Background and Objective: Fixed DRUG ERUPTION (FDE) is one kind of DRUG rashes that is characterized by re-appearance of the lesions on the same sites after re-exposure to the causative DRUG. This study was performed to evaluate the epidemiologic characteristics of FDE. Materials and Methods: This descriptive study was done on a series of 100FDE cases, whom were admitted at the outpatient dermatology clinic of Hazrat-e-Rasoul Hospital over a six-year period. The primary diagnosis of FDE was suggested according to clinical findings including a remaining hyperpigmentation at the site of healed skin lesion(s). Oral challenge test with a single low dose administration of the suspected DRUG was used to confinn the diagnosis. Recurrence of the lesion(s) at the same body area(s) was considered as positive result. Results: Most commonly causative agents were co-trimoxazole and codein, which were found in 88% and 3% FDE cases; respectively. The most common site of involvement was penile glans in 57.7% of male patients and trunk in 48.3% of females. In one patient, reaction to multiple DRUGs including co-trimoxazole, codein and tetracycline was observed and after re-challenge with each DRUG, re-appearance of the skin lesion at the same site was evident. Several patients reported concomitant acetaminophen intake, but there was no reaction to that DRUG. Conclusion: Co-trimoxazole is the most common cause of FDE.      

A-10-year-old girl was referred to our department for multiple hyperpigmented plaques. One week previously, she had been given one suppository of acetylsalicylic acid –phenobarbital for fever.Twelve hours after the DRUG intake the child developed pruritic red plaques on the left thigh. Six weeks after resolution of the acute reaction, patch tests were performed separately, with phenobarbital and acetylsalicylic acid. On 48-hour reading, only the phenobarbital patch test on residual pigmented lesion was positive. Because of possible cross-reactions between aromatic anticonvulsants, subsequent patch tests using carbamazepine and phenytoin on residual pigmented lesions were performed.They were all negative at 48-hour reading. To our knowledge, only two isolated pediatric cases of Phenobarbital-induced FDE have been reported in the literature.In this case report, as it was difficult to determine whether phenobarbital or acetylsalicylic acid was responsible for this reaction, subsequent patch tests allowed the identification of the culprit component since it was positive to phenobarbital.

Background: Fixed DRUG ERUPTION (FDE) is an uncommon adverse reaction to medications. Mucosal areas, particularly the male genitalia, are favored sites. To our knowledge, no study has investigated the causative agent (s) in FDE occurring on male genitals of Iranian patients. So, we conducted a study to determine the most common agents and areas of involvement in fixed genital DRUG ERUPTION of male patients.Methods: Diagnosis of FDE was supported by a positive history and physical examination. Data including age, site of lesions, time interval between DRUG administration and FDE development was collected and analyzed.Results: The age range of the 36 male patients was 17 to 60 years with a mean age ± standard deviation of 36.1±10.9 years. The most common causative DRUG was co-trimoxazole in 33 patients (91.7%). In the genital area, the most frequent involved site was the glans penis in 22 patients (61.1%), followed by the penis shaft in 11 patients (30.6 %) and the scrotum in 2 patients (5.6%).Conclusion: The most common causative DRUG is co-trimoxazole and the most common site is the glans penis.

Background: Cutaneous DRUG reaction seems to be relatively common the aim of the study was to recognize offending DRUGs, evaluate patients' characteristics and educate the patients to avoid selfadministration and re-administration of DRUGs.Methods: We retrospectively and prospectively analyzed data from Sina hospital in Tabriz (2000-2005) to determine the number of hospitalizations and visits with primary diagnoses of skin conditions that are often attributed to DRUGs. A physical examination was done by a dermatologist who completed a standardized questionnaire. Requested information included patient characteristics (associated disorders, severity scores), DRUG intake and characteristics of the skin reaction (type, course).Using statistical methods for surveys, we determined the demographic characteristics of patients with these diagnoses. Results: Three hundred patients (148 males and 152 females) with cutaneous DRUG ERUPTION were studied. The most common ERUPTIONs were erythroderma (41.3%) and maculopapular rash (26%) and the most common offending DRUGs were carbamazepine (28%), carbamazepinevalproate (20%) and Co-Ttrimoxazole-carbamazepine-diclofenac sodium combination (26.7%). The highest number of the patients belonged to the age group of 30-39 years (15%). The interval between developing lesions and intake of the offending DRUG varied from 1 day to 45 days. DRUG reactions showed that 20-30% of the ADRs from anticonvulsants, 15-25% of the ADRS from sulfonamides, 10% of the ADRs from antibiotics, and 7% of the ADRs from non-steroidal anti-inflammatory and anti-hypertensive DRUGs were dermatological. Conclusion: The pattern of ADRs and the DRUGs causing them is remarkably different in our population. Knowledge of these DRUG ERUPTIONs, the causative DRUGs and the prognostic indicators is essential for clinicians. It is recommended to advise patients to carry a card or some other form of an emergency identification in their wallets that lists DRUG allergies and/or intolerances, especially if they have had a severe reaction.

