eMedicine Specialties > Dermatology > Allergy & Immunology

Fixed Drug Eruptions: Treatment & Medication

Author: David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
Coauthor(s): Jordan R Ilse, MD, Staff Physician, Scott and White Internal Medicine Residency Program, Temple, Texas
Contributor Information and Disclosures

Updated: Aug 24, 2009

Treatment

Medical Care

The main goal of treatment is to identify the causative agent and avoid it. Treatment for fixed drug eruptions (FDEs) otherwise is symptomatic. Systemic antihistamines and topical corticosteroids may be all that are required. In cases in which infection is suspected, antibiotics and proper wound care are advised. Desensitization to medications has been reported in the literature, but this should be avoided unless no substitutes exist.35

Consultations

Consultation with a dermatologist is warranted if the diagnosis is in doubt. If patch testing is needed to determine which drug may be involved, a dermatologist with such experience may be required. If Stevens-Johnson syndrome or toxic epidermal necrolysis is suspected, hospitalization and possible referral to the intensive care unit or burn unit may be appropriate.

Diet

A regular diet is usually acceptable. However, food may be an exacerbating factor; reactivation has been reported with lentils and strawberries.8

Activity

Generally, no limits on activities are imposed. Multiple studies have sited male genital lesions occurring following intercourse with female partners taking trimethoprim-sulfamethoxazole.36 Therefore, patients may consider avoiding sexual activity while a partner is taking a medication that has resulted in a prior fixed drug eruption. If open lesions are present, general wound care precautions are recommended.

Medication

Lesions of fixed drug eruption resolve spontaneously with avoidance of the inciting drug. Additional medications should be used to relieve symptoms associated with the condition. Generally, an oral antihistamine (eg, hydroxyzine) and a topical corticosteroid may be sufficient. The use of corticosteroids may interfere with later diagnostic provocation testing. Hyperpigmentation may take many months to resolve. Incontinent pigment in the dermis responds poorly to topical bleaching agents such as hydroquinones.

More on Fixed Drug Eruptions

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Differential Diagnoses & Workup: Fixed Drug Eruptions
Treatment & Medication: Fixed Drug Eruptions
Follow-up: Fixed Drug Eruptions
Multimedia: Fixed Drug Eruptions
References
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References

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  34. 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. Jun 2002;46(6):352-3. [Medline].

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

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  37. 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. Aug 2004;51(2):57-62. [Medline].

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Further Reading

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Keywords

fixed drug eruption, fixed drug reaction, FDE, adverse drug reaction, adverse cutaneous drug reaction, drug-induced hypersensitivity, drug-induced pigmentation, postinflammatory hyperpigmentation, post-inflammatory hyperpigmentation

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Contributor Information and Disclosures

Author

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Jordan R Ilse, MD, Staff Physician, Scott and White Internal Medicine Residency Program, Temple, Texas
Jordan R Ilse, MD is a member of the following medical societies: American Medical Association and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, 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, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Medicis Honoraria Consulting; Celgene Honoraria Consulting

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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