Fixed Drug Eruption in Children: a 24-Year, Single-center, Retrospective Cohort Study from Turkey

Goncagül Babuna; Esen Özkaya

doi:10.26650/jchild.2021.925276

Research Article

Fixed Drug Eruption in Children: a 24-Year, Single-center, Retrospective Cohort Study from Turkey

Year 2021, , 142 - 148, 20.09.2021

Goncagül Babuna , Esen Özkaya

https://doi.org/10.26650/jchild.2021.925276

Abstract

Objective: Fixed drug eruption (FDE), although a common type of drug eruption affecting all ages, has rarely been reported in children. This study aimed to investigate the characteristics of pediatric patients with FDE diagnosed in a tertiary referral center from Turkey. Material and Methods: A single-center, retrospective cohort study based on the analysis of data of patients with an established diagnosis of FDE between 1996-2019, using standard forms prepared for the purpose of precise clinical documentation. Results: The overall prevalence of pediatric FDE was 10.4% (n=22/212). Cotrimoxazole was the leading sensitizer before 2003, whereas non- steroidal anti-inflammatory drugs (mainly naproxen) predominated thereafter. Phenobarbital in suppositories for fever was another important cause of pediatric FDE in younger children. The most frequently involved site was the trunk (68.2%), followed by the lips (54.5%), and extremities (45.5%). Cotrimoxazole was the leading causative agent in every location, except for phenobarbital in perioral area. Oral mucosa was involved in 36.4% of the patients, mainly with multiple lesions involving inner lip mucosa (75.0%). Its major morphological form was bullous/erosive (50.0%). Genital mucosa was less commonly (31.8%) involved. Among 9 children with cotrimoxazole-induced FDE, 5 (55.6%) were positive for complete haplotype (HLA-A30 B13 Cw6) or separate antigens (HLA-A30 or HLA-Cw6), supporting a possible link between cotrimoxazole-induced FDE and HLA-A30. Conclusion: This study showed that FDE is a common type of drug eruption in the pediatric population. Clinical findings, drug-specific site involvement, and most common inducers of FDE in children seem to be largely similar to those in adults.

Keywords

Children, cotrimoxazole, fixed drug eruption, non-steroidal anti-inflammatory drugs, naproxen, pediatric

