Case and Research Letters
Fixed Drug Eruption Due to Etoricoxib in a Patient With Tolerance to Celecoxib: The Value of Patch Testing
Exantema fijo medicamentoso por etoricoxib con tolerancia a celecoxib. Utilidad de las pruebas epicutáneas
E. Gómez de la Fuente
, A. Pampín Franco, D. Caro Gutiérrez, J.L. López Estebaranz
Corresponding author
Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Gómez de la Fuente, A. Pampín Franco, D. Caro Gutiérrez, J.L. López Estebaranz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Gómez de la Fuente" "email" => array:1 [ 0 => "egomezf@fhalcorcon.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Pampín Franco" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Caro Gutiérrez" ] 3 => array:2 [ "nombre" => "J.L." "apellidos" => "López Estebaranz" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Exantema fijo medicamentoso por etoricoxib con tolerancia a celecoxib. Utilidad de las pruebas epicutáneas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 719 "Ancho" => 951 "Tamanyo" => 101345 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Positive patch test with etoricoxib at 10% in petrolatum in the area previously affected by the fixed drug eruption.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Etoricoxib is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase 2 (cox-2); it was introduced recently onto the market and is used widely. It has been implicated in several skin reactions and has been described as an uncommon cause of fixed drug eruption. We present a new case confirmed by patch testing.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 32-year-old woman with no relevant history of allergy. She came to our outpatients for evaluation of a pruritic and painful erythematous plaque measuring 1.5<span class="elsevierStyleHsp" style=""></span>cm on the cubital border of the left hand. The lesion had resolved leaving slight residual pigmentation. She reported 2 similar episodes that had occurred at the same site over the previous 3 months. The patient had taken various analgesics for episodes of pain secondary to a disc hernia. Those drugs had been ibuprofen, which she had taken again with no problem after the most recent skin reaction, and etoricoxib, which she had started to take 3 months earlier. Two months after the final episode, patch tests were performed on normal skin using the standard series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC), and an NSAID series (Marti Tor) that included celecoxib and etoricoxib (both at 10% in petrolatum). The results were negative. In addition, patches of 10% etoricoxib were applied to the site of the skin lesion, giving a positive result (++) at 48 and 96 hours (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A celecoxib patch was then applied to the previously damaged skin, with negative results, and controlled oral challenge with celecoxib was performed without observing any adverse reaction during the test or afterwards when taken regularly at the usual doses.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Etoricoxib combines a potent anti-inflammatory activity with a good safety profile. As with other drugs of the same family, such as celecoxib, it has been implicated in various skin reactions, although with a much lower frequency. There are reports of cases of urticaria and angioedema,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> generalized exanthematous pustulosis,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> exudative erythema multiforme,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> toxic epidermal necrolysis,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and fixed drug eruption.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Fixed drug eruption is an uncommon skin reaction in which numerous drugs have been implicated, the NSAIDS being among the most common.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a> Fixed reactions to the NSAIDs that inhibit cox-2 have been reported since their development but, in the case of etoricoxib, only 6 cases have been published.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–9</span></a> Diagnosis is based on the medical history and the characteristic skin lesions: 1 or several well-defined erythematous lesions, occasionally affecting mucosas, that appear not long after administration of the causative drug and that typically recur at the same site on rechallenge with the causative agent. However, the etiological diagnosis is occasionally more complex, as the patient can be taking numerous drugs or may be unaware of or have forgotten about a certain medicine. In these cases, an oral challenge test is the gold standard for making the diagnosis, but this is not risk-free, and reactions are occasionally severe. Patch testing is therefore a valid alternative, as it is a safe and non-invasive diagnostic method. These tests must be performed at least 6 weeks after resolution of the episode. Patches are applied both to healthy skin and to the skin at the site of previous damage, which is where positive results are usually obtained; positive results on healthy skin are very rare. The sensitivity of the test is variable and depends on the concentration, the vehicle used, the area affected, and, in particular, on the substance tested. In a retrospective study performed on 52 patients, a positive reaction was detected in 21 patients (40%); in all cases, the test was only positive on the previously affected skin and in all except one the implicated drug was an NSAID.