Dimenhydrinate

Fixed drug eruption (FDE) is a common cutaneous reaction which may be seen in reaction to several medications. The usual etiologic agents associated with FDE are phenazones, sulfonamides, and tetracyclines. Often the causative agent is made out from the patient's history; in some cases, oral challenge or topical testing may be required. The pathophysiology of FDE is unclear. Cell-mediated, rather than humoral immunity is thought to be involved. Herein we report a case of FDE in a daughter and father.

**********

Case Report

A 14-year-old girl was evaluated for recurrent multiple erythematous plaques on her extremities (Figure 1). They had developed five hours following intake of ibuprofen for toothache. Her past history revealed similar eruptions the previous year with the same drug for sialadenitis. Cutaneous examination revealed localized erythematous macules on the hands, legs, and thighs. Some were dusky red. Skin biopsy revealed a mild perivascular mononuclear cell infiltrate, and scattered lymphocytes and neutrophils were present in the epidermis. The clinical and histopathological findings supported our impression of FDE. On a subsequent visit the father of this patient also reported similar reactions after taking ibuprofen for osteoarthritis. He had brownish post-inflammatory macules on the trunk (Figure 2) and thighs.

[FIGURE 1-2 OMITTED]

Discussion

Ibuprofen is 2-(4-isobutyl-phenyl)-propionic acid which belongs to the same group of nonsteroidal anti-inflammatory drugs (NSAIDs) as naproxen and ketoprofen. Skin reactions to ibuprofen include FIDE, contact dermatitis, and photosensitivity (1). FDE affecting families have been uncommonly reported (27). In one reported case it was due to cotrimoxazole (2), in another case due to tetracycline in a mother and son (3). In another report (4) FDE was reported in a mother after ingestion of dimenhydrinate or ace tylsalicylic acid and in her son after intake of either of the drugs with 'junk food'. This occurrence was investigated in detail in a family whose members including a girl who along with her grandmother and 2 great aunts developed FDE following use of pyrazolone derivatives (5); the authors performed HLA class I and II typing for 36 unrelated patients with FIDE and found higher frequencies of B22 and Cwl antigens suggesting a genetic predisposition (6).

It is clear that familial FDE can occur with different drugs. Therefore, it is important to inquire into the history of drug reactions in the family members when taking history. This may unearth instances that come to light only at the time of clinical presentation. The situation is akin to patients with anti-convulsant hypersensitivity syndrome (AAD guidelines) where detailed history of drug eruption in the family should be obtained at the time of recording history.

References:

(1.) Diaz Jara M. Perez Montero A, Gracia Bara MT, Cabrerizo S, Zapatero L. Martinez Molero MJ. Allergic Reactions Due to Ibuprofen in Children. Pediatr Dermatol 2001; 18(1):66-67.

(2.) Ozkaya-Bayazit E, Bayazit H. Ozarmagan G. Drug related clinical pattern in fixed drug eruption. Eur J Dermatol 2000: 10(4):288-91.

(3) Jolly HW Jr. Sherman IJ Jr, Carpenter CLJr. Nesbitt LT Jr. Meek TJ Jr. Fixed drug eruption to tetracyclines. Arch Dermatol 1978; 114(10): 1484-5.

(4.) Hatzis J. Noutsis K. Hatzidakis E, Bassioukas K, Perissios A. Fixed drug eruption in a mother and her son. Cutis 1992; 50(1):50-2.

(5.) Pellicano R, Ciavarella G, Lomuto M. Di Giorgio G. Genetic susceptibility to fixed drug eruption: evidence for a link with HLA B22. J Am Acad Dermatol 1994; 30(1):52-4.

(6.) Pellicano R, Silvestris A, Iannantuono M, Ciavarella G, Lomuto M. Familial occurrence of fixed drug eruptions. Acta Derm Venerol 1992: 72(4):292-3,

(7.) Gulati R, Bhargava P. Mathur NK. Fixed drug eruption due to multi-vitamin multi-mineral preparation as part of familial poly sensitivity. J Assoc Physicians India 1999; 47(2):253.

(8.) AAD Guidelines/Outcomes Committee, AAD Task Force. Guidelines of care for cutaneous adverse drug reactions. J Am Acad Dermarol 1996; 35(3):458 462.

KHALID AL ABOUD MD, V RAMESH MD, KHALID AL HAWSAWI MD

DERMATOLOGY UNIT, DEPARTMENT OF MEDICINE, KING FAISAL HOSPITAL, TAIF, SAUDI ARABIA

ADDRESS FOR CORRESPONDENCE: Khalid Al Aboud MD PO Box 5440 Makkah, Saudi Arabia Phone: 966-2-738-2444 Fax: 966-2-738-4719 E-mail: amoa65@hotmail.com

COPYRIGHT 2003 Journal of Drugs in Dermatology
COPYRIGHT 2004 Gale Group