Begrijpen van Huidziekten - Wat is een Fixed Drug Eruption?

Discussion

Although our cases numbered too few to give definitive trends, there was a predominance of men (31 men and 19 women). A slight male trend has been reported in some studies[5,3] while some analyzes report a female dominance.[6,7] According to some authors, FDEs account for 14%–22% of cutaneous drug reactions in children,[8,9] but in our study, there was only one child, 7 year old.

The most frequently affected sites in our series were the extremities (50.4%), followed by the lips (40%). Both these sites have been recognized as common sites of involvement in several studies.[1,2,6] We had only five cases with involvement of the genitalia.

Antimicrobials and NSAIDs are well-known triggers for an FDE[1,2,4] and were the common culprits in our series too. Among the antimicrobials, fluoroquinolones and nitroimidazoles were most commonly involved. This is in keeping with several other reports of FDE with these drugs as well as the increasing use of these drug groups in our country.[7,10,11] In 18 patients, these were given together, making it difficult to pinpoint any one drug as responsible. Sulfamethoxazole–trimethoprim, amoxicillin-clavulanic acid, and doxycycline were earlier more frequently responsible for FDE, but with a decrease in their prescription rate, incidence of FDE due to them is likewise decreasing.[3] The other drugs implicated in our series, that is, fluconazole,[12] terbinafine, cetirizine[13,14] levocetirizine,[13,15,16,17] opioids,[18] and multivitamin-mineral preparations[19] have all been recognized as possible causes of FDE.

In a little over half the patients (50.2%), there was a history of an FDE. Many authors have reported a high proportion of recurrent FDEs.[11] In two patients, there was cross-reaction between ciprofloxacin and norfloxacin – that was an FDE due to norfloxacin in a patient with history of FDE with ciprofloxacin and vice versa. Similarly, there was cross-reaction between secnidazole-metronidazole and levocetirizine-cetirizine. Cross-reaction between fluoroquinolones, nitroimidazoles, fluoroquinolone-nitroimidazole combinations, and levocetirizine-cetirizine have been previously reported.[20,21,22,23] In 5 patients with FDE following an NSAID, there was a history of FDE with an analgesic/antipyretic though the exact drug was unknown. It could imply recurrence with same or a related drug. Similarly, in two patients with FDE due to an FDC-containing norfloxacin + tinidazole, there was history of FDE with an antidiarrheal drug.

Conclusie

Het blijft belangrijk om bij patiënten met een onverklaarbare huiduitslag te vragen naar het gebruik van geneesmiddelen. Hierbij moet men ook denken aan zelfzorggeneesmiddelen die ogenschijnlijk weinig bijwerkingen hebben, zoals paracetamol.

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Fixed drug eruption

Authors: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, 2001, Updated: Dr Christine Condon, Resident Medical Officer, St Vincent’s Hospital Melbourne, Australia, A/Prof Rosemary Nixon AM, Dermatologist, Skin Health Institute, Carlton, Australia. Copy edited by Gus Mitchell. March 2021

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