Bullous fixed drug eruptions consequent to NSAID usage − a case series

Fixed drug eruption (FDE) is a distinct, delayed type-IV hypersensitivity manifesting as recurring cutaneous reaction (on skin or mucosa) in the same locations on re-exposure to the offending drug. This is most commonly due to oral medications, antimicrobials and NSAIDs being the most common culprits. Herein, we discuss six cases of bullous FDE due to diverse NSAIDs. The first case was Naproxen-induced bullous fixed drug eruption (BFDE), the second case was due to Etoricoxib, the third patient had Mefenamic acid-induced BFDE, the fourth was Ibuprofen-induced FDE, the fifth one was Diclofenac-induced BFDE, the sixth was Aceclofenac-induced BFDE, and the seventh was a case of paracetamol-induced BFDE. All these patients noticed skin reactions that were clinically diagnosed by the dermatologist as NSAID-induced BFDE. The mainstay of treatment adopted was to avoid the culprit drug. All the seven patients were treated with oral steroids, followed by antihistaminics for reducing FDE-associated pruritus, ointment soframycin, and topical steroids for hyperpigmented lesions. Prompt diagnosis of BFDE and drug withdrawal at the clinician side may help in rapid resolution of the reaction within days to delayed recovery within few weeks, thus preventing rise in morbidity and mortality.