Fixed drug eruption due to ibuprofen

Fixed drug eruptions due to ibuprofen have rarely been described. Two days after treatment with ibuprofen, a 61-year-old woman developed erythema and pain affecting the tongue and oral mucosa. Two months later, the patient started ibuprofen and erythromycin for a catarrhal episode with reappearance of the same lesions in the oral mucosa 24 hours later. Furthermore, two new erythematosus-violaceous maculae developed. Topical challenge through an occluded patch test with ibuprofen 5 % on the residual cutaneous lesion was positive. We present an unusual case of fixed drug eruption due to ibuprofen.

Rara vez se ha descrito algún caso de erupción fija medicamentosa debida al ibuprofeno. Una paciente de 61 años de edad, presentó eritema y dolor que afectaban a la lengua y la mucosa oral, dos días después de haber tomado ibuprofeno. Dos meses después, por un episodio catarral, volvió a tomar ibuprofeno además de eritromicina. Veinticuatro horas después reaparecieron las lesiones de la mucosa oral y además dos maculas eritemato-vesiculosas. La provocación tópica con prueba del parche con ibuprofeno al 5% sobre la lesión cutánea residual, resultó positiva, confirmando la causalidad de ese medicamento en la reacción atópica.

INTRODUCTION

Ibuprofen is a NSAID drug belonging to the arilpropionic group. Skin reactions to ibuprofen include urticaria, angioedema, contact dermatitis, and photosensitivity ^1-3. FDE due to ibuprofen has been rarely described.

MATERIALS AND METHODS

A 61-year-old woman, without allergic history. Two days after treatment with ibuprofen and erytromicine, for a dental infection, she presented erythema and pain affecting her tongue and oral mucosa with an oral bullous lesion in palatine mucosa. Drugs were discontinued and lesions resolve in two weeks with oral corticosteroids. Two months later, for a catarrhal episode, she started treatment with ibuprofen and erythomicine. 24 hours later the same lesions in oral mucosa reappeared and furthermore, two new erythematosus-violaceous maculae of 3 cm of diameter developed in thorax and thigh that evolved to blisters, and remained for two weeks, leaving a residual hyperpigmentation.

RESULTS

Topical challenged by occluded patch test with ibuprofen 5 % (Solvium gel^® Chefaro, Spain) and erytromicine (0.5 % in petrolatum) on residual cutaneous lesion, resulted positive with ibuprofen eliciting 24 hours later an erythematosus-violaceous lesion (2 × 1.5 cm). Single blind oral challenged test with erytromicine was negative.

DISCUSSION

There are many reports of FDE caused by NSAID, mainly pirazolones, oxicams or aspirin, but FDE due to ibuprofen has been exceptionally described.

Kanwar et al ³ analysed 98 cases of FDE who were subjected to oral provocation test. In only 6 of them ibuprofen was confirmed as the responsible drug. Diaz Jara et al reported one case of FDE due to ibuprofen confirmed by oral challenge test with a positive patch test on affected skin with ibuprofen 5 % in a 5-year-old boy treated for infection of respiratory tract with ibuprofen suspension ⁴. Khalid Al Aboud et al described a case of a father and his son, both with recurrent episodes of FDE due to ibuprofen. The diagnosis was made by clinical evaluation of cutaneous lesions and confirmed by skin biopsy.

We present an unusual case of FDE to ibuprofen. This is the second case reported diagnosed by positive epicutaneous test on residual lesion. In our case, patch test with a commercial topical ibuprofen drug was useful for diagnosis.

---

Correspondence:
Vanesa Tovar Flores
Hospital Gregorio Marañón
Unidad de Alergia. Madrid
E-mail: [e-mail]