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Fixed Drug Eruption • the development of one or more annular or oval erythematous patches as a result of systemic exposure to a drug. • normally resolve with hyperpigmentation and may recur at the same site with reexposure to the drug. Erythema Multiforme Lesion •Begin as sharply marginated, erythematous macules, which become raised, edematous papules over 24 to 48 hours •“target” or “iris” lesion with 3 zones – central dusky purpura; an elevated, edematous, pale ring; and surrounding macular erythema Age of Predilection Young adults Site of Predilection dorsal hands, dorsal feet, extensor limbs, elbows and knees, and palms and soles Fixed Drug Eruption •Begins as a red patch that soon evolves to an iris or target lesion identical to erythema multiforme, and may eventually blister and erode •Nonpigmenting fixed drug eruption: large, tender, often symmetrical eythematous plaques Oral and genital mucosa Etiologic Factors Treatment Erythema Multiforme Fixed Drug Eruption Usually has non-drug causes, most commonly herpes simplex infection Genetic susceptibility with an increased incidence of HLAB22 •Prevention is cornerstone of treatment if HSV can be demonstrated as the trigger. •Sunblock creams •Antiherpetic antibiotic •Stop taking the offending drug. Patient Fixed Drug Eruption Multiple erythematous to skin-colored plaques and nodules (1.5x3.5 to 2.0x4.0 cm) Begins as a red patch that soon evolves to an iris or target lesion identical to erythema multiforme, and may eventually blister and erode Forehead, malar area, left ear, trunk, and extremities Oral and genital mucosa (+) Leonine facies (+) HPN, DM