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Fixed drug eruption due to fluconazole: A third case

2002; Elsevier BV; Volume: 46; Issue: 3 Linguagem: Inglês

10.1067/mjd.2002.118356

1097-6787

Pierre‐Dominique Ghislain, Emile Ghislain,

Chemotherapy-related skin toxicity

To the Editor:We have read with interest the article of Heikkila, Timonen, and Stubb.1Heikkila H Timonen K Stubb S Fixed drug eruption due to fluconazole.J Am Acad Dermatol. 2000; 42: 883-884Abstract Full Text Full Text PDF PubMed Google Scholar We report a new case of fixed drug eruption induced by fluconazole. Clinical history is also typical, but patch tests in our case were negative. An oral provocation was positive and confirmed the diagnosis.A 21-year-old woman consulted us for evaluation of dusky erythematous macules on the left temple, the superior lip, the right palm, and the great toe of the left foot; the lesions had been present for 3 days. The patient was in good health, without any known allergy. Because of recurrent vaginal candidosis, a gynecologist had prescribed fluconazole (1 tablet, 200 mg, once a month). The patient had taken the ninth tablet the day before the eruption developed. Diagnosis of fixed drug eruption was proposed. The lesions disappeared spontaneously. One month later, the patient took the tenth tablet despite medical advice. After a few hours, all lesions reappeared at the same places. Six weeks later, patch tests with fluconazole, ketoconazole, and itraconazole on the back and fluconazole on a previous site of the fixed drug eruption were negative.The drugs most frequently implicated in fixed drug eruptions are trimethoprim-sulfamethoxazole, tetracycline, pyrazolone, sulfadiazine, dipyrone, paracetamol, and aspirin, but many others were reported. The systemic azole antifungal agents are safe; to our knowledge the literature mentions only two cases caused by fluconazole,1Heikkila H Timonen K Stubb S Fixed drug eruption due to fluconazole.J Am Acad Dermatol. 2000; 42: 883-884Abstract Full Text Full Text PDF PubMed Google Scholar, 2Morgan JM Carmichael AJ Fixed drug eruption with fluconazole.BMJ. 1994; 308: 454Crossref PubMed Scopus (32) Google Scholar one case from the use of ketoconazole,3Bharija SC Belhaj MS Ketoconazole-induced fixed drug eruption.Int J Dermatol. 1988; 27: 278-279Crossref PubMed Scopus (13) Google Scholar and none caused by itraconazole.Therefore to our knowledge our case constitutes the third observation of fixed drug eruption induced by fluconazole; it is closely comparable to the first two cases. However, in our case patch tests were negative, and involuntary oral provocation was positive. For fixed drug eruption, sensitivity of the patch test is variable; they are thus useful if positive, but no conclusion is possible if they are negative. If necessary, an oral provocation test may be undertaken; fixed drug eruption is the only drug reaction in which oral provocation is ethically admissible. We thus propose to add fluconazole to the list of drugs that can induce fixed drug eruption. We also pointed out that patch test sensitivity is not 100%; results can be false negative. To the Editor:We have read with interest the article of Heikkila, Timonen, and Stubb.1Heikkila H Timonen K Stubb S Fixed drug eruption due to fluconazole.J Am Acad Dermatol. 2000; 42: 883-884Abstract Full Text Full Text PDF PubMed Google Scholar We report a new case of fixed drug eruption induced by fluconazole. Clinical history is also typical, but patch tests in our case were negative. An oral provocation was positive and confirmed the diagnosis.A 21-year-old woman consulted us for evaluation of dusky erythematous macules on the left temple, the superior lip, the right palm, and the great toe of the left foot; the lesions had been present for 3 days. The patient was in good health, without any known allergy. Because of recurrent vaginal candidosis, a gynecologist had prescribed fluconazole (1 tablet, 200 mg, once a month). The patient had taken the ninth tablet the day before the eruption developed. Diagnosis of fixed drug eruption was proposed. The lesions disappeared spontaneously. One month later, the patient took the tenth tablet despite medical advice. After a few hours, all lesions reappeared at the same places. Six weeks later, patch tests with fluconazole, ketoconazole, and itraconazole on the back and fluconazole on a previous site of the fixed drug eruption were negative.The drugs most frequently implicated in fixed drug eruptions are trimethoprim-sulfamethoxazole, tetracycline, pyrazolone, sulfadiazine, dipyrone, paracetamol, and aspirin, but many others were reported. The systemic azole antifungal agents are safe; to our knowledge the literature mentions only two cases caused by fluconazole,1Heikkila H Timonen K Stubb S Fixed drug eruption due to fluconazole.J Am Acad Dermatol. 