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
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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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 32 | 9 | 41 |
| 2024 Octubre | 129 | 61 | 190 |
| 2024 Septiembre | 176 | 29 | 205 |
| 2024 Agosto | 216 | 100 | 316 |
| 2024 Julio | 184 | 46 | 230 |
| 2024 Junio | 184 | 49 | 233 |
| 2024 Mayo | 170 | 44 | 214 |
| 2024 Abril | 154 | 19 | 173 |
| 2024 Marzo | 167 | 29 | 196 |
| 2024 Febrero | 158 | 36 | 194 |
| 2024 Enero | 135 | 39 | 174 |
| 2023 Diciembre | 136 | 14 | 150 |
| 2023 Noviembre | 179 | 37 | 216 |
| 2023 Octubre | 139 | 25 | 164 |
| 2023 Septiembre | 145 | 36 | 181 |
| 2023 Agosto | 98 | 24 | 122 |
| 2023 Julio | 134 | 37 | 171 |
| 2023 Junio | 107 | 18 | 125 |
| 2023 Mayo | 149 | 34 | 183 |
| 2023 Abril | 125 | 23 | 148 |
| 2023 Marzo | 81 | 19 | 100 |
| 2023 Febrero | 97 | 28 | 125 |
| 2023 Enero | 100 | 28 | 128 |
| 2022 Diciembre | 68 | 43 | 111 |
| 2022 Noviembre | 44 | 24 | 68 |
| 2022 Octubre | 36 | 17 | 53 |
| 2022 Septiembre | 48 | 47 | 95 |
| 2022 Agosto | 66 | 31 | 97 |
| 2022 Julio | 48 | 36 | 84 |
| 2022 Junio | 40 | 32 | 72 |
| 2022 Mayo | 84 | 46 | 130 |
| 2022 Abril | 85 | 42 | 127 |
| 2022 Marzo | 85 | 61 | 146 |
| 2022 Febrero | 74 | 33 | 107 |
| 2022 Enero | 77 | 43 | 120 |
| 2021 Diciembre | 52 | 44 | 96 |
| 2021 Noviembre | 91 | 47 | 138 |
| 2021 Octubre | 87 | 47 | 134 |
| 2021 Septiembre | 66 | 33 | 99 |
| 2021 Agosto | 58 | 23 | 81 |
| 2021 Julio | 64 | 36 | 100 |
| 2021 Junio | 73 | 33 | 106 |
| 2021 Mayo | 52 | 43 | 95 |
| 2021 Abril | 160 | 93 | 253 |
| 2021 Marzo | 86 | 15 | 101 |
| 2021 Febrero | 76 | 21 | 97 |
| 2021 Enero | 62 | 14 | 76 |
| 2020 Diciembre | 51 | 11 | 62 |
| 2020 Noviembre | 45 | 21 | 66 |
| 2020 Octubre | 60 | 18 | 78 |
| 2020 Septiembre | 46 | 22 | 68 |
| 2020 Agosto | 48 | 17 | 65 |
| 2020 Julio | 42 | 16 | 58 |
| 2020 Junio | 42 | 25 | 67 |
| 2020 Mayo | 47 | 14 | 61 |
| 2020 Abril | 33 | 17 | 50 |
| 2020 Marzo | 23 | 12 | 35 |
| 2020 Febrero | 4 | 8 | 12 |
| 2020 Enero | 4 | 12 | 16 |
| 2019 Diciembre | 6 | 2 | 8 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 0 | 3 | 3 |
| 2019 Agosto | 7 | 2 | 9 |
| 2019 Julio | 4 | 9 | 13 |
| 2019 Junio | 4 | 17 | 21 |
| 2019 Mayo | 5 | 61 | 66 |
| 2019 Abril | 2 | 5 | 7 |
| 2019 Marzo | 2 | 7 | 9 |
| 2019 Enero | 4 | 0 | 4 |
| 2018 Diciembre | 2 | 2 | 4 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Junio | 0 | 4 | 4 |
| 2018 Mayo | 0 | 8 | 8 |
| 2018 Abril | 0 | 5 | 5 |
| 2018 Marzo | 3 | 1 | 4 |
| 2018 Febrero | 31 | 4 | 35 |
| 2018 Enero | 66 | 8 | 74 |
| 2017 Diciembre | 60 | 11 | 71 |
| 2017 Noviembre | 38 | 12 | 50 |
| 2017 Octubre | 58 | 7 | 65 |
| 2017 Septiembre | 41 | 4 | 45 |
| 2017 Agosto | 44 | 9 | 53 |
| 2017 Julio | 42 | 12 | 54 |
| 2017 Junio | 42 | 41 | 83 |
| 2017 Mayo | 49 | 21 | 70 |
| 2017 Abril | 40 | 13 | 53 |
| 2017 Marzo | 36 | 25 | 61 |
| 2017 Febrero | 51 | 11 | 62 |
| 2017 Enero | 26 | 19 | 45 |
| 2016 Diciembre | 43 | 8 | 51 |
| 2016 Noviembre | 58 | 26 | 84 |
| 2016 Octubre | 106 | 22 | 128 |
| 2016 Septiembre | 89 | 15 | 104 |
| 2016 Agosto | 59 | 10 | 69 |
| 2016 Julio | 43 | 12 | 55 |
| 2016 Junio | 8 | 11 | 19 |
| 2016 Mayo | 6 | 7 | 13 |
| 2016 Abril | 4 | 10 | 14 |
| 2016 Marzo | 5 | 2 | 7 |
| 2016 Febrero | 6 | 1 | 7 |
| 2016 Enero | 5 | 1 | 6 |
| 2015 Diciembre | 6 | 1 | 7 |
| 2015 Noviembre | 10 | 3 | 13 |
| 2015 Octubre | 8 | 3 | 11 |
| 2015 Septiembre | 5 | 9 | 14 |
| 2015 Agosto | 8 | 3 | 11 |
| 2015 Julio | 30 | 8 | 38 |
| 2015 Junio | 30 | 7 | 37 |
| 2015 Mayo | 49 | 19 | 68 |
| 2015 Abril | 33 | 12 | 45 |
| 2015 Marzo | 21 | 3 | 24 |
| 2015 Febrero | 21 | 4 | 25 |
| 2015 Enero | 14 | 4 | 18 |
| 2014 Diciembre | 21 | 7 | 28 |
| 2014 Noviembre | 17 | 2 | 19 |
| 2014 Octubre | 28 | 7 | 35 |
| 2014 Septiembre | 23 | 3 | 26 |
| 2014 Agosto | 11 | 7 | 18 |
| 2014 Julio | 14 | 7 | 21 |
| 2014 Junio | 25 | 11 | 36 |
| 2014 Mayo | 22 | 18 | 40 |
| 2014 Abril | 12 | 8 | 20 |
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