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> A negative test does not exclude the diagnosis or the implication of the suspected drug, but a positive result confirms the diagnosis, avoiding the need for oral challenge, with its associated risks.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In our case, the imputation was confirmed by the patch test. Another pharmacologically similar molecule, celecoxib, is structurally different from etoricoxib, as it belongs to the sulfonamide family, whereas etoricoxib is a substituted bipyridine. The negative result of the patch test with celecoxib thus allowed us to perform an oral challenge test, providing the patient with a safe therapeutic option. This case illustrates the usefulness of these tests for the study of certain adverse drug reactions, such as fixed drug eruption.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gómez de la Fuente E, Pampín Franco A, Caro Gutiérrez D, López Estebaranz J. Exantema fijo medicamentoso por etoricoxib con tolerancia a celecoxib. Utilidad de las pruebas epicutáneas. Actas Dermosifiliogr. 2014 105:314–315.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 719 "Ancho" => 951 "Tamanyo" => 101345 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Positive patch test with etoricoxib at 10% in petrolatum in the area previously affected by the fixed drug eruption.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Selective immediate hypersensitivity to etoricoxib" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 40 | 11 | 51 |
| 2024 October | 129 | 61 | 190 |
| 2024 September | 176 | 29 | 205 |
| 2024 August | 216 | 100 | 316 |
| 2024 July | 184 | 46 | 230 |
| 2024 June | 184 | 49 | 233 |
| 2024 May | 170 | 44 | 214 |
| 2024 April | 154 | 19 | 173 |
| 2024 March | 167 | 29 | 196 |
| 2024 February | 158 | 36 | 194 |
| 2024 January | 135 | 39 | 174 |
| 2023 December | 136 | 14 | 150 |
| 2023 November | 179 | 37 | 216 |
| 2023 October | 139 | 25 | 164 |
| 2023 September | 145 | 36 | 181 |
| 2023 August | 98 | 24 | 122 |
| 2023 July | 134 | 37 | 171 |
| 2023 June | 107 | 18 | 125 |
| 2023 May | 149 | 34 | 183 |
| 2023 April | 125 | 23 | 148 |
| 2023 March | 81 | 19 | 100 |
| 2023 February | 97 | 28 | 125 |
| 2023 January | 100 | 28 | 128 |
| 2022 December | 68 | 43 | 111 |
| 2022 November | 44 | 24 | 68 |
| 2022 October | 36 | 17 | 53 |
| 2022 September | 48 | 47 | 95 |
| 2022 August | 66 | 31 | 97 |
| 2022 July | 48 | 36 | 84 |
| 2022 June | 40 | 32 | 72 |
| 2022 May | 84 | 46 | 130 |
| 2022 April | 85 | 42 | 127 |
| 2022 March | 85 | 61 | 146 |
| 2022 February | 74 | 33 | 107 |
| 2022 January | 77 | 43 | 120 |
| 2021 December | 52 | 44 | 96 |
| 2021 November | 91 | 47 | 138 |
| 2021 October | 87 | 47 | 134 |
| 2021 September | 66 | 33 | 99 |
| 2021 August | 58 | 23 | 81 |
| 2021 July | 64 | 36 | 100 |
| 2021 June | 73 | 33 | 106 |
| 2021 May | 52 | 43 | 95 |
| 2021 April | 160 | 93 | 253 |
| 2021 March | 86 | 15 | 101 |
| 2021 February | 76 | 21 | 97 |
| 2021 January | 62 | 14 | 76 |
| 2020 December | 51 | 11 | 62 |
| 2020 November | 45 | 21 | 66 |
| 2020 October | 60 | 18 | 78 |
| 2020 September | 46 | 22 | 68 |
| 2020 August | 48 | 17 | 65 |
| 2020 July | 42 | 16 | 58 |
| 2020 June | 42 | 25 | 67 |
| 2020 May | 47 | 14 | 61 |
| 2020 April | 33 | 17 | 50 |
| 2020 March | 23 | 12 | 35 |
| 2020 February | 4 | 8 | 12 |
| 2020 January | 4 | 12 | 16 |
| 2019 December | 6 | 2 | 8 |
| 2019 November | 4 | 0 | 4 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 0 | 3 | 3 |
| 2019 August | 7 | 2 | 9 |
| 2019 July | 4 | 9 | 13 |
| 2019 June | 4 | 17 | 21 |
| 2019 May | 5 | 61 | 66 |
| 2019 April | 2 | 5 | 7 |
| 2019 March | 2 | 7 | 9 |
| 2019 January | 4 | 0 | 4 |
| 2018 December | 2 | 2 | 4 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 4 | 0 | 4 |
| 2018 June | 0 | 4 | 4 |
| 2018 May | 0 | 8 | 8 |
| 2018 April | 0 | 5 | 5 |
| 2018 March | 3 | 1 | 4 |
| 2018 February | 31 | 4 | 35 |
| 2018 January | 66 | 8 | 74 |
| 2017 December | 60 | 11 | 71 |
| 2017 November | 38 | 12 | 50 |
| 2017 October | 58 | 7 | 65 |
| 2017 September | 41 | 4 | 45 |
| 2017 August | 44 | 9 | 53 |
| 2017 July | 42 | 12 | 54 |
| 2017 June | 42 | 41 | 83 |
| 2017 May | 49 | 21 | 70 |
| 2017 April | 40 | 13 | 53 |
| 2017 March | 36 | 25 | 61 |
| 2017 February | 51 | 11 | 62 |
| 2017 January | 26 | 19 | 45 |
| 2016 December | 43 | 8 | 51 |
| 2016 November | 58 | 26 | 84 |
| 2016 October | 106 | 22 | 128 |
| 2016 September | 89 | 15 | 104 |
| 2016 August | 59 | 10 | 69 |
| 2016 July | 43 | 12 | 55 |
| 2016 June | 8 | 11 | 19 |
| 2016 May | 6 | 7 | 13 |
| 2016 April | 4 | 10 | 14 |
| 2016 March | 5 | 2 | 7 |
| 2016 February | 6 | 1 | 7 |
| 2016 January | 5 | 1 | 6 |
| 2015 December | 6 | 1 | 7 |
| 2015 November | 10 | 3 | 13 |
| 2015 October | 8 | 3 | 11 |
| 2015 September | 5 | 9 | 14 |
| 2015 August | 8 | 3 | 11 |
| 2015 July | 30 | 8 | 38 |
| 2015 June | 30 | 7 | 37 |
| 2015 May | 49 | 19 | 68 |
| 2015 April | 33 | 12 | 45 |
| 2015 March | 21 | 3 | 24 |
| 2015 February | 21 | 4 | 25 |
| 2015 January | 14 | 4 | 18 |
| 2014 December | 21 | 7 | 28 |
| 2014 November | 17 | 2 | 19 |
| 2014 October | 28 | 7 | 35 |
| 2014 September | 23 | 3 | 26 |
| 2014 August | 11 | 7 | 18 |
| 2014 July | 14 | 7 | 21 |
| 2014 June | 25 | 11 | 36 |
| 2014 May | 22 | 18 | 40 |
| 2014 April | 12 | 8 | 20 |
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