Medscape is available in 5 Language Editions – Choose your Edition here.


Fixed Drug Eruptions Differential Diagnoses

  • Author: David F Butler, MD; Chief Editor: Dirk M Elston, MD  more...
Updated: Mar 22, 2016
Contributor Information and Disclosures

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: XOMA; Biogen/IDEC; Novartis; Janssen Biotech, Abbvie, CSL pharma<br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor and intermittent author; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.


Jordan R Ilse, MD Staff Physician, Scott and White Internal Medicine Residency Program, Scott and White Clinic, Texas A&M University College of Medicine

Jordan R Ilse, MD is a member of the following medical societies: American Medical Association and Texas Medical Association

Disclosure: Nothing to disclose.

  1. Mahboob A, Haroon TS. Drugs causing fixed eruptions: a study of 450 cases. Int J Dermatol. 1998 Nov. 37(11):833-8. [Medline].

  2. Ozkaya-Bayazit E. Specific site involvement in fixed drug eruption. J Am Acad Dermatol. 2003 Dec. 49(6):1003-7. [Medline].

  3. Ozkaya-Bayazit E, Bayazit H, Ozarmagan G. Drug related clinical pattern in fixed drug eruption. Eur J Dermatol. 2000 Jun. 10(4):288-91. [Medline].

  4. Fischer G. Vulvar fixed drug eruption. A report of 13 cases. J Reprod Med. 2007 Feb. 52(2):81-6. [Medline].

  5. Gupta S, Gupta S, Mittal A, David S. Oral fixed drug eruption caused by gabapentin. J Eur Acad Dermatol Venereol. 2009 Feb 19. [Medline].

  6. Katoulis AC, Bozi E, Kanelleas A, et al. Psoriasiform fixed drug eruption caused by nimesulide. Clin Exp Dermatol. 2009 Oct. 34(7):e360-1. [Medline].

  7. Srivastava R, Bihari M, Bhuvan J, Saad A. Fixed drug eruptions with intraoral presentation. Indian J Dent. 2015 Apr-Jun. 6 (2):103-6. [Medline].

  8. Fathallah N, Ben Salem C, Slim R, Boussofara L, Ghariani N, Bouraoui K. Acetaminophen-induced cellulitis-like fixed drug eruption. Indian J Dermatol. 2011 Mar. 56(2):206-8. [Medline]. [Full Text].

  9. Teraki Y, Shiohara T. IFN-gamma-producing effector CD8+ T cells and IL-10-producing regulatory CD4+ T cells in fixed drug eruption. J Allergy Clin Immunol. 2003 Sep. 112(3):609-15. [Medline].

  10. Mizukawa Y, Shiohara T. Fixed drug eruption: a prototypic disorder mediated by effector memory T cells. Curr Allergy Asthma Rep. 2009 Jan. 9(1):71-7. [Medline].

  11. Shiohara T. Fixed drug eruption: pathogenesis and diagnostic tests. Curr Opin Allergy Clin Immunol. 2009 Aug. 9(4):316-21. [Medline].

  12. Weedon D. The lichenoid reaction pattern ('interface dermatitis'). Skin Pathology. 2nd ed. London, England: Churchill Livingstone; 2002. 42-43.

  13. Smoller BR, Luster AD, Krane JF, et al. Fixed drug eruptions: evidence for a cytokine-mediated process. J Cutan Pathol. 1991 Feb. 18(1):13-9. [Medline].

  14. Hindsen M, Christensen OB, Gruic V, Lofberg H. Fixed drug eruption: an immunohistochemical investigation of the acute and healing phase. Br J Dermatol. 1987 Mar. 116(3):351-60. [Medline].

  15. Shiohara T, Nickoloff BJ, Sagawa Y, Gomi T, Nagashima M. Fixed drug eruption. Expression of epidermal keratinocyte intercellular adhesion molecule-1 (ICAM-1). Arch Dermatol. 1989 Oct. 125(10):1371-6. [Medline].

