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Presentation
Case Findings: This 25 year old man says he has had this blister between his toes for about 1 week. He has had a similar problem in the same spot, two times previously. He says is always happens in the winter.
3304% Bullous tinea pedis
1176% Pemphigus
345% Fixed drug reaction
587% Contact dermatitis
Fixed drug eruption (FDE) is an adverse drug reaction manifested by non-migratory lesions. The lesions occur at the same body site each time the individual is re-exposed to the specific drug. Lesions are usually asymptomatic but infrequently cause burning or pruritus. Sometimes these lesions will form blisters (bullous FDE) that eventually rupture. Post-inflammatory hyperpigmentation is common. Lesions generally occur 30 minutes to 8 hours after drug ingestion and are self-limited. The treatment of FDE is symptomatic.
While over 100 drugs have been implicated in causing FDE, commonly associated drugs include trimethoprim-sulfamethoxazole (and other sulfonamides), naproxen, ibuprofen, tetracyclines, other antibiotics (ampicillin, metronidazole), barbiturates, oral contraceptives, quinine, and phenolphthalein.
Solitary or multiple sharply demarcated red or brown-red patches recurring in exactly the same location(s) each time the drug is taken. Fixed drug eruptions usually start as a red patch and frequently leave hyperpigmented patches between acute flares. Most frequent locations are the genitals, with the glans penis being a common location for a plaque, but lesions can occur anywhere.
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