The physician recognized this as a hyperpigmented fixed drug eruption (FDE) secondary to doxycycline. The FP asked the patient if she had ever taken doxycycline before. The patient did remember having an episode of bronchitis a year earlier, but couldn’t remember what medicine she’d taken at the time. The FP looked in her electronic medical record and found that she had been given doxycycline a year earlier, prior to the onset of the initial hyperpigmented rash.
FDEs occur with phenolphthalein, tetracycline, ibuprofen, sulfonamide antibiotics, and barbiturates. An FDE presents with single or multiple sharply demarcated circular, violaceous, edematous plaques that may include a central blister. The lesions appear after drug exposure and reappear exactly at the same site each time the drug is taken. The site resolves, leaving an area of macular hyperpigmentation.
Lesions can occur anywhere, including the hands and feet, but are commonly found on the glans penis in men. The eruption presents 30 minutes to 8 hours after drug administration.
This patient was told to never take doxycycline again and the FP recorded doxycycline as a new allergy in the patient's medical record.
Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. Photo courtesy of Jeffrey Meffert, MD. This case was adapted from: Allred A, Usatine R. Cutaneous drug reactions. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:869-877.
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