Fixed drug eruption: state of the art

Fixed drug eruption (FIDE) is a common type of cutaneous adverse drug reaction. There may be a genetic background as significant associations have been identified between HLA types and specific FDE. Systemic provocation is still the gold standard for establishing the offending agent in FIDE, but topical provocation testing offers a promising alternative approach. A standardized method does not exist, and the approach must likely be varied for different agents. The mystery of site preference in FIDE is still unresolved. Possible explanations include properties of the drug, trauma and viscerocutaneous reflex patterns

Allergic contact cheilitis from a lipstick misdiagnosed as herpes labialis: Subsequent worsening due to Zovirax contact allergy

A 29-year-old Turkish woman with allergic contact cheilitis from a lipstick was misdiagnosed as herpes labialis and subsequently worsened with the application of Zovirax (R) cream. Patch tests were positive to Zovirax (R) cream, propylene glycol, the patient's favourite lipstick and propyl gallate. No reaction was seen with Zovirax (R) ophthalmic ointment and Zovirax (R) tablet. The propylene glycol component of the Zovirax (R) cream and the propyl gallate component of the lipstick were regarded as the responsible contact sensitizers. The differential diagnosis was challenging due to concomitant contact sensitization with these agents

Ceftriaxone-induced fixed drug eruption - First report

Fixed drug eruption (FDE) is an unusual type of cutaneous adverse drug reaction that is characterized by recurrent site-specific lesions each time the drug responsible is taken. FDE from cephalosporins has been rarely reported, and to the best of our knowledge there is no published report of ceftriaxone-induced FDE in the literature. We report the first case of a 54-year-old Turkish woman who presented with ceftriaxone-induced FDE. Topical provocation with ceftriaxone sodium salt (1% in water [aq.], 5% aq., 10% in petrolatum [pet.], 20% pet.) remained negative both at previously affected sites and in the unaffected skin of the back. Therapeutic re-exposure with intravenous ceftriaxone I g confirmed the diagnosis. The patient tolerated amoxicillin and cefazolin, suggesting that the sensitizing portion was not the P-lactam ring. Identification of the antigenic determinants of FDE-inducing drugs will make predicting safe alternatives in patients with FDE an easier task