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Fixed drug eruption - Oral Mucosal Lesion
See also in: Overview,Cellulitis DDx,Anogenital
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Fixed drug eruption - Oral Mucosal Lesion

See also in: Overview,Cellulitis DDx,Anogenital
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Contributors: Rajini Murthy MD, Elizabeth B. Wallace MD, Belinda Tan MD, PhD, Susan Burgin MD, Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc
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Synopsis

Fixed drug eruption : Lips, Tongue, Feet, Hands
Fixed drug eruption (FDE) is a drug reaction manifested by cutaneous and/or mucosal lesions recurring at the same body site each time an individual is re-exposed to the culprit drug. In most cases, FDE develops within minutes to hours of exposure. The oral and anogenital mucosa are the most frequently involved body sites. The oral mucosa may be the only site of involvement or may occur in association with cutaneous and/or genital mucosal lesions.

Lesions begin as sharply demarcated, red or violaceous patches and are often 0.5 cm to several centimeters in size or larger. Occasionally, these lesions will form vesicles or bullae, and on the mucosal skin, they can present as erosions or appear similar to aphthous ulcers. They are often associated with symptoms of burning, but may also be painful or pruritic. The most common presentation is with a solitary lesion, but some individuals may develop multiple lesions. Healing with postinflammatory hyperpigmentation is less commonly seen after oral mucosal involvement.

Numerous drugs have been implicated in causing FDE. Studies have shown certain drugs appear to have a predilection for causing the eruption to occur in or near the mouth. Commonly associated drug classes for FDE in the oral mucosal region are also the most frequently seen culprit medications for FDE in general. These medication classes include antibiotics, in particular sulfonamides, trimethoprim, and tetracyclines, and NSAIDs, including naproxen, ibuprofen, and celecoxib. Other drugs implicated in FDE include amoxicillin, erythromycin, metronidazole, fluconazole, paracetamol (acetaminophen), cetirizine, hydroxyzine, methylphenidate, oral contraceptives, quinine, and phenolphthalein. A nonpigmenting variant is seen with pseudoephedrine.

Codes

ICD10CM:
L27.1 – Localized skin eruption due to drugs and medicaments taken internally

SNOMEDCT:
73692007 – Fixed drug eruption

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:02/02/2021
Last Updated:02/16/2022
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Fixed drug eruption - Oral Mucosal Lesion
See also in: Overview,Cellulitis DDx,Anogenital
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A medical illustration showing key findings of Fixed drug eruption : Lips, Tongue, Feet, Hands
Clinical image of Fixed drug eruption - imageId=1453376. Click to open in gallery. caption: 'A close-up of a round bright red plaque with a central darker color.'
A close-up of a round bright red plaque with a central darker color.

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