Supporting Institution

None

Project Number

None

Thanks

None

References

1. Özkaya E. Fixed drug eruption: state of the art. J Dtsch Dermatol Ges 2008;6(3):181-8. google scholar
2. Waldman R, Whitaker-Worth D, Grant-Kels JM. Cutaneous adverse drug reactions: Kids are not just little people. Clin Dermatol 2017;35(6):566-82. google scholar
3. Nguyen E, Gabel CK, Yu J. Pediatric drug eruptions. Clin Dermatol 2020;38(6):629-40. google scholar
4. Özkaya E. Changing trends in inducer drugs of fixed drug eruption: a 20-year cross-sectional study from Turkey. J Dtsch Dermatol Ges 2018;16(4):474-6. google scholar
5. Ozkaya-Bayazit E. Specific site involvement in fixed drug eruption. J Am Acad Dermatol 2003;49(6):1003-7. google scholar
6. Özkaya E. Oral mucosal fixed drug eruption: characteristics and differential diagnosis. J Am Acad Dermatol 2013;69(2):e51-8. google scholar
7. Kanwar AJ, Bharija SC, Belhaj MS. Fixed drug eruptions in children: a series of 23 cases with provocative tests. Dermatologica 1986;172(6):315-8. google scholar
8. Morelli JG, Tay YK, Rogers M, Halbert A, Krafchik B, Weston WL. Fixed drug eruptions in children. J Pediatr 1999;134(3):365-7. google scholar
9. Nussinovitch M, Prais D, Ben-Amitai D, Amir J, Volovitz B. Fixed drug eruption in the genital area in 15 boys. Pediatr Dermatol 2002;19(3):216-9. google scholar
10. Özkaya E, Kutlay A. Suppositories for fever as a major risk for phenobarbital-induced fixed drug eruption in children. J Eur Acad Dermatol Venereol 2017;31(10):e443-4. google scholar
11. Ozkaya-Bayazit E, Akar U. Fixed drug eruption induced by trimethoprim-sulfamethoxazole: evidence for a link to HLA-A30 B13 Cw6 haplotype. J Am Acad Dermatol 2001;45(5):712-7. google scholar
12. Khaled A, Kharfi M, Ben Hamida M, El Fekih N, El Aidli S, Zeglaoui F, et al. Cutaneous adverse drug reactions in children. A series of 90 cases. Tunis Med 2012;90(1):45-50. google scholar
13. Sharma VK, Dhar S. Clinical pattern of cutaneous drug eruption among children and adolescents in north India. Pediatr Dermatol 1995;12(2):178-83. google scholar
14. Mahboob A, Haroon TS. Drugs causing fixed eruptions: a study of 450 cases. Int J Dermatol 1998;37(11):833-8. google scholar
15. Bharija SC, Singh M, Belhaj MS. Fixed drug eruption in an 8-month-old infant. Dermatologica 1988;176(2):108. google scholar
16. Dogra S, Handa S. Bullous necrotizing fixed drug eruption in an infant. Pediatr Dermatol 2004;21(3):281-2. google scholar
17. Pellicano R, Silvestris A, Iannantuono M, Ciavarella G, Lomuto M. Familial occurrence of fixed drug eruptions. Acta Derm Venereol 1992;72(4):292-3. google scholar
18. Pellicano R, Ciavarella G, Lomuto M, Di Giorgio G. Genetic susceptibility to fixed drug eruption: evidence for a link with HLA-B22. J Am Acad Dermatol 1994;30(1):52- 4. google scholar
19. Ozkaya-Bayazit E, Akar U. Fixed drug eruption induced by trimethoprim-sulfamethoxazole: evidence for a link to HLA-A30 B13 Cw6 haplotype. J Am Acad Dermatol 2001;45(5):712-7. google scholar
20. Ozkaya E, Babuna G. A challenging case: Symmetrical drug related intertriginous and flexural exanthem, fixed drug eruption, or both? Pediatr Dermatol 2011;28(6):711-4. google scholar
21. Mohamed KB. Fixed drug eruption associated with co-trimoxazole. J Pediatr 1999;135(3):396. google scholar
22. Agnich LE, Stogner JM, Miller BL, Marcum CD. Purple drank prevalence and characteristics of misusers of codeine cough syrup mixtures. Addict Behav 2013;38(9):2445-9. google scholar

Çocuklarda Görülen Fiks İlaç Erüpsiyonu: Türkiye’den 24-Yıllık, Tek Merkezli, Retrospektif Bir Çalışma

Year 2021, , 142 - 148, 20.09.2021

Goncagül Babuna , Esen Özkaya

https://doi.org/10.26650/jchild.2021.925276

Abstract

Amaç: Fiks ilaç erüpsiyonu (FİE), sık görülen ve her yaşı etkileyebilen bir ilaç döküntüsü olmasına rağmen çocuklarda nadiren bildirilmiştir. Çalışmamızda, Türkiye’de üçüncü basamak bir referans merkezde FİE tanısı konulmuş olan pediatrik hastaların karakteristik özelliklerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Bu tek-merkezli, retrospektif kohort çalışması, kliniğimizde 1996-2019 yılları arasında FİE tanısı konularak takip ve tedavi edilen çocuk hastaların, standart olarak hazırlanmış hasta takip formlarındaki verilerinin analiz edilmesiyle gerçekleştirilmiştir. Bulgular: Çalışmamızda pediatrik FİE’nin genel prevalansı %10,4 (n=22/212) olarak bulundu. Çocuklarda FİE’nin en sık nedeni 2003 yılın- dan önce kotrimoksazol iken daha sonraki yıllarda non-steroidal antienflamatuvar ilaçlar (özellikle naproksen) ön plandaydı. Ateş düşürücü supozituvarlar içinde bulunan fenobarbital de özellikle küçük çocuklarda FİE’nin bir diğer önemli nedeniydi. Çocuklarda en çok tutulan alanlar sırasıyla gövde (%68,2), dudaklar (%54,5) ve ekstremiteler (%45,5) olarak bulundu. Hemen her bölgede FİE’nin en sık nedeni kotrimoksazol iken, perioral bölgede fenobarbitaldi. Çocukların %36,4’ünde oral mukoza tutulumu görüldü. Oral mukoza lezyonları genellikle multiple olup iç dudak mukozasını tutmaktaydı (%75,0) ve en sık görülen morfolojik formu büllöz/erozif (50,0%) idi. Çocuklarda genital mukoza tutulumuna daha nadir (%31,8) rastlandı. Kotrimoksazole-bağlı FİE’si olan ve HLA tiplendirilmesi yapılan 9 çocuktan 5’inde (%55,6) komplet haplotip (HLA- A30 B13 Cw6) veya tek başına antijen (HLA-A30 veya HLA-Cw6) pozitiflikleri saptandı. Bu bulgu, kotrimoksazole bağlı FİE ile HLA-A30 arasında potansiyel bir ilişki olduğunu destekler nitelikteydi. Sonuç: Çalışmamız, FİE’nin pediatrik yaş grubunda sık görülen bir ilaç erüpsiyonu olduğunu ortaya koymuştur. Ayrıca, çocuklarda görülen FİE’nin, klinik bulgular, ilaca-spesifik bölge tutulumu ve en sık neden olan ilaçlar açısından erişkinlerde görülen FİE’ye büyük ölçüde benzerlik gösterdiği saptanmıştır.

