Fixed Drug Eruption Fix 2

FIXED DRUG ERUPTION DUE TO COMMON COLD MEDICATION

CONFIRMED BY ORAL PROVOCATION TEST

KEPANITERAAN KLINIK FAKULTAS KEDOKTERAN UNIVERSITAS TRISAKTISMF ILMU KESEHATAN KULIT DAN PENYAKIT KELAMIN

RUMKITAL Dr. MINTOHARDJO

Made Ayu Intan Winayati Oka 030.09.140

INTRODUCTION

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1. Gendermalik SB, Galeckas KJ: Fixed drug eruptions: A case report and review of the literature. Cutis 2009,84:215-2192. Farshner J, Ericson K, Werner S: Treatment of the common cold in children and adults. Am Fam Physician 2012, 86: 153-159

CASE

- 5 yearsHistory medication:-Ibuprofen - Mixagrip-Panadol cold and flu - Decolgen

-1 monthHistory medication:-Panadol cold and flu - Zylorics-Zyloric-Simvastatin

- 1 dayHistory medication:- Ibuprofen

55 years old Indonesian woman presented with sudden oval, dusky red patches with stinging sensation on her back

Day enter Hospital27 – 01 - 2015 )

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BP 110/70 mmHg, HR 96x /min, RR 18x /min, Temp. 36,7 BP 110/70 mmHg, HR 96x /min, RR 18x /min, Temp. 36,7 00CC

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30/1/2015 05/02/201531/1/2015 01/2/2015 02/02/2015

PCT Antalgin Bodrex Tetrasiklin Panadol cold & flu

Bodrex : Paracetamol 150 mg, Phenylpropanolamin 5 mg, Dexteomethorphan 3,5 mgPanadol cold & flu : Paracetamol 500 mg, Pseudoephedrine HCL 30 mg, DMP Hbr 15 mg

Oral challenge test +

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WORKING DIAGNOSIS

FIXED DRUD ERUPTION due to COMMON COLD MEDICATION (IBUPROFEN)

Exactly drugs

Still unknowm

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TREATMENT

•STOP COMMON COLD MEDICATION !!! (especially concist of Ibuprofen, Pseudoephedrine)•Cetirizine 10 mg, once daily•Topical Desoxymetason•Education : Avoid Scratching

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• Sympathomimetic rare induce hypersensitivity reactions

• The most common reaction to oral sympathomimetics is non pigmenting fixed exanthema

• Medication induced fixed drug eruption has been confirmed by oral provocative test

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3. Ozkaya E, Sevunc M, Asien E. Pseudoephedrine may cause pigmenting fixed drug eruption. Dermatitis 2011, 22:e7-94. Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J (et al). Drug provocation testing in the diagnosis of drug hypersensitivity reaction: General considerations. Allergy 2003, 58: 854-863

• In Indonesia Pseudoephedrine as common cold medication usually sold in combination with other substances

• Diagnosis -> quite hard• Patients had a history of recurrent signs and

symptoms of FDE.• Time of taking the medication until symptoms

occur become increasingly fast and symptoms are also more intense.

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• FDE characteristically recurs in the same site each time the drug is administered.

• Intraepidermal CD8+ T cells resident in the FDE lesions have a major contributory role in the development of localized tissue damage.

• Treatment includes stopping the offending drug with topical steroid and oral antihistamines.

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5. Shiohara T. Fixed drug eruption: pathogenesis and diagnosis test. Curr Opin Allergy Clin Immunol 2009. 9: 316-3216. Dubey AK, Prabhu S, Shankar PR. Subish P, Prabhu MM, Mishra P. Dermatological adverse drug reactions due to systemic medications- a review of literature. Journal of Pakistan Association of Dermatologists 2006; 16: 28-38

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