Patient Case: Fixed Drug Eruption
A 28-year-old man presents to the dermatology clinic with a recurrent, well-defined dark red patch on his inner thigh. He reports that this lesion first appeared six months ago, lasted about a week, and then faded to a dark brown color. However, the same spot has reactivated multiple times, always after taking ibuprofen for headaches. He denies itching, pain, or other systemic symptoms.
On examination, there is a single, round, well-demarcated, erythematous patch with central dusky discoloration on the inner thigh. No blistering or scaling is observed. The rest of the skin and mucous membranes are unaffected.
A diagnosis of fixed drug eruption (FDE) due to ibuprofen is made. The patient is advised to avoid ibuprofen and use alternative pain relievers like acetaminophen. He is also educated on the recurrence of lesions at the same site upon re-exposure to the offending drug.
- What is the most likely diagnosis for this patient’s condition?
a) Contact dermatitis
b) Fixed drug eruption
c) Erythema multiforme
d) Psoriasis - What is a key characteristic of a fixed drug eruption?
a) Lesions resolve completely without recurrence
b) Rash occurs at different locations each time
c) Lesions recur at the same site upon re-exposure to the drug
d) Rash spreads rapidly and involves mucous membranes - Which medication is most likely responsible for this patient’s reaction?
a) Acetaminophen
b) Ibuprofen
c) Acyclovir
d) Metformin - What is the best management for this condition?
a) Continued use of the drug with antihistamines
b) Immediate withdrawal of the offending drug and avoidance in the future
c) High-dose systemic steroids in all cases
d) Skin biopsy for confirmation before stopping the drug