Keywords

Çocuklar, fiks ilaç erüpsiyonu, kotrimoksazol, non- steroidal antienflamatuvar ilaçlar, naproksen, pediatrik

Project Number

None

References

1. Özkaya E. Fixed drug eruption: state of the art. J Dtsch Dermatol Ges 2008;6(3):181-8. google scholar
2. Waldman R, Whitaker-Worth D, Grant-Kels JM. Cutaneous adverse drug reactions: Kids are not just little people. Clin Dermatol 2017;35(6):566-82. google scholar
3. Nguyen E, Gabel CK, Yu J. Pediatric drug eruptions. Clin Dermatol 2020;38(6):629-40. google scholar
4. Özkaya E. Changing trends in inducer drugs of fixed drug eruption: a 20-year cross-sectional study from Turkey. J Dtsch Dermatol Ges 2018;16(4):474-6. google scholar
5. Ozkaya-Bayazit E. Specific site involvement in fixed drug eruption. J Am Acad Dermatol 2003;49(6):1003-7. google scholar
6. Özkaya E. Oral mucosal fixed drug eruption: characteristics and differential diagnosis. J Am Acad Dermatol 2013;69(2):e51-8. google scholar
7. Kanwar AJ, Bharija SC, Belhaj MS. Fixed drug eruptions in children: a series of 23 cases with provocative tests. Dermatologica 1986;172(6):315-8. google scholar
8. Morelli JG, Tay YK, Rogers M, Halbert A, Krafchik B, Weston WL. Fixed drug eruptions in children. J Pediatr 1999;134(3):365-7. google scholar
9. Nussinovitch M, Prais D, Ben-Amitai D, Amir J, Volovitz B. Fixed drug eruption in the genital area in 15 boys. Pediatr Dermatol 2002;19(3):216-9. google scholar
10. Özkaya E, Kutlay A. Suppositories for fever as a major risk for phenobarbital-induced fixed drug eruption in children. J Eur Acad Dermatol Venereol 2017;31(10):e443-4. google scholar
11. Ozkaya-Bayazit E, Akar U. Fixed drug eruption induced by trimethoprim-sulfamethoxazole: evidence for a link to HLA-A30 B13 Cw6 haplotype. J Am Acad Dermatol 2001;45(5):712-7. google scholar
12. Khaled A, Kharfi M, Ben Hamida M, El Fekih N, El Aidli S, Zeglaoui F, et al. Cutaneous adverse drug reactions in children. A series of 90 cases. Tunis Med 2012;90(1):45-50. google scholar
13. Sharma VK, Dhar S. Clinical pattern of cutaneous drug eruption among children and adolescents in north India. Pediatr Dermatol 1995;12(2):178-83. google scholar
14. Mahboob A, Haroon TS. Drugs causing fixed eruptions: a study of 450 cases. Int J Dermatol 1998;37(11):833-8. google scholar
15. Bharija SC, Singh M, Belhaj MS. Fixed drug eruption in an 8-month-old infant. Dermatologica 1988;176(2):108. google scholar
16. Dogra S, Handa S. Bullous necrotizing fixed drug eruption in an infant. Pediatr Dermatol 2004;21(3):281-2. google scholar
17. Pellicano R, Silvestris A, Iannantuono M, Ciavarella G, Lomuto M. Familial occurrence of fixed drug eruptions. Acta Derm Venereol 1992;72(4):292-3. google scholar
18. Pellicano R, Ciavarella G, Lomuto M, Di Giorgio G. Genetic susceptibility to fixed drug eruption: evidence for a link with HLA-B22. J Am Acad Dermatol 1994;30(1):52- 4. google scholar
19. Ozkaya-Bayazit E, Akar U. Fixed drug eruption induced by trimethoprim-sulfamethoxazole: evidence for a link to HLA-A30 B13 Cw6 haplotype. J Am Acad Dermatol 2001;45(5):712-7. google scholar
20. Ozkaya E, Babuna G. A challenging case: Symmetrical drug related intertriginous and flexural exanthem, fixed drug eruption, or both? Pediatr Dermatol 2011;28(6):711-4. google scholar
21. Mohamed KB. Fixed drug eruption associated with co-trimoxazole. J Pediatr 1999;135(3):396. google scholar
22. Agnich LE, Stogner JM, Miller BL, Marcum CD. Purple drank prevalence and characteristics of misusers of codeine cough syrup mixtures. Addict Behav 2013;38(9):2445-9. google scholar