  16. Krahenbuhl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krahenbuhl S. Drug-related problems in hospitals: a review of the recent literature. Drug Saf. 2007. 30(5):379-407. [Medline].

  17. Lee AY. Fixed drug eruptions. Incidence, recognition, and avoidance. Am J Clin Dermatol. 2000 Sep-Oct. 1(5):277-85. [Medline].

  18. Pellicano R, Ciavarella G, Lomuto M, Di Giorgio G. Genetic susceptibility to fixed drug eruption: evidence for a link with HLA-B22. J Am Acad Dermatol. 1994 Jan. 30(1):52-4. [Medline].

  19. Pellicano R, Lomuto M, Ciavarella G, Di Giorgio G, Gasparini P. Fixed drug eruptions with feprazone are linked to HLA-B22. J Am Acad Dermatol. 1997 May. 36(5 Pt 1):782-4. [Medline].

  20. Bolognia JL, Jorizzo JL, Rapini RP. Fixed drug eruptions. Dermatology. London, England: Mosby; 2003. 344-5.

  21. Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI. Fixed drug eruptions. Fitzpatrick’s Dermatology in General Medicine. 6th ed. New York, NY: McGraw-Hill; 2003. 1333.

  22. Sehgal VN, Srivastava G. Fixed drug eruption (FDE): changing scenario of incriminating drugs. Int J Dermatol. 2006 Aug. 45(8):897-908. [Medline].

  23. Zawar V, Chuh A. Fixed drug reaction may be sexually induced. Int J Dermatol. 2006 Aug. 45(8):1003-4; author reply 1004. [Medline].

  24. Berger RE. Fixed drug eruption--a sexually inducible reaction?. J Urol. 2005 Jun. 173(6):1990. [Medline].

  25. Zawar V, Kirloskar M, Chuh A. Fixed drug eruption - a sexually inducible reaction?. Int J STD AIDS. 2004 Aug. 15(8):560-3. [Medline].

  26. Vidal C, Prieto A, Pérez-Carral C, Armisén M. Nonpigmenting fixed drug eruption due to pseudoephedrine. Ann Allergy Asthma Immunol. 1998 Apr. 80 (4):309-10. [Medline].

  27. Montoro J, Díaz M, Genís C, Lozano A, Bertomeu F. Non-pigmenting cutaneous-mucosal fixed drug eruption due to piroxicam. Allergol Immunopathol (Madr). 2003 Jan-Feb. 31 (1):53-5. [Medline].

  28. Rasi A, Khatami A. Unilateral non-pigmenting fixed drug eruption associated with cotrimoxazole. Dermatol Online J. 2006 Oct 31. 12 (6):12. [Medline].

  29. Tanabe K, Amoh Y, Mii S, Eto H, Iwamura M, Katsuoka K. Non-pigmenting fixed drug eruption induced by sorafenib. Acta Derm Venereol. 2010 May. 90 (3):307. [Medline].

  30. Das S, Das S, Chowdhury J, Bhanja DC. Non pigmenting mucosal fixed drug eruption due to tadalafil: A report of two cases. Indian Dermatol Online J. 2014 Apr. 5 (2):167-9. [Medline].

  31. Sánchez-Morillas L, Rojas Pérez-Ezquerra P, González Morales ML, Mayorga C, González-Mendiola R, Laguna Martínez JJ. Fixed drug eruption due to norfloxacin and cross-reactivity with other quinolones. Allergol Immunopathol (Madr). 2012 Jan 20. [Medline].

  32. Pérez-Calderón R, Gonzalo-Garijo MA, Pérez-Rangel I, Sánchez-Vega S, Zambonino MA. Fixed drug eruption due to nabumetone in a patient with previous fixed drug eruptions due to naproxen. J Investig Allergol Clin Immunol. 2011. 21(2):153-4. [Medline].

  33. Leleu C, Boulitrop C, Bel B, Jeudy G, Vabres P, Collet E. Quinoline Yellow dye-induced fixed food-and-drug eruption. Contact Dermatitis. 2013 Mar. 68(3):187-8. [Medline].

