Dermatology, Rutgers New Jersey Medical School, 185 South Orange Avenue, Medical Science Building H-576, Newark, NJ, 07103-2757, USA.
Dermatology, Robert Wood Johnson University Hospital, One World's Fair Drive, Suite 2400, Somerset, NJ, 08873, USA.
Am J Clin Dermatol. 2020 Jun;21(3):393-399. doi: 10.1007/s40257-020-00505-3.
A fixed drug eruption (FDE) is a relatively common reaction associated with more than 100 medications. It is defined as a same-site recurrence with exposure to a particular medication. The primary approach and treatment for all types of FDEs are to identify and remove the causative agent, often accomplished by a thorough history of medication and other chemical exposures, and possibly prior episodes. The most common category of FDE, localized FDE, whether bullous or non-bullous, is self-limited. Although one can confirm the causative agent using oral challenge testing, it is not recommended due to the risk of severe exacerbation or possible generalization; patch testing is now preferred. Bullous FDE may resemble erythema multiforme. Treatment of localized FDE includes medication removal, patient counseling, and symptomatic relief. Failure to remove the causative agent in localized FDE can lead to recurrence, which is associated with increased inflammation, hyperpigmentation, and risk of a potentially lethal generalized bullous FDE (GBFDE), which may resemble Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Distinguishing GBFDE from SJS and TEN is salient and will be stressed: GBFDE has more rapid onset in 1-24 h rather than in weeks, less or no mucosal involvement, less or no systemic involvement, and a tendency for a more favorable prognosis; however, recent experience suggests it may be just as life-threatening. This review will provide a comprehensive update and approach to diagnosis and management.
固定性药物疹（FDE）是一种相对常见的反应，与 100 多种药物有关。它被定义为在接触特定药物时在同一部位的复发。所有类型 FDE 的主要方法和治疗是识别和去除病因，通常通过对药物和其他化学物质暴露的详细病史，以及可能的既往发作来完成。最常见的 FDE 类别，局部性 FDE，无论是大疱性还是非大疱性，都是自限性的。虽然可以通过口服挑战测试来确认病因，但由于严重恶化或可能的泛化的风险，不建议这样做；现在更推荐斑贴试验。大疱性 FDE 可能类似于多形红斑。局部性 FDE 的治疗包括药物去除、患者咨询和症状缓解。如果在局部性 FDE 中未能去除病因，可能会导致复发，这与炎症增加、色素沉着和潜在致命的全身性大疱性 FDE（GBFDE）的风险增加有关，GBFDE 可能类似于史蒂文斯-约翰逊综合征（SJS）或中毒性表皮坏死松解症（TEN）。将 GBFDE 与 SJS 和 TEN 区分开来是很重要的，我们将强调这一点：GBFDE 的发病更快，在 1-24 小时内，而不是在数周内，较少或没有粘膜受累，较少或没有全身受累，且预后较好；然而，最近的经验表明，它可能同样危及生命。这篇综述将提供一个全面的更新和诊断及管理方法。
