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
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]
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]
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]
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]
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
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]
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]
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]
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]