Fixed drug eruption probably induced by azithromycin

Abstract

Plant products for practising procedural dermatologyProcedures form an inextricable part of the dermatologist's practice. When first undertaking a new procedure, novices are often daunted by the steep learning curve in the first few months, an experience we (the authors) empathise with. The use of fruit and vegetables may lessen some of the stress and enhance a sense of fulfilment in the nascent proceduralist. Bananas, the most popular fruit in the Western world, provide a readily available curved surface with intrinsic layers on which newly appointed registrars can practise suturing. Mohs fellows can practise removing surgical 'debulks' and taking bevelled, uniformly thin Mohs layers, 1 an initially alien concept to the recently graduated dermatology registrar that will become increasingly familiar during their training. For the new laser practitioner, aubergines provide a ready source of water-rich material that provides an ideal medium on which to practise ablative laser surgery, including with devices such as the carbon dioxide laser. The purple skin of the aubergine provides a clearly visible surface that can be ablated and give an indication of the depth of penetration and the extent of fractionation. Furthermore, aubergines do not tend to explode on being vaporisedan important, pragmatic advantage of this vegetable. Plant-procured products can provide a cheap, accessible, less pungent alternative to porcine skin and synthetic models and can hugely improve the experience of procedural dermatologists. We suggest those learning new procedures (and their trainers) consider these tools to augment their learning.

Viral exanthem with “Spins and needles sensation” on extremities of a COVID-19 patient: A self-reported case from an Indonesian medical frontliner

“…Azithromycin was known to cause fixed drug eruption and erythema multiforme. However, target lesions that were pathognomonic for erythema multiforme were not present, and despite continued use of azithromycin from day two to day eleven of symptoms, the skin lesions improved and resolved from day seven of symptoms, proving the skin eruptions to be caused by viral exanthema (Shah et al, 2014;An et al, 2017). Aside from due to drug eruption, viral exanthem distributed in the extremities area was at first thought to be the manifestation of hand, foot, and mouth disease (HFMD).…”

Diagnosis and management of the drug hypersensitivity reactions in Coronavirus disease 19: An EAACI Position Paper

“…Azithromycin has been implicated in contact dermatitis in occupational 75 and nonoccupational settings 76 . Cases of fixed drug eruption (FDE), 77 AGEP, 78 and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), 79 SJS, 80,81 leukocytoclastic vasculitis, 82 and hypersensitivity myocarditis 83 were reported(Table 2).…”

Treating COVID-19: Review of Drug Hypersensitivity Reactions

“…However, some cases of both immediate hypersensitivity (including urticaria, angioedema and anaphylaxis), and delayed hypersensitivity (fixed drug eruptions [FDE] and severe cutaneous adverse reactions [SCAR]) have been described with macrolides. [20][21][22]. SCAR reactions with azithromycin include drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) [23], AGEP [24], Stevens-Johnson syndrome (SJS) [25,26] and vasculitis [27].…”