Pediatric emergency medicine trisk 1312 1312
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months to resolve. Although usually solitary, multiple or very large lesions may
form in fixed drug eruption following repeated exposure to the triggering
medication. The lesions can be pruritic, burning, or asymptomatic.
Initially, lesions appear within 2 weeks of starting a medication, but with
repeated exposure, onset can occur in minutes to hours. Sulfonamides,
particularly trimethoprim-sulfamethoxazole, are the most common causes of
fixed drug eruption in children ( Fig. 68.7 ), though NSAIDs and tetracycline are
also frequent causes. Some foods and food additives have also been reported to
cause fixed drug reactions.
Fixed drug eruption can often be confused for arthropod bites, urticaria, or EM.
The history of recurrence in the exact same location with prominent
postinflammatory hyperpigmentation is more suggestive of a fixed drug eruption
rather than arthropod bites. Similarly, fixed drug eruption is typically not as
pruritic as arthropod bites. As noted above, urticaria is transient, so individual
lesions resolve within 24 hours, with any residual pigmentation or purpura
resolving within days rather than the months that fixed drug eruption
hyperpigmentation may last. As compared to EM, the lesions of fixed drug
eruption are larger and fewer and occur in a different distribution.
Stopping and avoiding the causative medication allows for resolution of the
fixed drug eruption and prevents recurrence. A fixed drug eruption does not
progress to more severe drug eruptions, like DHR or Stevens–Johnson syndrome
(SJS). If needed, a topical steroid can treat pruritus.
