Department of Dermatology and Venereology, Coimbra University Hospital, 3000-075 Coimbra, Portugal.
Contact Dermatitis. 2011 Oct;65(4):195-201. doi: 10.1111/j.1600-0536.2011.01946.x. Epub 2011 Jun 27.
The fixed drug eruption is a common adverse drug reaction. Clear identification of the culprit drug is not always possible in the clinical setting, and oral rechallenge may induce new lesions or severe reactions.
The main purpose of this study was to evaluate the diagnostic value of patch testing in establishing an aetiological diagnosis in fixed drug eruptions.
A retrospective analysis was conducted evaluating 52 patients (17M/35F, mean age 53±17 years) with clinical diagnoses of fixed drug eruptions submitted to patch tests in a 20-year period in a Dermatology Department. Nonsteroidal anti-inflammatory drugs (NSAID) were clinically suspected in 90.4% of the cases, followed by antibiotics (28.9%) and paracetamol (15.4%).
Patch tests on pigmented lesions were reactive in 21 patients (40.4%), 20 of those to NSAID (nimesulide, piroxicam and etoricoxib) and 1 to an antihistamine (cetirizine). All patch tests using other drugs were negative, even under conditions of high clinical suspicion. Oral rechallenge allowed confirmation of drug imputability in 5 of 31 test-negative cases. Cross reactivity was frequently observed between piroxicam and other oxicams, and between different antihistamines.
Patch testing was shown to be a simple and safe method to confirm drug imputabililty in fixed drug eruption, mainly when NSAID or multiple drugs are suspected. Persistent lack of reactivity to drug classes such as antibiotics and allopurinol represent an important limitation.
固定型药物疹是一种常见的药物不良反应。在临床环境中，并不总能明确确定罪魁祸首药物，口服再激发试验可能会诱发新的皮损或严重反应。
本研究的主要目的是评估斑贴试验在确定固定型药物疹病因诊断中的诊断价值。
回顾性分析了皮肤科在 20 年期间接受斑贴试验的 52 例（17 例男性/35 例女性，平均年龄 53±17 岁）具有固定型药物疹临床诊断的患者。90.4%的病例临床怀疑与非甾体抗炎药（NSAID）有关，其次是抗生素（28.9%）和对乙酰氨基酚（15.4%）。
21 例（40.4%）有色斑皮损的斑贴试验呈阳性，其中 20 例与 NSAID（尼美舒利、吡罗昔康和依托考昔）有关，1 例与抗组胺药（西替利嗪）有关。所有其他药物的斑贴试验均为阴性，即使在高度临床怀疑的情况下也是如此。在 31 例试验阴性的病例中，有 5 例通过口服再激发试验证实了药物的归因。吡罗昔康和其他昔康类药物之间以及不同抗组胺药之间经常观察到交叉反应。
斑贴试验是一种简单、安全的方法，可以确认固定型药物疹中药物的归因，主要是在怀疑 NSAID 或多种药物时。对类抗生素和别嘌呤醇等药物类别持续缺乏反应是一个重要的局限性。
