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Fixed drug eruption: topical provocation and subsequent phenomena

Journal Article:

Abstract

To determine the usefulness of topical provocation in detecting the incriminated drug causing fixed eruption. Three hundred and five, clinically diagnosed cases of Fixed Drug Eruption (FDE) of either gender and of any age were subjected to topical provocation with different drugs by using concentration of 1% (n=203), 2% (n=210) and 5% (n=235) in white soft paraffin. Drug ointment of one strength was applied one at a time on normal skin of flexor surface of right or left forearm. The effects of tests on involved and uninvolved skin were observed for 48 hours. The changes in lesions like erythema, hyperpigmentation, itching, burning or appearance of new lesion were considered a positive response. In case of no change, the patients (n=5) were subjected to oral provocation test, by giving half to full therapeutic dose of the suspected drug depending upon the severity of the initial attack. A patient who exhibited see-sawing phenomenon with 5% metamizole TPT was given oral challenge with same drug. Control topical tests were repeated in equal number of normal persons with various drug ointments and in patients of FDE with white soft paraffin on normal and affected skin. One hundred and thirty-seven patients were males and one  More>>
Authors:
Mahboob, A; Haroon, T S; [1]  Haroon, T S; [2]  Iqbal, Z; Iqbal, F [3] 
  1. Shaikh Zayed FPGMI, Lahore (Pakistan). Dept. of Dermatology
  2. King Edward Medical Univ., Lahore (Pakistan). Dept. of Dematology
  3. Shaikh Zayed FPGMI, Lahore (Pakistan). Dept. of Medicine
Publication Date:
Dec 15, 2006
Product Type:
Journal Article
Resource Relation:
Journal Name: JCPSP. Journal of the College of Physicians and Surgeons Pakistan; Journal Volume: 16; Journal Issue: 12
Subject:
60 APPLIED LIFE SCIENCES; DIAGNOSIS; ERYTHEMA; PARAFFIN; PATIENTS; PLAQUE FORMATION; SKIN
OSTI ID:
20873011
Country of Origin:
Pakistan
Language:
English
Other Identifying Numbers:
Journal ID: ISSN 1022-386X; TRN: PK0700177040996
Submitting Site:
INIS
Size:
page(s) 747-750
Announcement Date:
Jun 06, 2007

Journal Article:

Citation Formats

Mahboob, A, Haroon, T S, Haroon, T S, Iqbal, Z, and Iqbal, F. Fixed drug eruption: topical provocation and subsequent phenomena. Pakistan: N. p., 2006. Web.
Mahboob, A, Haroon, T S, Haroon, T S, Iqbal, Z, & Iqbal, F. Fixed drug eruption: topical provocation and subsequent phenomena. Pakistan.
Mahboob, A, Haroon, T S, Haroon, T S, Iqbal, Z, and Iqbal, F. 2006. "Fixed drug eruption: topical provocation and subsequent phenomena." Pakistan.
@misc{etde_20873011,
title = {Fixed drug eruption: topical provocation and subsequent phenomena}
author = {Mahboob, A, Haroon, T S, Haroon, T S, Iqbal, Z, and Iqbal, F}
abstractNote = {To determine the usefulness of topical provocation in detecting the incriminated drug causing fixed eruption. Three hundred and five, clinically diagnosed cases of Fixed Drug Eruption (FDE) of either gender and of any age were subjected to topical provocation with different drugs by using concentration of 1% (n=203), 2% (n=210) and 5% (n=235) in white soft paraffin. Drug ointment of one strength was applied one at a time on normal skin of flexor surface of right or left forearm. The effects of tests on involved and uninvolved skin were observed for 48 hours. The changes in lesions like erythema, hyperpigmentation, itching, burning or appearance of new lesion were considered a positive response. In case of no change, the patients (n=5) were subjected to oral provocation test, by giving half to full therapeutic dose of the suspected drug depending upon the severity of the initial attack. A patient who exhibited see-sawing phenomenon with 5% metamizole TPT was given oral challenge with same drug. Control topical tests were repeated in equal number of normal persons with various drug ointments and in patients of FDE with white soft paraffin on normal and affected skin. One hundred and thirty-seven patients were males and one hundred and sixty-eight patients were females. Maximum number of patients belonged to third decade. With 1% drug preparations 12 out of 316, with 2% drug preparations 28 out of 422 and with 5% drug preparations, 312 out of 523 TPTs were positive. The comparison revealed a highly significant association (Chi-square 448.1 and p<0.000) among various strengths of preparations and positive response. Sulphamethoxazole was found to be the most commonly incriminated cause of FDE applied in 5% concentration yielded sensitivity rate of 91% compared to 4% with lower concentrations. Positive patch test was also observed with oxytetracycline. Five patients who were given oral provocation with different drugs were found to be positive to tinidazole, dapsone, propylphenazone, belladonna and phenobarbitone. Interesting phenomena like earlier reactivation of lesion situated distal to site of application of preparation, marching, see-sawing (with oral metamizole) and lightening observed, are not yet reported in literature. (author)}
journal = {JCPSP. Journal of the College of Physicians and Surgeons Pakistan}
issue = {12}
volume = {16}
place = {Pakistan}
year = {2006}
month = {Dec}
}