Fixed Drug Eruption Presenting as Erythema dyschromicum perstans: A Flare without Taking Any Medications

Abstract

Fixed drug eruption (FDE) can present as multiple pigmented macules that flare at fixed sites even when the patient has taken no medications. Although this presentation is not characteristic of FDE, it must be borne in mind in order to make a correct diagnosis. We describe such a patient whose condition was initially diagnosed as erythema dyschromicum perstans (EDP). Immunohistochemically intraepidermal T cells were distributed between basal and suprabasal keratinocytes in the lesional skin, a finding suggestive of FDE. A flare occurred not only with exposure to theophylline but also without exposure. A flare has never recurred and pigmented macules faded gradually after avoiding theophylline. On the basis of these findings, we recommend that patients with an EDP-like presentation be examined completely for causes such as drugs before labeling the cutaneous lesions.

Fixed drug eruption (FDE): changing scenario of incriminating drugs

“…[7][8][9][10][11] The advent and use of new drug(s) in the therapy of the disease has brought into focus new drugs and new chemical agents that cause FDE, [12][13][14] and the many unusual presentations of the entity. [15][16][17] The purpose of this article is to review the available information regarding FDE.…”

Annular fixed drug eruption

“…This unique clinical feature prompted us to review the literature concerning the rare forms of FDE. Atypical FDE varies considerably, from poorly‐defined margins, erythema multiforme‐like, toxic epidermal necrolysis‐like, non‐pigmented, giant, urticarial, papular, purpuric, linear, and reticular to butterfly‐like lesions [2–6]. Occasionally it may mimic lichen planus, paronychia, cheilitis, herpes simplex and psoriasis [7, 8].…”

“…pigmentierte, gigantische, urtikarielle, papulöse, juckende, lineare und retikuläre Läsionen beschrieben [2][3][4][5][6]. Gelegentlich kann die fixe Arzneireaktion einen Lichen planus, Paronychien, Cheilitiden, einen Herpes simplex und eine Psoriasis imitieren [7,8].…”

Fixed exanthema emerged following narrowband ultraviolet B irradiation

“…1,2 It is mostly induced by repeated administration of causative drugs or chemicals. [1][2][3] We report a case of FE that emerged after repeated narrowband ultraviolet B (NBUVB) irradiation against vitiligo.…”

“…Fixed exanthema should be differentiated from the other pigmented macules, such as lichen planus pigmentosus (LPP) and erythema dyschromicum perstans (EDP). [3][4][5] Histopathological features of these conditions are characterized by lichenoid reaction of lymphocytes at the dermoepidermal junction resulting in pigment incontinence. LPP shows pruritic pigmented papules or plaques without erythematous border, and frequently involves mucosae.…”