Transcript Erythema Multiforme Fixed Drug Eruption

Fixed Drug Eruption
• the development of one or more annular or
oval erythematous patches as a result of
systemic exposure to a drug.
• normally resolve with hyperpigmentation and
may recur at the same site with reexposure to
the drug.
Erythema Multiforme
Lesion
•Begin as sharply marginated,
erythematous macules, which
become raised, edematous
papules over 24 to 48 hours
•“target” or “iris” lesion with
3 zones – central dusky
purpura; an elevated,
edematous, pale ring; and
surrounding macular
erythema
Age of Predilection
Young adults
Site of Predilection
dorsal hands, dorsal feet,
extensor limbs, elbows and
knees, and palms and soles
Fixed Drug Eruption
•Begins as a red patch that
soon evolves to an iris or
target lesion identical to
erythema multiforme, and
may eventually blister and
erode
•Nonpigmenting fixed drug
eruption: large, tender, often
symmetrical eythematous
plaques
Oral and genital mucosa
Etiologic Factors
Treatment
Erythema Multiforme
Fixed Drug Eruption
Usually has non-drug causes,
most commonly herpes
simplex infection
Genetic susceptibility with an
increased incidence of HLAB22
•Prevention is cornerstone of
treatment if HSV can be
demonstrated as the trigger.
•Sunblock creams
•Antiherpetic antibiotic
•Stop taking the offending
drug.
Patient
Fixed Drug Eruption
Multiple erythematous to skin-colored plaques
and nodules (1.5x3.5 to 2.0x4.0 cm)
Begins as a red patch that soon evolves to an
iris or target lesion identical to erythema
multiforme, and may eventually blister and
erode
Forehead, malar area, left ear, trunk, and
extremities
Oral and genital mucosa
(+) Leonine facies
(+) HPN, DM