Etoricoxib‐induced fixed drug eruption: Report of seven cases

Abstract

Background Fixed drug eruption (FDE) is a characteristic form of intraepidermal CD8+ T cell‐mediated drug reaction, with repeated appearance of isolated or multiple skin lesions in the same location after receiving the offending drug. Non‐steroidal anti‐inflammatory drugs (NSAID) are the most common cause. Selective inhibitors of inducible cyclooxygenase 2 (COX‐2) provoke a lesser degree of allergic or idiosyncratic adverse reactions than conventional NSAID, but they can cause skin reactions of variable severity. Objective Etoricoxib has been related to a variety of unusual skin reactions, including several reports of FDE. Methods We perfomed epicutaneous test to diagnose patients with suspected etoricoxib fixe drug rash due to clinical features and reproducibility on at least two occasions. Results We present seven new cases of etoricoxib‐induced fixed drug eruption, with a diagnosis based on clinical presentation. This diagnosis was confirmed by an etoricoxib‐positive lesional patch test in six cases and by a positive low‐dose oral challenge in the other one. Two patients showed negative patch tests with celecoxib (10% in pet.) on the residual lesions, and oral tolerance was confirmed in one. Conclusion To our knowledge, this is the largest series on FDE induced by etoricoxib reported to date.

Eritema pigmentado fixo ao etoricoxib

“…Anti -inflamatórios não esteroides (AINES), antibióticos e anticonvulsionantes são os medicamentos que mais induzem EPF. Reações de hipersensibilidade aos coxibes têm sido descritas ao celecoxibe, rofecoxibe e valdecoxibe, sendo pouco frequentes com o etoricoxib 3 .…”

“…A evicção do agente desencadeante é fundamental para a melhoria do quadro clínico. O EPF representa aproximadamente 25% de todas as dermatoses medicamentosas, pelo que o seu diagnóstico deverá ser considerado 1,2,3 . drug administration, but can occur up to two weeks after drug exposure.…”