Extensive Fixed Drug Eruption Due to Diclofenac

Abstract

A 46-year-old male construction worker was admitted to a clinic in Kolkata, India, in 2016 with a sudden-onset black rash appearing in patches all over his body. He had sprained his left foot two days previously for which he was prescribed oral diclofenac tablets at a dose of 50 mg three times a day. He had taken three doses of the drug before noticing the skin lesions; however, he continued taking the drug due to the pain and presented to the clinic on the third day when the lesions became extensive. He was not currently taking any other drugs and had no history of similar skin lesions.On examination, the patient was noted to have darkly pigmented patches on his trunk and both the upper and lower limbs [ Figure 1]. The patches covered more than 50% of his body surface and were nonpruritic and non-tender, with sharply demarcated margins and surrounding erythema. No evidence of mucosal lesions or hair or nail changes was seen. The patient was treated with local emollients and a steroid cream. A skin biopsy revealed interface dermatitis with vacuolar changes. The patient was diagnosed with a fixed drug eruption (FDE) caused by the diclofenac. After 10 days, the patches became scaly and started to desquamate [ Figure 2].