D1.19 - Etoricoxib-Induced Fixed Drug Eruption: A Case Series and Assessment of Tolerance to Alternative NSAIDs

Reports of Etoricoxib-induced fixed drug eruption (FDE) are uncommon. However, it is increasingly seen in clinical practice. Data regarding tolerance to alternative non-steroidal anti-inflammatory drugs (NSAIDs) in affected patients are limited. Since NSAIDs are frequent inducers of FDE, assessing such tolerance through oral provocation (OP) testing is essential to identify and offer safe therapeutic alternatives.

We conducted a retrospective case series at a tertiary-care hospital in Cali, Colombia, including patients diagnosed with etoricoxib-induced FDE between July 2024 and January 2026. Demographic and clinical variables were collected, and tolerance to alternative NSAIDs was assessed through supervised OP testing or documented exposures.

Eleven patients with etoricoxib-induced FDE were included. The median age was 57 years (37–72), and 7 patients (63.6%) were male. Median latency after drug intake was 24 hours (6–120). A multifocal pattern was observed in 8 patients (72.7%), and mucosal involvement was observed in 2 patients (18.2%). The most frequent lesion sites were the lower limbs in 7 patients (63.6%) and the genital area in 5 patients (45.5%), followed by the upper limbs, upper trunk, and gluteal region in 2 patients each (18.2%); oral mucosal involvement was observed in 1 patient (9.1%).

Clinical diagnosis was consistent with FDE in all patients. Four patients (36.4%) reported recurrence after uncontrolled re-exposure. Skin biopsy was performed in 2 patients (18.2%), both confirming FDE. Patch testing was conducted in 1 patient (9.1%) with a positive result.

OP testing with alternative NSAIDs was performed in 8 patients, with complete tolerance in all of them (100%). Provocations were carried out with aspirin in 4 patients (50%), ibuprofen in 2 (25%), naproxen in 1 (12.5%), and meloxicam in 1 (12.5%).

This case series highlights that etoricoxib-induced FDE may be more frequent than previously reported. Notably, most patients exhibited a multifocal pattern. OP testing with alternative NSAIDs was well tolerated in all evaluated cases.