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Fixed drug eruption associated with aspirin
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  1. Menfil Orellana-Barrios1,
  2. Rita Medrano Juarez2,
  3. Nachiket J. Patel3
  1. 1Cardiology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
  2. 2Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
  3. 3Interventional Cardiology, University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
  1. Correspondence to Dr Menfil Orellana-Barrios, menfil{at}gmail.com

https://doi.org/10.1136/bcr-2017-222004

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    Description

    A previously healthy 27-year-old woman presented to the outpatient urgent care clinic complaining of dark spots that appeared suddenly on both her feet and face. She had been prescribed aspirin (650 mg orally every 6 hours as needed) the day prior to presentation as therapy for migraine-type headache. She also then recalled that these spots had appeared suddenly, in exactly the same areas approximately 1 year before the current episode, also associated with ingestion of an over-the-counter medication (Alka-Seltzer; aspirin/citric acid/sodium bicarbonate). Physical examination was unremarkable with the exception of dark, erythematous, slightly oedematous round plaques asymmetrically distributed over her feet (figure 1) and left eyelid (figure 2). A complete blood count was ordered (results within normal range), and the patient was advised to substitute aspirin with ibuprofen, which controlled her headache. The skin lesions subsided and disappeared without complications within 2 weeks. 1

    Figure 1
    Figure 1

    Painless hyperpigmented asymmetrically distributed plaques on feet.

    Figure 2
    Figure 2

    Painless hyperpigmentation of skin over the left eye.

    Learning points

    • Fixed drug eruption is a cutaneous drug reaction noted to recur in the same anatomical locations on recurrent exposure to the offending agent.

    • Lesions usually resolve with cessation of the culprit drug, but may leave postinflammatory hyperpigmentation. Supportive treatment may include oral H1 antihistamines and a short course of steroids in more severe cases.

    • The most common drugs associated with fixed drug eruption are antibacterial agents, aspirin, and other non-steroidal anti-inflammatory agents, acetaminophen and barbiturates.1

    Reference

    1. ↵
      1. Mahboob A,
      2. Haroon TS
      . Drugs causing fixed eruptions: a study of 450 cases. Int J Dermatol 1998;37:833–8.doi:10.1046/j.1365-4362.1998.00451.x
      OpenUrlCrossRefPubMedWeb of Science
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    Footnotes

    • Contributors All authors had substantial contributions to the conception and design of the work. MO-B and RMJ were directly involved in the case, and the acquisition, analysis and interpretation of data for the work. MO-B and NP wrote the manuscript and revised it critically for important intellectual content. All authors approved the final manuscript and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.