE cases developed as multiple lesions in 59.4% and as solitary lesion in 30.6%. (C) Involved sites differed between patients with multiple lesions and those with a solitary lesion.

Fig. 2

Causative drugs of fixed drug eruption. Causative drugs were described in broad, ambiguous terms in 46.3% of the study subjects (A) and in specific, accurate terms in 28.4% of the study subjects (B). NSAIDs, Non-steroidal anti-inflammatory drugs.

Fig. 3

Treatment for fixed drug eruption. Topical steroids were prescribed most frequently for FDE, followed by other topical agents, oral antihistamines, and systemic steroids.