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 Table of Contents  
CASE BASED LEARNING
Year : 2016  |  Volume : 2  |  Issue : 2  |  Page : 124-127

Fixed drug eruption secondary to doxycycline


1 Department of Skin and VD, B J Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
2 Department of Ophthalmology, D.Y. Patil Medical College, Pune, Maharashtra, India

Date of Web Publication20-Dec-2016

Correspondence Address:
Bhavana Ravindra Doshi
Department of Skin and VD, B J Government Medical College and Sassoon General Hospital, Pune - 411 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2455-3972.196229

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How to cite this article:
Doshi BR, Chougule N S, Belgaumkar V A, Chavan R B. Fixed drug eruption secondary to doxycycline. Indian J Drugs Dermatol 2016;2:124-7

How to cite this URL:
Doshi BR, Chougule N S, Belgaumkar V A, Chavan R B. Fixed drug eruption secondary to doxycycline. Indian J Drugs Dermatol [serial online] 2016 [cited 2020 Aug 7];2:124-7. Available from: http://www.ijdd.in/text.asp?2016/2/2/124/196229

A 25-year-old female came with complaints of a few fluid-filled lesions located over her wrist, back and fingers associated with burning and itching since one day. She stated that these lesions had appeared within a few hours of taking a single dose of oral doxycycline which was prescribed to her by an ophthalmologist for recurrent chalazion along with topical steroids for a few days. On deep probing, she recollected to have had a previous episode of a similar reaction at the same site after taking the same drug 3 years back which healed with residual pigmentation. Her medical history was insignificant. The patient denied taking any concomitant drug or any other new drug in the preceding days.

Cutaneous examination revealed a well-defined oval, erythematous, bright red patch measuring about 2-2.5 cm with central vesicle and erythematous halo over the left wrist and the left little finger and lesion with central violaceous hue and halo of pallor with peripheral erythema over the back [Figure 1]. Complete blood count and biochemical investigations were normal. A biopsy from the lesion showed a few necrotic keratinocytes with hydropic degeneration and superficial dermal infiltrate of admixture of lymphocytes with few eosinophils and neutrophils along with melanin incontinence in the upper dermis [Figure 2]. Thus, based on history and examination, a diagnosis of fixed drug eruption (FDE) to doxycycline was made. The patient was told to stop the offending agent and was started on oral antihistamine and topical steroid with complete recovery of symptoms in five days. Doxycycline was thought to be the causative agent for FDE in this patient based on history and clinical criteria. However, the patient did not consent for a provocative test or a patch test. Naranjo algorithm for causality assessment revealed a score of 9.
Figure 1: Violaceous patches with halo of erythema over the finger and back

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Figure 2: Biopsy from the lesion showing occasional keratinocyte necrosis with hydropic degeneration of basal layer, pigment incontinence and a mixed lymphohistiocytic, neutrophils, and eosinophils infiltrate on H and E ×100

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  Questions Top


  • Why the diagnosis of FDE was made in this case?
  • Which are the other causative agents implicated in causing FDE?
  • If this patient requires antibiotic or pain relievers what drug substitution should be done in this case?
  • What are the mechanism and different types of FDE?
  • How can FDE can be prevented in future?
  • Are there any reliable diagnostic tests for confirming the diagnosis and identifying causative agent of FDE?




Click here to view answer. View Answer
Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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2.
Litt JZ. Litt′s Drug Eruption Reference Manual. 11 th ed. London: Taylor and Francis; 2005.  Back to cited text no. 2
    
3.
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Aouam K, Fadhel NB, Fredj NB, Chaabane A, Belhadjali H, Boughattas NA, et al. Non steroidal anti-inflammatory drugs-induced fixed drug eruptions: A case series. Clin Transl Allergy 2014;4:82.  Back to cited text no. 4
    
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8.
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14.
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239-45.  Back to cited text no. 14
    
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21.
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[PUBMED]  Medknow Journal  
22.
Kim MY, Jo EJ, Chang YS, Cho SH, Min KU, Kim SH. A case of levocetirizine-induced fixed drug eruption and cross-reaction with piperazine derivatives. Asia Pac Allergy 2013;3:281-4.  Back to cited text no. 22
    
23.
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