Vulvar fixed drug eruption. A report of 13 cases.

BACKGROUND: The fixed drug eruption (FDE) is an uncommon adverse event related to drug ingestion that presents with a recurrent eruption occurring on the same site with each drug exposure. The genital area is a well-recognized site for the so-called nonpigmenting fixed drug eruption. Most of the medical literature has focused on the male genitalia. In the female, FDE may present as acute, recurrent or chronic vulvitis that resolves rapidly when the offending drug is ceased.

CASES: Thirteen women aged 15-84 were seen with vulvitis related to drug ingestion. Four of those patients experienced 1 acute episode related to diverse medications. Two presented with acute recurrent vulvitis related to ingestion of ibuprofen. Seven women, aged 58-77, presented with chronic erosive vulvitis, nonspecific on biopsy and unresponsive to all therapeutic measures other than the cessation of the offending drug, most often HMG Co-A or COX-2 inhibitors.

CONCLUSION: In younger women, FDE may present as recurrent acute vulvitis often related to analgesic ingestion. In older patients, FDE presents as a perplexing, unresponsive erosive vulvitis. Genital FDE is characteristically nonpigmenting, erosive, bilaterally symmetric and nonspecific on biopsy. A drug history is imperative in any patient with chronic unresponsive vulvitis.