Bullous Non-Pigmenting Fixed Drug Eruption

Figure

A man in his fourth decade presented with recurrent erythematous patches and bullae on the glans penis for 3 years, previously managed as balanoposthitis and contact dermatitis. He had taken etoricoxib irregularly for musculoskeletal pain. Skin examination revealed flaccid bullae on the glans without pigmentary changes. A 6-mg oral challenge with etoricoxib induced bullae within 2 hours, confirming etoricoxib-induced bullous non-pigmenting fixed drug eruption (NPFDE). Six months after discontinuation of etoricoxib no lesions were present. Fixed drug eruption (FDE) is a cutaneous reaction recurring at identical sites and healing with residual pigmentation upon re-exposure to the offending drug. It commonly involves the glans penis (cotrimoxazole, fluoroquinolones, tetracycline, nicorandil, etc.) and other mucocutaneous areas. Recognition of atypical FDE variants presenting with bullous or non-pigmenting features (pseudoephedrine, paracetamol, etoricoxib, ibuprofen, dextromethorphan, etc.) facilitates precise diagnosis and prevents unnecessary interventions.

Min-Yu Qian, MD, Cheng Tan, Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing,China, [e-mail]

Conflict of interest statement: The authors state that no conflict of interest exists.

Cite this as: Qian MY, Tan C: Bullous non-pigmenting fixed drug eruption. Dtsch Arztebl Int 2025; 122: 510b. DOI: 10.3238/arztebl.m2025.0139