7.

FIXED DRUG ERUPTION (FDE)

Health Problems
Fixed Drug Eruption (FDE) is the most common type of drug eruptions. Based on its name
FDE can be concluded that lesions will occur many time at the same place. FDE have a
typical lesions and specific predilection area which different from the exanthematous Drug
Eruption. FDE is an allergic reaction type 2 (cytotoxic).
History (Subjective)
Complaint
Patients came with complaints about redness or sores on the mouth, lips, or genitals, which
felt hot. Complaints arise after consuming drugs which are often the cause of FDE such as
Sulphonamides, barbiturates, Trimethoprim, and analgesics.
History taking should be include a history of the use of drugs or herbs. Abnormalities arise
acutely or may be a few days after taking the drug. Another complaint is the itching that may
be accompanied by subfebrile fever.
Risk Factors
1. History of drug consumption (quantity, type, dose, route of administration, the effect of
exposure to sunlight, or medication on open wound)
2. Family and self-history of atopy
3. Allergy to other allergens
4. Previous history of drug allergy
Physical examination (Objective)
Pathognomonic Signs
Typical Lesions:
1. Vesicles, spotting
2. Erythema
3. Target lesions shaped oval or numular
4. Sometimes accompanied by erosion
5. Patches of hyperpigmentation with redness around the edges, especially on the recurrent
lesions
Sites of predilection:
1. Around the mouth
2. Lips region
3. Penis or vulva region

Source: http://www.nejm.org/doi/full/10.1056/NEJMicm1013871

Additional examination
Usually not required
Enforcement diagnostic (Assessment)
Clinical diagnosis
Diagnosis is based on history and examination
Differential Diagnosis
1. Bullous pemphigoid,
2. Cellulitis,
3. Herpes simplex,
4. SJS (Steven Johnson Syndrome)
Complication
Secondary infection
Comprehensive Management (Plan)
Management
The principle is to stop the drugs that caused FDE. Basically drug eruption can be cured when the
cause can be determined and removed immediately.
1. To address the complaints, pharmacotherapy can be given, namely:
- Systemic corticosteroids, such as prednisone tablets 30 mg / day divided into 3 feedings per day
- Systemic antihistamines to relieve itching; hydroxyzine tablets 10 mg / day 2 times a day for 7
days or loratadine tablets 1x10 mg / day for 7 days
2. Topical Treatment
- Provision of topical lesions depending on the circumstances, if there is erosion or madidans do
compress NaCl 0.9% or Potassium permanganate solution diluted 1:10.000 with 3 layers of gauze
for 10-15 minutes. Compress should be done 3 times a day until the lesions dry.
- Therapy continued by applying a mild-moderate potency topical corticosteroid, such as 2.5%
hydrocortisone cream or 0.1% mometasone furoate cream
Counseling & Education
1. The principle is elimination the drug that cause FDE
2. Patients and families were told to make a small note about drug allergy in his wallet
3. Patients can be cured but with hyperpigmentation on the lesion site. When recurrent allergies
occur, disorder and location of lesions will be the same.
Referral criteria
1. When it is necessary to prove the type of medicine that is suspected as the cause:
- Closed Patch test, if negative proceed with
- Prick test, if negative proceed with
- Test provocation.
2. If there is no improvement after standard treatment for 7 days and avoid drugs.
3. Lesion widespreads.
Facilities and Infrastructure
Prognosis
If the patient does not experience complication or do not meet the referral criteria:
Life (Vitam): Good

Function (Fungsionam): Good

Healing (Sanationam): Good (healed without complications)
Reference
1. Djuanda, A. Hamzah, M. Aisah, S. Buku Ajar Ilmu Penyakit Kulit dan Kelamin, 5 th Ed.
Balai Penerbit FKUI. Jakarta. 2007.
2. Perhimpunan Dokter Spesialis Kulit dan Kelamin. Pedoman Pelayanan Medik tahun
2011.
3. James, W.D. Berger, T.G. Elston, D.M. Andrews Diseases of the Skin: Clinical
Dermatology. 10th Ed. Saunders Elsevier. Canada. 2000.
Medical Records
No. ICPC II: A85 Adverse effect medical agent
No. ICD X: L27.0 Generalized skin eruption due to drugs and medicaments