  34. Lim WS, Kim DH, Jin SY, Choi YS, Lee SH, Huh HJ, et al. A case of fixed drug eruption due to doxycycline and erythromycin present in food. Allergy Asthma Immunol Res. 2013 Sep. 5(5):337-9. [Medline]. [Full Text].

  35. Ohira A, Yamaguchi S, Miyagi T, et al. Fixed eruption due to quinine in tonic water: a case report with high-performance liquid chromatography and ultraviolet A analyses. J Dermatol. 2013 Aug. 40(8):629-31. [Medline].

  36. Allchurch LG, Crilly H. Fixed drug eruption to propofol. Anaesth Intensive Care. 2014 Nov. 42 (6):777-81. [Medline].

  37. Centers for Disease Control and Prevention. Fixed drug eruption associated with sulfonamides sold in Latino grocery stores - Greater Washington, DC, area, 2012-2013. MMWR Morb Mortal Wkly Rep. 2013 Nov 22. 62(46):914-6. [Medline].

  38. Lopez Abad R, Iriarte Sotes P, Castro Murga M, Gracia Bara MT, Sesma Sanchez P. Fixed drug eruption induced by phenylephrine: a case of polysensitivity. J Investig Allergol Clin Immunol. 2009. 19(4):322-3. [Medline].

  39. Ghosh SK, Bandyopadhyay D. Clopidogrel-induced fixed drug eruption. J Eur Acad Dermatol Venereol. 2009 Jan 20. [Medline].

  40. Oyama N, Kaneko F. Solitary fixed drug eruption caused by finasteride. J Am Acad Dermatol. 2009 Jan. 60(1):168-9. [Medline].

  41. Knapp CF 3rd, Cooke ER, Sheehan DJ. Bullous fixed drug eruption caused by flecainide. J Am Acad Dermatol. 2009 Feb. 60(2):e3. [Medline].

  42. Ozkaya E, Mirzoyeva L, Jhaish MS. Ceftriaxone-induced fixed drug eruption: first report. Am J Clin Dermatol. 2008. 9(5):345-7. [Medline].

  43. Fukushima S, Kidou M, Ihn H. Fixed food eruption caused by cashew nut. Allergol Int. 2008 Sep. 57(3):285-7. [Medline].

  44. Takahama H. A fixed drug eruption that developed cross-sensitivity among amide local anaesthetics, including mepivacaine hydrochloride, lidocaine hydrochloride and propitocaine hydrochloride. J Eur Acad Dermatol Venereol. 2008 Nov. 22(11):1400-1. [Medline].

  45. Bohm I, Medina J, Prieto P, Block W, Schild HH. Fixed drug eruption induced by an iodinated non-ionic X-ray contrast medium: a practical approach to identify the causative agent and to prevent its recurrence. Eur Radiol. 2007 Feb. 17(2):485-9. [Medline].

  46. Benomar S, Ismaili N, Koufane J, Senouci K, Hassam B. [Fixed food eruption caused by liquorice.]. Ann Dermatol Venereol. 2010 Feb. 137(2):121-123. [Medline].

  47. Lammintausta K, Kortekangas-Savolainen O. Oral challenge in patients with suspected cutaneous adverse drug reactions: findings in 784 patients during a 25-year-period. Acta Derm Venereol. 2005. 85(6):491-6. [Medline].

  48. Lammintausta K, Kortekangas-Savolainen O. The usefulness of skin tests to prove drug hypersensitivity. Br J Dermatol. 2005 May. 152(5):968-74. [Medline].

  49. Zedlitz S, Linzbach L, Kaufmann R, Boehncke WH. Reproducible identification of the causative drug of a fixed drug eruption by oral provocation and lesional patch testing. Contact Dermatitis. 2002 Jun. 46(6):352-3. [Medline].

  50. Andrade P, Brinca A, Gonçalo M. Patch testing in fixed drug eruptions--a 20-year review. Contact Dermatitis. 2011 Oct. 65(4):195-201. [Medline].