2000; 42: 883-884Abstract Full Text Full Text PDF PubMed Google Scholar, 2Morgan JM Carmichael AJ Fixed drug eruption with fluconazole.BMJ. 1994; 308: 454Crossref PubMed Scopus (32) Google Scholar one case from the use of ketoconazole,3Bharija SC Belhaj MS Ketoconazole-induced fixed drug eruption.Int J Dermatol. 1988; 27: 278-279Crossref PubMed Scopus (13) Google Scholar and none caused by itraconazole.Therefore to our knowledge our case constitutes the third observation of fixed drug eruption induced by fluconazole; it is closely comparable to the first two cases. However, in our case patch tests were negative, and involuntary oral provocation was positive. For fixed drug eruption, sensitivity of the patch test is variable; they are thus useful if positive, but no conclusion is possible if they are negative. If necessary, an oral provocation test may be undertaken; fixed drug eruption is the only drug reaction in which oral provocation is ethically admissible. We thus propose to add fluconazole to the list of drugs that can induce fixed drug eruption. We also pointed out that patch test sensitivity is not 100%; results can be false negative. We have read with interest the article of Heikkila, Timonen, and Stubb.1Heikkila H Timonen K Stubb S Fixed drug eruption due to fluconazole.J Am Acad Dermatol. 2000; 42: 883-884Abstract Full Text Full Text PDF PubMed Google Scholar We report a new case of fixed drug eruption induced by fluconazole. Clinical history is also typical, but patch tests in our case were negative. An oral provocation was positive and confirmed the diagnosis. A 21-year-old woman consulted us for evaluation of dusky erythematous macules on the left temple, the superior lip, the right palm, and the great toe of the left foot; the lesions had been present for 3 days. The patient was in good health, without any known allergy. Because of recurrent vaginal candidosis, a gynecologist had prescribed fluconazole (1 tablet, 200 mg, once a month). The patient had taken the ninth tablet the day before the eruption developed. Diagnosis of fixed drug eruption was proposed. The lesions disappeared spontaneously. One month later, the patient took the tenth tablet despite medical advice. After a few hours, all lesions reappeared at the same places. Six weeks later, patch tests with fluconazole, ketoconazole, and itraconazole on the back and fluconazole on a previous site of the fixed drug eruption were negative. The drugs most frequently implicated in fixed drug eruptions are trimethoprim-sulfamethoxazole, tetracycline, pyrazolone, sulfadiazine, dipyrone, paracetamol, and aspirin, but many others were reported. The systemic azole antifungal agents are safe; to our knowledge the literature mentions only two cases caused by fluconazole,1Heikkila H Timonen K Stubb S Fixed drug eruption due to fluconazole.J Am Acad Dermatol. 2000; 42: 883-884Abstract Full Text Full Text PDF PubMed Google Scholar, 2Morgan JM Carmichael AJ Fixed drug eruption with fluconazole.BMJ. 1994; 308: 454Crossref PubMed Scopus (32) Google Scholar one case from the use of ketoconazole,3Bharija SC Belhaj MS Ketoconazole-induced fixed drug eruption.Int J Dermatol. 1988; 27: 278-279Crossref PubMed Scopus (13) Google Scholar and none caused by itraconazole. Therefore to our knowledge our case constitutes the third observation of fixed drug eruption induced by fluconazole; it is closely comparable to the first two cases. However, in our case patch tests were negative, and involuntary oral provocation was positive. For fixed drug eruption, sensitivity of the patch test is variable; they are thus useful if positive, but no conclusion is possible if they are negative. If necessary, an oral provocation test may be undertaken; fixed drug eruption is the only drug reaction in which oral provocation is ethically admissible. We thus propose to add fluconazole to the list of drugs that can induce fixed drug eruption. We also pointed out that patch test sensitivity is not 100%; results can be false negative.