D2.300 - Fixed Drug Eruption related to the use of NSAIDs

Fixed drug eruption is a drug-induced skin reaction, characterized by well-defined lesions that appear in the same location after re-exposure to the offending drug, which is usually an antibiotic or anti-inflammatory in most cases. The lesions may resolve upon discontinuation of the medication but may leave residual pigmentation. This study analyzes a series of clinical cases to identify common patterns and management strategies.

Clinical data were collected from five patients diagnosed with Fixed Drug Eruption due to NSAIDs over a one-year perio. History, medications involved, clinical characteristics, and results of diagnostic tests were reviewed. 

The patients were in an age range of 25 to 70 year, who presented different cutaneous manifestations, such residual hyperpigmentation. All patients were treated by discontinuing the responsible drug and using safe alternatives. (Table 1.)

Fixed drug eruption is an autoimmune phenomenon primarily caused by medications such as antibiotics and anti-inflammatories, in which its presentation in certain skin areas increases the expression of ICAM-1, thereby activating CD8 lymphocytes with autolytic potential. The presented clinical cases highlight that NSAIDs (especially pyrazolones) are common causes of Fixed Drug Eruption. Although patch test and provocation tests are useful, the diagnosis often depends on the clinical presentation (red or violaceous, edematous macules that evolve into plaques, vesicles, and blisters, eventually leaving residual hyperpigmentation). Early identification and avoidance of the implicated drugs are key to preventing recurrences. Alternative drugs are generally safe in most cases, given the low rate of cross-reactivity.