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Fixed drug eruption associated with co-trimoxazole
I NSIGHTS
Fixed drug eruption associated with co-trimoxazole
Fig 1. Erythematous rashes with hyperpig-
Fig 3. Symmetric hyperpigmented patch
mentation, mimicking injury.
around the anus.
Fig 2. Well-defined FDE lesions on the back.
A 3-year-old girl was referred because of what appeared to be “bruises” over the anterior chest and left deltoid region for the previous week (Fig 1). She was previously investigated for child abuse, which the parents strongly denied. On physical examination, the girl had circular, erythematous lesions with irregular, ill-defined margins, which almost coalesced on the front of her chest. She had a few scattered, well-defined, rounded lesions surrounded by erythema on her back (Fig 2). The parents admitted to having given her some medicine for a cough before the eruptions but disagreed with any probable causal relationship to the drug. An 8-year-old girl presented with bilaterally symmetric, circular, hyperpigmented lesions over
J Pediatr 1999;135:396. Copyright © 1999 by Mosby, Inc. 0022-3476/99/$8.00 + 0 9/45/100325
396
the perianal region of 3 months’ duration (Fig 3); the lesions were itchy and erythematous initially. The parents denied giving her any medication in the previous 6 months. Both these children presented with clinical features of fixed drug eruption (FDE), although denial of drug administration can be misleading. Because FDE is a unique form of cutaneous eruption, which can be reproduced at the same site(s) by the same drug(s) and provocation tests are safe in FDE, the children were challenged with the drugs that commonly produce this eruption such as paracetamol, aspirin, phenobarbitone, penicillin G, dapsone, and co-trimoxazole. These girls experienced burning sensation and moderate to severe pruritus at the lesional sites, which became warm and erythematous within 2 to 3 hours after co-trimoxazole (trimethoprim and sulfamethoxazole) challenge. In the first case the lesion became slightly swollen. Consent was not granted for a separate challenge with the components. However, the parents were warned not to use the drug in the future. Kader B. Mohamed, MBBS, Dip Derm, Dip Ven(Lond) Department of Dermatology General Hospital 10990 Penang, Malaysia
Fixed drug eruption associated with co-trimoxazole
Fig 1. Erythematous rashes with hyperpig-
Fig 3. Symmetric hyperpigmented patch
mentation, mimicking injury.
around the anus.
Fig 2. Well-defined FDE lesions on the back.
A 3-year-old girl was referred because of what appeared to be “bruises” over the anterior chest and left deltoid region for the previous week (Fig 1). She was previously investigated for child abuse, which the parents strongly denied. On physical examination, the girl had circular, erythematous lesions with irregular, ill-defined margins, which almost coalesced on the front of her chest. She had a few scattered, well-defined, rounded lesions surrounded by erythema on her back (Fig 2). The parents admitted to having given her some medicine for a cough before the eruptions but disagreed with any probable causal relationship to the drug. An 8-year-old girl presented with bilaterally symmetric, circular, hyperpigmented lesions over
J Pediatr 1999;135:396. Copyright © 1999 by Mosby, Inc. 0022-3476/99/$8.00 + 0 9/45/100325
396
the perianal region of 3 months’ duration (Fig 3); the lesions were itchy and erythematous initially. The parents denied giving her any medication in the previous 6 months. Both these children presented with clinical features of fixed drug eruption (FDE), although denial of drug administration can be misleading. Because FDE is a unique form of cutaneous eruption, which can be reproduced at the same site(s) by the same drug(s) and provocation tests are safe in FDE, the children were challenged with the drugs that commonly produce this eruption such as paracetamol, aspirin, phenobarbitone, penicillin G, dapsone, and co-trimoxazole. These girls experienced burning sensation and moderate to severe pruritus at the lesional sites, which became warm and erythematous within 2 to 3 hours after co-trimoxazole (trimethoprim and sulfamethoxazole) challenge. In the first case the lesion became slightly swollen. Consent was not granted for a separate challenge with the components. However, the parents were warned not to use the drug in the future. Kader B. Mohamed, MBBS, Dip Derm, Dip Ven(Lond) Department of Dermatology General Hospital 10990 Penang, Malaysia