  51. Kelso JM, Keating RM. Successful desensitization for treatment of a fixed drug eruption to allopurinol. J Allergy Clin Immunol. 1996 May. 97(5):1171-2. [Medline].

  52. Zawar V, Kirloskar M, Chuh A. Fixed drug eruption - a sexually inducible reaction?. Int J STD AIDS. 2004 Aug. 15(8):560-3. [Medline].

  53. Tornero P, De Barrio M, Baeza ML, Herrero T. Cross-reactivity among p-amino group compounds in sulfonamide fixed drug eruption: diagnostic value of patch testing. Contact Dermatitis. 2004 Aug. 51(2):57-62. [Medline].

  54. Gonzalo-Garijo MA, de Argila D, Rodriguez-Nevado I. Generalized reaction after patch testing with metamizol. Contact Dermatitis. 2001 Sep. 45(3):180. [Medline].

  55. Baird BJ, De Villez RL. Widespread bullous fixed drug eruption mimicking toxic epidermal necrolysis. Int J Dermatol. 1988 Apr. 27(3):170-4. [Medline].

  56. Hiware S, Shrivastava M, Mishra D, Mukhi J, Puppalwar G. Evaluation of Cutaneous Drug Reactions in Patients Visiting Out Patient Departments of Indira Gandhi Government Medical College and Hospital (IGGMC and H), Nagpur. Indian J Dermatol. 2013 Jan. 58(1):18-21. [Medline]. [Full Text].

  57. Lipowicz S, Sekula P, Ingen-Housz-Oro S, et al. Prognosis of generalized bullous fixed drug eruption: comparison with Stevens-Johnson syndrome and toxic epidermal necrolysis. Br J Dermatol. 2013 Apr. 168(4):726-32. [Medline].

  58. Ognongo-Ibiaho AN, Atanda HL. Epidemiological study of fixed drug eruption in Pointe-Noire. Int J Dermatol. 2012 Nov. 51 Suppl 1:30-1, 33-5. [Medline].

  59. Özkaya E. Oral mucosal fixed drug eruption: characteristics and differential diagnosis. J Am Acad Dermatol. 2013 Aug. 69(2):e51-8. [Medline].

Targetoid fixed drug eruption on the abdomen of a child.
Hyperpigmented fixed drug eruption on the hip of an adult.
Vesicular fixed drug eruption on the glans penis.
Multiple hyperpigmented fixed drug eruptions on the trunk.
Hyperpigmented fixed drug eruption on the right side of the upper lip.
Acute interface dermatitis with prominent vacuolar change and individual necrotic keratinocytes within the epidermis (X10).
Interface dermatitis, vacuolar change, necrotic keratinocytes, and incontinent pigment in the dermis (X40).
Table. Substances Implicated in Fixed Drug Eruptions
AcetaminophenAcyclovirAllopurinolAllylisopropyl-acetylureaAmide local anesthetics
AtenololBarbituratesBotulinum toxinCarbamazepineCashew nut
CeftriaxoneCelecoxibCetirizineChloral hydrateChlordiazepoxide
ChlorhexidineChlormezanoneChlorphenesin carbonateCiticolineClarithromycin
Cyproterone acetateDextromethorphanDimenhydrinateDiphenhydramineDipyrone
DocetaxelEperisone hydrochlorideErythromycinEthenzamideFeprazone
Iodinated radiography contrast mediaIomeprolKakkonKetoconazoleLactose


LormetazepamMagnesium trisilicateMefenamic acidMelatoninMethaqualone
NaproxenNimesulideOmeprazoleOndansetronOpium alkaloids
OxyphenbutazonePaclitaxelPamabromPapaverinePara-aminosalicylic acid
PhenylpropanolaminePhenytoinPipemidic acidPiroxicamProcarbazine
Sodium benzoateStrawberriesSulfamethoxazoleTartrazineTerbinafine
Tolfenamic acidTosufloxacinTranexamic acidTrimethoprimTropisetron
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.