Generalized bullous fixed drug eruption

Medical condition

Generalized bullous fixed drug eruption

Other names| Bullous drug eruption,[1] multilocular bullous fixed drug eruption[2]: 554
Drug eruption: Bullous dermatitis medicamentosa caused by sulfathiazole.
Specialty| Dermatology

Generalized bullous fixed drug eruption (GBFDE) most commonly refers to a drug reaction in the erythema multiforme group.[3]: 129 These are uncommon reactions to medications, with an incidence of 0.4 to 1.2 per million person-years for toxic epidermal necrolysis and 1.2 to 6.0 per million person-years for Stevens–Johnson syndrome.[3]: 129 The primary skin lesions are large erythemas (faintly discernible even after confluence), most often irregularly distributed and of a characteristic purplish-livid color, at times with flaccid blisters.[2]: 554

## Signs and symptoms

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A rare and severe variation of fixed drug eruption, generalized bullous fixed drug eruption involves blisters and erosions involving at least 10% of the body's surface area, affecting three of the six anatomic sites: the head and neck, the anterior and posterior trunk, the upper and lower extremities, and the genitalia.[4]

## Causes

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Fixed drug eruptions are linked to anti-infective (ß-lactam antibiotics, tinidazole, and acyclovir), analgesics (acetaminophen (paracetamol), mefenamic acid, and metamizole), non-steroidal anti-inflammatory drugs (NSAIDs), anti-epileptic (carbamazepine), psychoactive (barbiturates, codeine, and others), and other miscellaneous medications (omeprazole, contrast media, loratadine, and allopurinol).[4]

## Diagnosis

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In cases where the clinical presentation is unclear, a skin biopsy may be necessary to confirm the diagnosis of GBFDE. A subepidermal blister or denuded epidermis, vacuolar alterations at the dermo-epidermal junction, and a variable number of necrotic keratinocytes within the lesional intact epidermis are characteristic histopathologic findings of GBFDE.[5]

## Treatment

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Antihistamines and topical steroids are used in symptomatic therapy. Antibiotics should be given if an infection is thought to be present.[6] It is also important to counsel the patient to stay away from the offending medication.[7]

## See also

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* Skin lesion
* List of cutaneous conditions

## References

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1. ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. p. 470\. ISBN 978-1-4160-2999-1.
2. ^ a b Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
3. ^ a b James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
4. ^ a b Paulmann, Maren; Reinkemeier, Felix; Lehnhardt, Marcus; Mockenhaupt, Maja (August 14, 2023). "Case report: Generalized bullous fixed drug eruption mimicking epidermal necrolysis". Frontiers in Medicine. 10. Frontiers Media SA. doi:10.3389/fmed.2023.1125754. ISSN 2296-858X. PMC 10461315. PMID 37644986.
5. ^ Anderson, Hannah J.; Lee, Jason B. (September 1, 2021). "A Review of Fixed Drug Eruption with a Special Focus on Generalized Bullous Fixed Drug Eruption". Medicina. 57 (9). MDPI AG: 925. doi:10.3390/medicina57090925. ISSN 1648-9144. PMC 8468217. PMID 34577848.
6. ^ Girisha, BanavasiShanmukha; Noronha, TonitaMariola; Alva, AkshataCharan; Menon, Ashok (2018). "Generalized bullous fixed drug eruption mimicking toxic epidermal necrolysis caused by paracetamol". Clinical Dermatology Review. 2 (1). Medknow: 34. doi:10.4103/cdr.cdr_25_17. ISSN 2542-551X.
7. ^ Das, Anupam; Podder, Indrashis; Chandra, Somodyuti; Gharami, RameshChandra (2016). "Doxycycline induced generalized bullous fixed drug eruption". Indian Journal of Dermatology. 61 (1). Medknow: 128. doi:10.4103/0019-5154.174197. ISSN 0019-5154. PMC 4763688. PMID 26955169.

