• Physical Examination Skills
    • General Examination
    • Examination of the Cardiovascular System
    • Examination of the Gastrointestinal System
    • Examination of the Neurological System
    • Examination of the Respiratory System
    • Examination of the Musculoskeletal System
    • Demonstration on putting on a surgical/ N95 mask properly
  • eLearning Materials of Individual Divisions
    • Cardiology
    • Clinical Pharmacology
    • Dermatology
    • Endocrinology
    • Gastroenterology & Hepatology
    • Geriatrics
      • Common Physical Signs in the Geriatric Setting
      • Commonly used Assessments in the Geriatric Setting
    • Haematology
    • Infectious Diseases
    • Nephrology
      • General Nephrology
      • Imaging
      • Peritoneal Dialysis
      • Hemodialysis
    • Neurology
    • Rehabilitation Medicine
      • Modified Ashworth Scale
      • Complex Regional Pain Syndrome
      • Case 1
      • Case 2
    • Respiratory Medicine
    • Rheumatology
      • Common Rheumatological Cases
      • Clinical Signs and Radiographs of Patients with Rheumatological Disorders
  • Credits
The HKU E-learning Platform in Clinical Medicine
The HKU E-learning Platform in Clinical Medicine
  • Physical Examination Skills
    • General Examination
    • Examination of the Cardiovascular System
    • Examination of the Gastrointestinal System
    • Examination of the Neurological System
    • Examination of the Respiratory System
    • Examination of the Musculoskeletal System
    • Demonstration on putting on a surgical/ N95 mask properly
  • eLearning Materials of Individual Divisions
    • Cardiology
    • Clinical Pharmacology
    • Dermatology
    • Endocrinology
    • Gastroenterology & Hepatology
    • Geriatrics
      • Common Physical Signs in the Geriatric Setting
      • Commonly used Assessments in the Geriatric Setting
    • Haematology
    • Infectious Diseases
    • Nephrology
      • General Nephrology
      • Imaging
      • Peritoneal Dialysis
      • Hemodialysis
    • Neurology
    • Rehabilitation Medicine
      • Modified Ashworth Scale
      • Complex Regional Pain Syndrome
      • Case 1
      • Case 2
    • Respiratory Medicine
    • Rheumatology
      • Common Rheumatological Cases
      • Clinical Signs and Radiographs of Patients with Rheumatological Disorders
  • Credits
Home
Dermatology

An Elderly Woman with a Recurrent Itchy, Circinate Rashes

November 17th, 2014

An Elderly Woman with a Recurrent Itchy, Circinate Rashes

A 78-year-old woman was admitted with multiple itchy lesions over the face, buttock and limbs. She had a recent upper respiratory tract infection and was given few “flu-medications” by her general practitioner. The rash appeared the next day after administration of these medications and she complained of an itchy, stinging sensation over the affected areas. The patient recalled that similar episodes of pruritic rash over the same locations had occurred a few times in the past 2 years.

On examination, there were multiple roundish, well-circumscribed patches noted over the right forehead, buttock and bilateral shins. The patches had a violaceous hue and significant hyperpigmentation was noted at around the lesions. There was no involvement of the mucous membrane.

Diagnosis

Fixed drug eruptions are characterized by solitary or multiple well-circumscribed, erythematous to violaceous patches, which may evolve into edematous plaques or bullas. Patients may complain of pruritus or a burning sensation at the site of the lesion. Typical sites include the face and external genitalia. Lesions typically resolve with significant post-inflammatory hyperpigmentation. The skin eruption tends to recur at exactly the same location after rechallenging by the offending drug.

Common inciting agents include antibiotics (e.g. penicillin, sulphonamides, tetracyclines, quinolones), non-steroidal anti-inflammatory drugs (e.g. piroxicam, ibuprofen, acetylsalicylic acid), barbiturates and phenolphthalein (active ingredients of many non-prescription laxatives). It is worthwhile to note that the active constituents of many commercially available preparations for common cold often contain potentially inciting agents such as acetaminophen, diphenhydramine and pseudoephedrine.

Management

The suspected drug should be withdrawn as soon as possible. The usual practice is to discontinue all drugs that are non-essential. Topical steroids may provide symptomatic relief to patients with significant pruritis or burning sensation.

Related Posts

Nov 16th, 2014

Painful Vesiculo-pustular Eruptions on the Buttock

Nov 19th, 2014

A Woman with Linear Thickening of Skin on Left Index and Middle Fingers

Nov 20th, 2014

A Man with Pustular Dermatosis, Peripheral Eosinophilia and Deranged Liver and Renal Function Tests

Nov 18th, 2014

A Middle-aged Man with “Dark Lines” over Fingernails

  • Click here - to select or create a menu