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Immunologically mediated skin disorders
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Fixed drug eruption: characterized by the repeated onset of a single (occasionally multiple) erythematous plaque at the same site. The skin lesion can be bullous or erosive and heals with hyperpigmentation. Numerous drugs – including dapsone, the sulfonamides, tetracycline, and mefenamic acid – may be responsible.
Drug Allergy
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Fixed drug eruptions are called that because they recur in the same location on reintroduction of the causative drug. Typical fixed drug eruptions present as round or oval, sharply demarcated, red to livid, slightly elevated plaques, ranging from a few millimeters to several centimeters in diameter. They frequently involve the lips, hands and genitalia. A number of medications are associated with fixed drug eruptions including tetracycline, NSAIDs and carbamazepine (Ben Fadhel et al. 2019).
Adverse drug reactions on the skin
Published in Robert A. Norman, Geriatric Dermatology, 2020
The reason for the specific localization of the skin lesions in a fixed drug eruption is unknown. The offending drug cannot be detected at the skin site. Certain drugs cause a fixed eruption at specific sites, for example tetracycline and ampicillin often elicit a fixed eruption on the penis, whereas aspirin usually causes skin lesions on the face, limbs and trunk.
Protocols for drug allergy desensitization in children
Published in Expert Review of Clinical Immunology, 2020
Lucia Diaferio, Mattia Giovannini, Evangéline Clark, Riccardo Castagnoli, Davide Caimmi
DDS is contraindicated in patients reporting a history of type II and type III reaction, because the interaction between the antigen and the antibody may possibly lead to the activation and consumption of the complement system [21]. On the other hand, DDS has been proposed for type IV delayed reactions, in patients without a history of severe symptoms, such as drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens–Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). There is only little literature data concerning the mechanism of desensitization in cell-mediated reactions [15]. The process seems to be mediated by the recruitment and activation of T regulatory (Treg) cells. Teraki et al. [22] showed that, in patients with a history of fixed drug eruption (FDE) caused by allopurinol, the number of intralesional skin Treg cells increased significantly after desensitization, whereas the number of CD8+ T cells decreased, suggesting a suppressive effect on the effector function of CD8+ T cells by desensitization-induced Treg cells. Similar findings have been reported for FDE caused by phenytoin [23,24].
Fixed drug eruption due To 2,3-dimercapto-1-propanesulfonic acid (DMPS) treatment for mercury poisoning: a rare adverse effect
Published in Acta Clinica Belgica, 2019
Fatma Erden, Erol Rauf Agis, Meside Gunduzoz, Omer Hinc Yilmaz
Drug eruptions are substantially common dermatological problems and can be seen in about 2.2% of inpatients [1]. Drug reactions are often maculopapular or morbilliform, but there are different types. Rather than a laboratory study, images of lesions, drug use history, clinical status of the patient, and histopathological findings in some cases help diagnosis. One of these situations is fixed drug eruptions. Fixed drug eruptions (FDE) are characterized by recurrent, usually solitary erythematous or dark red macular, plaque or bullous lesions, all at the same site [2,3]. There are many drugs that can trigger this clinical picture. Drugs often accused include sulfonamides, dapsone, barbiturates, nonsteroidal anti-inflammatory drugs, tetracycline, and carbamazepine [4]. Among the first choices for antidotal treatment in mercury exposure, DMPS (Dimaval®) is generally a drug with a low incidence of side effects. Fixed drug eruption due to DMPS was not detected in our literature review and so we aimed to present this rare case [5].
Managing the ADR of Stevens-Johnson syndrome/toxic epidermal necrolysis
Published in Expert Opinion on Drug Safety, 2022
Bertrand Sheng-Yang Lian, Haur Yueh Lee
Likewise, there have been several reports of SJS/TEN following vaccinations. It is likely that several of such reports are (generalized) bullous fixed drug eruptions based on the clinical morphology of well-defined purpuric plaques/erosions with normal intervening skin and short latency [84]. Published cases are summarized in Table 3 [85,86]. Nonetheless, the widespread and rapid adoption of vaccination globally and inadequate information of concurrent exposure to other drugs in existing reports makes the causal association difficult. Future registries and pharmacovigilance databases are required to clarify this. Nonetheless, based on the existing doses administered, COVID vaccines are unlikely of high notoriety.