## Further reading

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* Cho, Yung-Tsu; Lin, Jheng-Wei; Chen, Yi-Chun; Chang, Chia-Ying; Hsiao, Cheng-Hsiang; Chung, Wen-Hung; Chu, Chia-Yu (2014). "Generalized bullous fixed drug eruption is distinct from Stevens-Johnson syndrome/toxic epidermal necrolysis by immunohistopathological features". Journal of the American Academy of Dermatology. 70 (3). Elsevier BV: 539–548\. doi:10.1016/j.jaad.2013.11.015. ISSN 0190-9622. PMID 24388722.539-548&rft.date=2014&rft.issn=0190-9622&rft_id=info:pmid/24388722&rft_id=info:doi/10.1016/j.jaad.2013.11.015&rft.aulast=Cho&rft.aufirst=Yung-Tsu&rft.au=Lin,+Jheng-Wei&rft.au=Chen,+Yi-Chun&rft.au=Chang,+Chia-Ying&rft.au=Hsiao,+Cheng-Hsiang&rft.au=Chung,+Wen-Hung&rft.au=Chu,+Chia-Yu&rfr_id=info:sid/en.wikipedia.org:Generalized+bullous+fixed+drug+eruption" class="Z3988">
* Byrd, Rachel Chikowski; Mournighan, Kimberly J.; Baca-Atlas, Michael; Helton, Margaret R.; Sun, Natalie Z.; Siegel, Marni B. (2018). "Generalized bullous fixed-drug eruption secondary to the influenza vaccine". JAAD Case Reports. 4 (9). Elsevier BV: 953–955\. doi:10.1016/j.jdcr.2018.07.013. ISSN 2352-5126. PMC 6197945. PMID 30364778.953-955&rft.date=2018&rft_id=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197945#id-name=PMC&rft.issn=2352-5126&rft_id=info:pmid/30364778&rft_id=info:doi/10.1016/j.jdcr.2018.07.013&rft.aulast=Byrd&rft.aufirst=Rachel+Chikowski&rft.au=Mournighan,+Kimberly+J.&rft.au=Baca-Atlas,+Michael&rft.au=Helton,+Margaret+R.&rft.au=Sun,+Natalie+Z.&rft.au=Siegel,+Marni+B.&rft_id=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197945&rfr_id=info:sid/en.wikipedia.org:Generalized+bullous+fixed+drug+eruption" class="Z3988">

## External links

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* DermNet
* VisualDx

Classification|

* ICD-11: EH66
* ICD-10: L27.0

|

External resources|

* eMedicine: article/1062790
* Scholia: Q4997013

* v
* t
* e

Adverse drug reactions

Antibiotics|

* Penicillin drug reaction
* Sulfonamide hypersensitivity syndrome
* Urticarial erythema multiforme
* Adverse effects of fluoroquinolones
* Red man syndrome
* Jarisch–Herxheimer reaction

Hormones|

* Steroid acne
* Steroid folliculitis

Chemotherapy|

* Chemotherapy-induced acral erythema
* Chemotherapy-induced hyperpigmentation
* Scleroderma-like reaction to taxanes
* Hydroxyurea dermopathy
* Exudative hyponychial dermatitis

Anticoagulants|

* Anticoagulant-induced skin necrosis
* Warfarin necrosis
* Vitamin K reaction
* Texier's disease

Immunologics|

* Adverse reaction to biologic agents
* Leukotriene receptor antagonist-associated Churg–Strauss syndrome
* Methotrexate-induced papular eruption
* Adverse reaction to cytokines

Other drugs|

* Anticonvulsant hypersensitivity syndrome
* Allopurinol hypersensitivity syndrome
* Vaccine adverse event
* Eczema vaccinatum
* Bromoderma
* Halogenoderma
* Iododerma

General|

| Skin and body membranes|

* Acute generalized exanthematous pustulosis
* Generalized bullous fixed drug eruption
* Drug-induced acne
* Drug-induced angioedema
* Drug-related gingival hyperplasia
* Drug-induced lichenoid reaction
* Drug-induced lupus erythematosus
* Drug-induced nail changes
* Drug-induced pigmentation
* Drug-induced urticaria
* Stevens–Johnson syndrome
* Injection site reaction
* Linear IgA bullous dermatosis
* Toxic epidermal necrolysis
* HIV disease-related drug reaction
* Photosensitive drug reaction

|

Other|

* Fixed drug reaction
* Serum sickness-like reaction

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