Mima Yoshihito, Yamamoto Masako, Obikane Hiyo, Norimatsu Yuta, Iozumi Ken
Department of Dermatology, Tokyo Metropolitan Police Hospital, Tokyo 164-8541, Japan.
Department of Diagnostic Pathology, Tokyo Metropolitan Police Hospital, Tokyo 164-8541, Japan.
Diagnostics (Basel). 2024 Dec 28;15(1):48. doi: 10.3390/diagnostics15010048.
Fixed drug eruption (FDE) is a type of drug-induced skin inflammation characterized by the recurrence of lesions in the same region following repeated exposure to the causative drug. FDE typically presents as localized spots or plaques without systemic symptoms; however, it can manifest in other forms, such as blisters and papules. In FDE, effector memory CD8-positive T cells that remain dormant in the basal layer after a previous inflammation are reactivated upon re-exposure to the causative drug, leading to the development of erythema at the same sites. Herein, we report the case of a 23-year-old man who developed ibuprofen-induced multiple FDE. The diagnosis was confirmed by detecting a rash immediately following ibuprofen administration, and histopathological findings were consistent with FDE. Ibuprofen is widely available as an over-the-counter medication, and patients may not always report its use-making the diagnosis of ibuprofen-induced FDE particularly challenging. Approximately 24 h following drug-induced CD8-positive T cell activation, regulatory T cells normally infiltrate the epidermis to suppress inflammation and promote resolution. However, in multiple FDE, CD8-positive T cell activity may outweigh that of regulatory T cells, causing uncontrolled inflammation and leading to the spread of poorly-demarcated lesions that can progress to severe drug reactions such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). We reviewed 13 cases of ibuprofen-induced multiple FDE. Over-the-counter medications can cause multiple FDEs, and the repeated administration of the causative drug can result in severe reactions such as SJS/TEN. The early diagnosis and strict discontinuation of the causative drugs are therefore crucial.
固定性药疹（FDE）是一种药物性皮肤炎症，其特征是在反复接触致病药物后，同一部位的皮损会复发。FDE通常表现为局限性斑点或斑块，无全身症状；然而，它也可以表现为其他形式，如水疱和丘疹。在FDE中，先前炎症后潜伏在基底层的效应记忆CD8阳性T细胞在再次接触致病药物时会重新激活，导致同一部位出现红斑。在此，我们报告一例23岁男性发生布洛芬诱导的多发性FDE的病例。通过在服用布洛芬后立即检测到皮疹确诊，组织病理学结果与FDE一致。布洛芬作为非处方药广泛可得，患者可能并不总是报告其使用情况，这使得布洛芬诱导的FDE诊断特别具有挑战性。在药物诱导的CD8阳性T细胞激活后约24小时，调节性T细胞通常会浸润表皮以抑制炎症并促进消退。然而，在多发性FDE中，CD8阳性T细胞的活性可能超过调节性T细胞，导致炎症失控，导致界限不清的皮损扩散，进而发展为严重的药物反应，如史蒂文斯-约翰逊综合征（SJS）或中毒性表皮坏死松解症（TEN）。我们回顾了13例布洛芬诱导的多发性FDE病例。非处方药可引起多发性FDE，反复使用致病药物可导致SJS/TEN等严重反应。因此，早期诊断和严格停用致病药物至关重要。
