Track: Case Reports

Topic: Inflammatory Diseases

Abstract:

Fixed drug eruption (FDE) is a common recurrent cutaneous disorder presenting as single or multiple red to brown macules that can evolve into vesicular or blistering plaques. The hallmark of this diagnosis is the same-site recurrence shortly after re-exposure to the culprit drug. Perioral dermatitis (PD) is another common benign eruption occurring mostly in young-adult females. The classic clinical presentation is that of papulopustular or scaly patches most commonly around the mouth, as well as in the paranasal or periocular locations.

We report a case of a 20-year-old female suffering from an erythematous vesicular eruption involving the perioral region. She states that the rash recurs monthly, a day prior to her cycle. For her menstrual cramps, she acknowledges using an over-the-counter pain reliver containing acetaminophen, pamabrom, and pyrilamine maleat.

Spironolactone did not improve her presumed PD, and autoimmune progesterone dermatitis was excluded due to the non-classical presentation.

Therefore, to rule out FDE due to pamabrom, patch testing was performed and showed a positive reaction. To further support the diagnosis, a punch biopsy showed spongiotic dermatitis with interface changes, and a moderately dense superficial perivascular lymphohistiocytic infiltrate, with rare neutrophils and eosinophils. The overall histomorphologic and clinical features were consistent with a fixed drug eruption from pamabrom.

In conclusion, fixed drug eruption should always be in the differential diagnosis of any recurrent rash especially in patients taking over the counter medications.

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Simon Moubarak, MD