Fixed drug eruption due to ibuprofen

FIXED DRUG ERUPTION

The well-demarcated violaceous plaque on the groin in this patient raised suspicion for a variety of lesions, including an insect bite, bullous pemphigoid, bullous fixed drug eruption, erythema multiforme, leukocytoclastic vasculitis, lichen planus, large plaque parapsoriasis, and sarcoidosis (Table 1).^1,2 Of these diagnoses, the rapid onset of a solitary plaque with symptoms of burning following a recent medication exposure was most suggestive of fixed drug eruption, a relatively uncommon cutaneous reaction to medication.³

Fixed drug eruption lesions usually present as 1 or more circular patches with a violaceous hue on any part of the trunk or extremities. Mucosal and genital lesions may also occur.³ This reaction typically recurs in the same site on reexposure to the causative medication. Although the lesions are mostly asymptomatic, there may be mild pruritus, burning, or stinging.

A history of recent medication exposures, including over-the-counter agents, is a clue to the diagnosis.^1,3 Fixed drug eruptions are associated with many drugs, especially antibiotics (eg, trimethoprim-sulfamethoxazole, tetracyclines, penicillin), nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen, antifungals, antihistamines, and acetaminophen; less common associations include carbamazepine and allopurinol.^1,3,4,5

Workup for a suspected fixed drug eruption, including the need for laboratory evaluation and biopsy, varies based on the clinical examination and history. Because the diagnosis of fixed drug eruption is largely clinical, primary care clinicians should maintain a low threshold for referral to dermatology if there is diagnostic uncertainty or lack of supportive history.²

Management includes discontinuation of the drug, and the prognosis is good, with the lesion(s) usually resolving without treatment. For symptomatic relief, medium-to-high potency topical corticosteroids can be prescribed.² A short course of systemic corticosteroids may be needed for multiple lesions.¹

Because these lesions are uncommon, they are often overlooked or misdiagnosed. Early diagnosis can prevent long-term complications such as rare generalized bullous lesions or postinflammatory hyperpigmentation.

DISCLOSURES

The authors report no relevant financial relationships which, in the context of their contributions, could be perceived as a potential conflict of interest.