The idea of forced ERUPTION or extrusion was first introduced for the treatment of transverse root fractures in 1973 but indications of forced ERUPTION were increased in modern dentistry. The intent of this article is to review the periodontal indications, clinical considerations and techniques for this procedure.

Background and Aim: Adverse DRUG reactions are inevitable outcomes of DRUG therapy, which may cause mortality and morbidity for those whom are treated in this way. Cutanous adverse DRUG reactions are abserved in 2% to 3% of inpatients but only 2% of them are considered serious and may cause death. The aim of this study was to determine the cause and clinical forms of adverse DRUG reactions referred to department of dermatology.Methods: This cross-sectional study that was done on patients with diagnosis of cutanous adverse DRUG reactions in 2007 and 2009. All patients suspected with diagnosis of adverse DRUG reactions were examined by an experienced dermatologist for determination of different kinds of clinical manifestations.Results: During the study period, 308 patients were recruited. Cutanous adverse DRUG reactions were found to be more frequent in females (63%) than in males (37%). Betalactam antibiotics were found to be the most frequent cause of adverse cutaneous DRUG reactions (42.7%), followed by non-steroidal anti-inflammatory DRUGs (16.5%). Acute urticaria was the most frequent observed DRUG reaction (59.2%) followed by fixed DRUG ERUPTION (18.5%) and maculopapular rashes (14.9%).Conclusion: In this study adverse cutaneous DRUG reactions was mainly induced by betalactam antibiotics and non-steroidal anti-inflammatory DRUGs. The most common forms of cutaneous adverse DRUG reactions were found to be: acute urticaria, fixed DRUG ERUPTION and maculopapular rashes.

Generalized bullous fixed DRUG ERUPTION (GBFDE) is a specific variant of fixed DRUG ERUPTION that belongs to severe cutaneous adverse reactions (SCARs) and its diagnosis is based mainly on clinical course and especially on the reoccurrence of typical bullous lesions in previous and new sites after re-administration of the offending DRUG. We present a well-documented case of fluconazole-induced GBFDE, with a positive patch test to fluconazole (30% weight/volume preparation) and clinical tolerance to itraconazole proven by negative oral provocation. Even in SCARs, patch testing represents a useful diagnostic tool, while oral provocation remains the gold standard in cases that an alternative but the chemically relevant DRUG must be administered.

Restoration of severely damaged teeth requires comprehensive, carefully planned pretreatment. Usually, the teeth with fractures or caries extended up to or below the alveolar crest can be treated by conventional surgical crown lengthening at the expense of supporting bone. Forced ERUPTION or extrusion of teeth is an alternative procedure to overcome problems with dental esthetics and removing of supporting tissues.Two case reports are used as a basis for reviewing the forced ERUPTION with and without supracrestal fibrotomy.

ObjectiveAnticonvulsant DRUGs can cause various forms of skin DRUG reactions, rangingfrom exanthema to severe blistering reactions. An association betweenHLA-B*1502 allele and severe skin reactions have been reported.Materials & MethodsFifteen patients with severe skin reactions following treatment withanticonvulsant DRUGs (Carbamazepine, lamotrigine, phenobarbital, primidone)and 15 controls (age-matched epileptic patients taking similar anticonvulsantswithout DRUG ERUPTION) were included. They were referred to Mofid Children’sHospital in Tehran, Iran, between Jan 2012 to Jan 2014. Genomic DNA wasextracted from peripheral blood of all patients and HLA- B*1502 genotype wasdetected by real-time PCR.ResultsNone of the patients was positive for HLA- B*1502, but two patients in controlgroup had positive HLA- B*1502.ConclusionThe HLA- B*1502 is not correlated with severe anticonvulsant DRUGs -inducedskin reactions in Iranian children.

Background and Objective: DRUG reactions are type of skin diseases that could appear as a kind of cutaneous inflammation such as maculopapular rash, urticaria, papulosquamous, pustule and bulla. Incidence of cutaneous DRUG ERUPTIONs gradually increase with DRUG consumption, therefore having knowledge about these reactions and the incriminating DRUGs can facilitate early detection and prevention of their recurrence. The goal of this research was to evaluation of incidence of cutaneous DRUG ERUPTIONs, from point of view of sex, age, incriminating DRUG and the pattern of the ERUPTIONs.Subjects and Methods: This was a retrospective and descriptive study. In this research all the patients with cutaneous DRUG ERUPTIONs referred to Imam Khomeini hospital, and a private office were evaluated during 2001-2006. Required data and information were gathered by referring to archieve of hospital and clinic. The information was: sex, age, incriminating DRUG, type of DRUG ERUPTION, site of ERUPTION-Incubation period and history of DRUG used.Results: Totally 110 patients with cutaneous DRUG ERUPTIONs which included 70 females (64 %) and 40 males (36 %). The maximum rate of incidence was seen at 3rd decade (21-30 years) and the minimum rate of incidence was seen in the age group of less than 10 years.Conclusion: The most common cutaneous DRUG ERUPTIONs were morbili form rash that occurred in 24 patients (22%). The most common DRUGs were antibiotics that have been seen in 28 patients (25%). Most DRUG reactions occurred in less than one week (55.5 %).