FIXED DRUG ERUPTION DUE TO

COMMON COLD MEDICATION

CONFIRMED BY ORAL
PROVOCATION TEST

KEPANITERAAN KLINIK FAKULTAS KEDOKTERAN UNIVERSITAS TRISAKTI

SMF ILMU KESEHATAN KULIT DAN PENYAKIT KELAMIN
RUMKITAL Dr. MINTOHARDJO

Made Ayu Intan Winayati Oka 030.09.1

INTRODUCTION

2
2

1. Gendermalik SB, Galeckas KJ: Fixed drug eruptions: A case report and review of the
literature. Cutis 2009,84:215-219
2. Farshner J, Ericson K, Werner S: Treatment of the common cold in children and adults. Am
Fam Physician 2012, 86: 153-159

CASE
55 years old Indonesian woman presented with sudden
oval, dusky red patches with stinging sensation on her
back
History medication:
-5
years

-1 month

- 1 day

Day enter Hospital

27 01 - 2015 )

-Ibuprofen
- Mixagrip
-Panadol cold and flu - Decolgen

History medication:
-Panadol cold and flu
-Zyloric
-Simvastatin
History medication:
- Ibuprofen

- Zylorics

BP 110/70 mmHg, HR 96x /min, RR 18x /min, Temp. 36,7 0C

30/1/20
15
PCT

31/1/201
5
Antalgin

01/2/2015

02/02/201
5

Bodrex

Tetrasiklin

Bodrex: Paracetamol 150 mg,

Phenylpropanolamin 5 mg,
Dexteomethorphan 3,5 mg
Panadol cold & flu : Paracetamol 500 mg,
Pseudoephedrine HCL 30 mg, DMP Hbr
15 mg
4

05/02/201
5
Panadol cold & flu

Oral challenge
test +

WORKING DIAGNOSIS
FIXED DRUD ERUPTION due to
COMMON COLD MEDICATION
(IBUPROFEN)
Exactly
drugs
Still
unknowm
5

TREATMENT
STOP COMMON COLD MEDICATION !!!
(especially
concist
of
Ibuprofen,
Pseudoephedrine)
Cetirizine 10 mg, once daily
Topical Desoxymetason
Education : Avoid Scratching
6

 Sympathomimetic
rare
induce
hypersensitivity reactions
The most common reaction to oral
sympathomimetics is non pigmenting
fixed exanthema
Medication
induced
fixed
drug
eruption has been confirmed by oral
test
3. provocative
Ozkaya E, Sevunc M, Asien E.
Pseudoephedrine may cause pigmenting fixed drug
7

eruption. Dermatitis 2011, 22:e7-9

4. Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J (et al). Drug provocation
testing in the diagnosis of drug hypersensitivity reaction: General considerations. Allergy

 In
Indonesia
Pseudoephedrine
as
common cold medication usually sold in
combination with other substances
Diagnosis -> quite hard
Patients had a history of recurrent signs
and symptoms of FDE.
Time of taking the medication until
symptoms occur become increasingly
fast and symptoms are also more
intense.
8

 FDE characteristically recurs in the same

site each time the drug is administered.
Intraepidermal CD8+ T cells resident in
the FDE lesions have a major contributory
role in the development of localized tissue
damage.
Treatment includes stopping the offending
drug with topical steroid and oral
antihistamines.
9

5. Shiohara T. Fixed drug eruption: pathogenesis and diagnosis test. Curr Opin Allergy Clin
Immunol 2009. 9: 316-321
6. Dubey AK, Prabhu S, Shankar PR. Subish P, Prabhu MM, Mishra P. Dermatological adverse
drug reactions due to systemic medications- a review of literature. Journal of Pakistan

10

11