Fixed drug eruption - Oral Mucosal Lesion
See also in: Overview,Cellulitis DDx,AnogenitalAlerts and Notices
Synopsis

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
Look For
Subscription Required
Diagnostic Pearls
Subscription Required
Differential Diagnosis & Pitfalls
- Aphthous stomatitis
- Behçet syndrome
- Allergic contact stomatitis
- Oral lichen planus
- Recurrent herpes simplex virus infection
- Mucous patch of secondary syphilis
- Thermal burns
- Erythema multiforme
- Reactive infectious mucocutaneous eruption (RIME)
- Stevens-Johnson syndrome / toxic epidermal necrolysis
- Pemphigus vulgaris
Best Tests
Subscription Required
Management Pearls
Subscription Required
Therapy
Subscription Required
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.Subscription Required
References
Subscription Required
Last Reviewed:02/02/2021
Last Updated:02/16/2022
Last Updated:02/16/2022
Fixed drug eruption - Oral Mucosal Lesion
See also in: Overview,Cellulitis DDx,Anogenital