Fixed Drug Eruptions Due To/Caused by Levocetirizine and Cetirizine: An Uncommon Adverse Cutaneous Drug Reaction to Commonly Used Piperazine Derivatives
Abstract
Dear Editor, Piperazine derivative antihistamines like cetirizine and levocetirizine are commonly used anti-pruritic agents. Fixed drug eruption (FDE) is a rarely reported side effect of these drugs. Identification of causative agent becomes challenging since patients and doctors often do not suspect easily available and safe antihistamines. Here, we report three cases of FDE due to the piperazine class of antihistamines. Case 1 A 38 year old man presented with pigmented FDE on the trunk, upper arms, thighs [Figure 1] and lower lip. There had been five such episodes, the last being a year and a half back with medications for fever, cough, and sneezing. Suspected drugs included amoxicillin, paracetamol, etoricoxib, dextromethorphan and cetirizine.Figure 1: Case 1: Multiple large well-defined hyperpigmented patches on the trunk and armsCase 2 A 28 year old man developed bullous FDE over the palm [Figure 2], penile shaft and glans, after taking a drug for urticaria. There had been seven such episodes in the last 15 years associated with medications consumed for rhinitis and fever. Suspected drugs included cetirizine, levocetirizine, fexofenadine, hydroxyzine and loratadine.Figure 2: Case 2: Erythematous macule over right hand compared to the normal left palmCase 3 A 17 year old female presented with pigmented FDE on multiple sites [Figure 3] including the lips after taking medicines for recurrent sinusitis and generalized weakness. This was her fourth episode and the suspected…
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