The many faces of fixed drug eruptions Wiele twarzy rumienia trwa ego

Fixed drug eruption (FDE) is a form of presentation of recurrent cutaneous drug reaction characterized by appearance of single or multiple erythematous annular hyperpigmented macules/patch or bullae that appears each time at the same site whenever the offending drug is used. The lesion heals each time with typical post inflammatory hyperpigmentation. Diagnosis is based on drug history, drug associated excercebations and remissions, clinical presentations of typical polycyclic lesions with lack of systemic symptoms, drug challenge, skin tests and histology of skin biopsy. Diagnosis may not always easy. Unusual and atypical cases of FDE have been reported to raise awareness and raise index of suspicion in non classical or altered lesions. We report seven different presentations of Fixed Drug eruptions in a Nigerian population presenting in our skin clinic. The possibility of variant lesions occurring in Fixed Drug Eruptions is hereby highlighted. Typical lesions of FDE can be altered secondarily by chronicity and application of some topical agents before the patient presents making correct diagnosis difficult. We suggest that attending dermatologist be aware and have these unusual presentations of FDE in mind while making a diagnosis. The role of detailed accurate and precise history taking in these cases cannot be overemphasized.