There are 22 citations in total.

Details

Primary Language	English
Subjects	Paediatrics
Journal Section	Research Articles
Authors	Goncagül Babuna 0000-0002-0985-5027 Esen Özkaya 0000-0002-9585-9509
Project Number	None
Publication Date	September 20, 2021
Published in Issue	Year 2021

Cite

APA	Babuna, G., & Özkaya, E. (2021). Fixed Drug Eruption in Children: a 24-Year, Single-center, Retrospective Cohort Study from Turkey. Çocuk Dergisi, 21(2), 142-148. https://doi.org/10.26650/jchild.2021.925276
AMA	Babuna G, Özkaya E. Fixed Drug Eruption in Children: a 24-Year, Single-center, Retrospective Cohort Study from Turkey. Çocuk Dergisi. September 2021;21(2):142-148. doi:10.26650/jchild.2021.925276
Chicago	Babuna, Goncagül, and Esen Özkaya. “Fixed Drug Eruption in Children: A 24-Year, Single-Center, Retrospective Cohort Study from Turkey”. Çocuk Dergisi 21, no. 2 (September 2021): 142-48. https://doi.org/10.26650/jchild.2021.925276.
EndNote	Babuna G, Özkaya E (September 1, 2021) Fixed Drug Eruption in Children: a 24-Year, Single-center, Retrospective Cohort Study from Turkey. Çocuk Dergisi 21 2 142–148.
IEEE	G. Babuna and E. Özkaya, “Fixed Drug Eruption in Children: a 24-Year, Single-center, Retrospective Cohort Study from Turkey”, Çocuk Dergisi, vol. 21, no. 2, pp. 142–148, 2021, doi: 10.26650/jchild.2021.925276.
ISNAD	Babuna, Goncagül - Özkaya, Esen. “Fixed Drug Eruption in Children: A 24-Year, Single-Center, Retrospective Cohort Study from Turkey”. Çocuk Dergisi 21/2 (September 2021), 142-148. https://doi.org/10.26650/jchild.2021.925276.
JAMA	Babuna G, Özkaya E. Fixed Drug Eruption in Children: a 24-Year, Single-center, Retrospective Cohort Study from Turkey. Çocuk Dergisi. 2021;21:142–148.
MLA	Babuna, Goncagül and Esen Özkaya. “Fixed Drug Eruption in Children: A 24-Year, Single-Center, Retrospective Cohort Study from Turkey”. Çocuk Dergisi, vol. 21, no. 2, 2021, pp. 142-8, doi:10.26650/jchild.2021.925276.
Vancouver	Babuna G, Özkaya E. Fixed Drug Eruption in Children: a 24-Year, Single-center, Retrospective Cohort Study from Turkey. Çocuk Dergisi. 2021;21(2):142-8.

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