Fixed Drug Eruption

FDE appears to be an extremely rare occurrence on the anogenital skin in females, whereas it is reasonably well documented in males. The author has only seen one case, which involved the mons pubis, buttocks, and nongenital sites because of fluconazole (Fig. 25A and B). The patient was treated for recurrent "thrush'' with oral fluconazole and developed urticated erythematous plaques on the trunk and anogenital skin. There were no further problems on discontinuation of the repeated doses of fluconazole.

Postinflammatory pigmentation is often a striking feature of a FDE. Pigmentary changes can be the sequelae of inflammatory conditions of the vulva and may result in hypopigmentation or hyperpigmentation (Fig. 26). The hyperpigmentation may be because of either hemosiderin, which results in a reddish-brown discoloration, or melanin. The hemosiderin deposition is a result of extravasation of red blood cells and is seen in capillaritis, urethral caruncles, LS, Zoon's vulvitis, and chronic vulvar purpura. Melanin pigmentation is most frequently seen following inflammatory conditions where there is a disruption of the dermoepidermal junction and the melanin pigment has dropped down into the upper dermis. It is commonly seen with LP and very occasionally with LS (Table 13).

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