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Clinical and histological features of fixed drug eruption: a single-centre series of 73 cases with comparison between bullous and non-bullous forms

  • Clinical Report
  • Published:
European Journal of Dermatology

Abstract

Background

The clinical and pathological aspects of fixed drug eruption (FDE) have been described based on a few case series.

Objectives

To compare bullous FDE (BFDE) and non-bullous FDE (NBFDE) and to determine whether BFDE can be histologically distinguished from other dermatoses presenting with an apoptotic pan-epidermolysis.

Materials & Methods

In this retrospective monocentre study (2005–2016), FDE was classified as BFDE or NBFDE and localized (one anatomical site) or generalized (≥ two sites; GBFDE). Clinical data were extracted from charts, and images were reviewed. Skin biopsies were analysed and compared to the clinical presentation. Three dermatopathologists, blinded to the final clinical diagnosis, evaluated a subset of BFDE cases (n = 8) and 25 biopsies of other bullous diseases known to have an epidermal necrolysis (EN)-like pattern. In total, 73 patients were included in the study.

Results

Patients with BFDE (n = 58; GBFDE n = 48) were significantly older (p < 0.001). All patients with GBFDE were hospitalized; 25 had a complication (infectious; n = 19), and eight died (median age: 80). Histology revealed spongiotic (6.7%), interface dermatitis (48.3%) and EN-like (66.3%) patterns. The EN-like pattern was more frequent in BFDE than NBFDE (74% vs 27%; p = 0.008). Melanophages (100% vs 66%; p = 0.02) and massive dermal melanosis (40% vs 4%; p = 0.0005) were more prominent in NBFDE than BFDE. BFDE could not be reliably distinguished from other bullous diseases with EN-like patterns.

Conclusion

BFDE belongs to the spectrum of skin conditions with an EN pattern, for which the concept of acute syndrome of apoptotic panepidermolysis (ASAP) was previously introduced. Clinical-pathological correlation is mandatory for a diagnosis of BFDE.

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Acknowledgements and disclosures

Acknowledgements: Emilie Perron gratefully acknowledges the “Bourse du doyen McLaughlin de la Faculté de Médecine” (Laval University) and the TEVA Canada Innovation fellowship grant. She thanks Dr. Francois Thériault-Proulxfor revising the manuscript many times over and lengthy discussions. Financial support: none. Conflicts of interest: none.

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Author notes

  1. These authors contributed equally

  2. These authors contributed equally

Authors and Affiliations

  1. Pathology department, CHU de Québec, Laval University, Quebec, Canada

    Emilie Perron

  2. Faculty of Medicine, Laval University, Quebec, Canada

    Emilie Perron

  3. Pathology department, Henri Mondor hospital, AP-HP, 94010, Créteil Cedex, France

    Emilie Perron, Emilie Perron, Lea Marciano, Raymond Karkouche, Janine Wechsler & Nicolas Ortonne

  4. Dermatology department, Henri Mondor hospital, AP-HP, 94010, Créteil Cedex, France

    Alice Viarnaud, Olivier Chosidow, Pierre Wolkenstein & Saskia Ingen-Housz-Oro

  5. Intensive care unit, Henri Mondor hospital, AP-HP, 94010, Créteil Cedex, France

    Nicolas De Prost & Nicolas Ortonne

  6. Paris Est Créteil University (UPEC), 94010, Créteil Cedex, France

    Nicolas De Prost, Olivier Chosidow & Pierre Wolkenstein

  7. Reference centre for toxic bullous diseases and severe cutaneous adverse reactions TOXIBUL, Créteil, France

    Nicolas De Prost, Olivier Chosidow, Pierre Wolkenstein, Saskia Ingen-Housz-Oro & Nicolas Ortonne

  8. Univ Paris Est Créteil EpiDermE, Créteil, France

    Olivier Chosidow & Saskia Ingen-Housz-Oro

Authors
  1. Emilie Perron
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  2. Alice Viarnaud
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  3. Lea Marciano
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  4. Raymond Karkouche
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  5. Janine Wechsler
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  6. Nicolas De Prost
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  7. Olivier Chosidow
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  8. Pierre Wolkenstein
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  9. Saskia Ingen-Housz-Oro
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  10. Nicolas Ortonne
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Corresponding author

Correspondence to Saskia Ingen-Housz-Oro.

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Perron, E., Viarnaud, A., Marciano, L. et al. Clinical and histological features of fixed drug eruption: a single-centre series of 73 cases with comparison between bullous and non-bullous forms. Eur J Dermatol 31, 372–380 (2021). https://doi.org/10.1684/ejd.2021.4051

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  • DOI: https://doi.org/10.1684/ejd.2021.4051

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