Genital fixed drug eruption: cross-reactivity between doxycycline and minocycline

• Type: Another Publication in an International Scientific Journal
• Date: 1999

Authors

correia, o (Author) Other; delgado, l (Author) FMUP; polonia, j (Author) FMUP

Journal

Title: Clinical and Experimental Dermatology

Vol. 24

Pages: 137-137

ISSN: 0307-6938

Publisher: Wiley-Blackwell

Indexing

ISI Web of Knowledge - 18 Citations

Scopus - 23 Citations

Scientific classification

FOS: Medical and Health sciences > Clinical medicine

Other information

Authenticus ID: P-001-4YJ

DOI: 10.1046/j.1365-2230.1999.00436.x

Abstract (EN): Tetracyclines are a well recognized cause of fixed drug eruptions (FDE). Although cross-reactivity has been described between tetracycline-type drugs, a lack of cross-sensitivity between tetracycline, doxycycline and minocycline has also been reported. We now report a case of FDE after minocycline in a patient with a previous FDE due to doxycyline. A 48-year-old man with an unspecified urethritis was treated with doxycycline 100 mg twice daily. At the end of the first day he complained of an erythematous patch of the glans penis with burning and itching, and by the next day it had become bullous and eroded. He stopped doxycyline and was cured easily with symptomatic treatment. Eight months later he was treated with minocycline 100 mg once a day for rosacea; at the time he was not taking any other medication. A few hours after taking the first tablet, oval erythematous patches, 1-2 cm in diameter appeared on the glans, prepuce and scrotum; these patches rapidly became violaceous and developed superficial erosions. No other skin or mucous membrane lesions appeared. He stopped the medication and rapidly improved with potassium permanganate soaks and a topical steroid cream. FDE are peculiar cutaneous eruptions characterized by solitary or multiple, round or oval, erythematous patches which are variable in size and progressively become dusky violaceous or brown in colour; some of them develop bulla or superficial erosions. They characteristically appear in the same site each time the responsible drug is administered, although the number of involved sites and the size of the lesions may increase with repeated exposures. The lesions usually develop 30 min to 8 h after drug administration with itching or burning, and fade over a period of 1-2 weeks with crusting and scaling followed by hyperpigmentation that may persist for months. Lesions are more frequent on the limbs than on the trunk but mucous membrane lesions, in particular genital lesions, are not unusual. Male genital FDE are more frequent on the glans or coronal sulcus but the shaft or scrotum may also be involved. A high number of drugs can induce FDE, but in a male genital case series the more commonly implicated drugs were cotrimoxazole, tetracycline and ampicillin. When the medical history is not enough to incriminate the drug, epicutaneous occlusive or, ideally, open testing can identify the drug responsible, and avoid an oral provocation test. FDE to doxycycline and minocycline has been reported but a lack of cross-sensitivity between them has been emphasized. To our knowledge this is the first report of a case of FDE after minocycline in a patient with a previous FDE due to doxycyline. Clinicians must be aware of the potential cross-sensitivity when prescribing these two tetracycline-like drugs that are widely used in the treatment of skin disorders.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 1