Track

Case Reports

Abstract

We report a novel case of bullous fixed drug eruption from topical occupational exposure. A 24-year-old African-American woman with severe and episodic chronic oral aphthosis of unknown etiology, for which she follows with rheumatology, presented to dermatology for a painful eruption after she worked on a new line at her new job – a company that processes powdered medications. On exam her right elbow had a large erythematous and hyperpigmented plaque with central ulceration. The border was hypopigmented and erythematous with small coalescing vesicles in a circumferential distribution. Punch biopsy demonstrated vacuolar interface changes and vesiculation with necrotic keratinocytes and prominent melanophages, compatible with bullous fixed drug eruption. Over the next two years, the patient continued to develop additional painful bullae, that healed with well demarcated hyperpigmented patches, only on skin that was not covered by her work uniform. Eruptions only occurred when she was pulled to work on lines packaging the following medications: gentamicin, glycopyrrolate, protamine sulfate, and hydralazine. Repeat biopsy was consistent with fixed drug eruption, further confirming the diagnosis. We present this case as a novel presentation of fixed drug eruption. To our knowledge, there are no published cases of bullous fixed drug eruption to topical drug exposures in the literature.