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Differential diagnosis
Solitary genital erosion: Recurrent herpetic lesion,
arthropod bite reaction
Multiple erosions: Stevens-Johnson syndrome, toxic
epidermal necrolysis
Oral erosions: Aphthous stomatitis, primary herpetic
gingivostomatitis, erythema multiforme
Diagnosis
The diagnosis of FDE is usually evident from the histo-
ry and clinical examination. Readmission of the drug
confirms the diagnosis, but should be avoided.
However, if one is in doubt, a biopsy may be per-
formed.
Histopathology reveals a superficial and deep intersti-
tial and perivascular infiltrate in the dermis composed
of lymphocytes and eosinophils. There may be necrot-
ic keratinocytes in the epidermis. Dermal melano-
phages are often the only histological finding in non-
inflammatory lesions.
Patch test: The suspected drug can be placed as a
patch test at a previously involved site; an inflammato-
ry response occurs in 30% of cases.
Figs 1 and 2. Post-inflammatory pigmentation from Management
fixed drug eruption.
Identify and withhold the offending drug.
Treatment of lesion(s): A newly erupted lesion of FDE
Aetiology presents as an inflammatory plaque, with or without
Drugs most commonly implicated include: erosion. Non-eroded plaques can be treated with a
potent topical corticosteroid. Erosions can be treated
Phenolphthalein-containing laxatives with fucidic acid (Fucidin) or mupirocin (Bactroban) and
Antimicrobial agents a dressing until the site is re-epithelialised. Post-inflam-
- Tetracyclines and minocycline matory hyperpigmentation may persist for years and
the patient should be advised to avoid excessive expo-
- Sulfonamide antibiotics; crossreactions with sure and to use sunblock cream.
antidiabetic drugs (sulphontyl urea) and diuret-
ics or the thiazide group
FURTHER READING
Fitzpatrick, Atlas of Dermatology
Correspondence: Dr ME Docrat, Wale Street Chambers, c/o Wale Bolognia JL, Jorizzo JL, Rapini RP. Dermatology Vol.1.
and Long Streets, Cape Town 8001. Tel 021-423-3180/90,
fax 021-423-2323, email medocrat@intekom.co.za
Philadelphia: Mosby, 2003: 344-346.
24 Current Allergy & Clinical Immunology, March 2005 Vol 18, No.1