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Fixed drug eruption hyperpigmentation

Some drugs may cause fixed drug eruption, which is followed by localised hyperpigmentation and gradually fades Fixed drug eruption Fixed drug eruption manifests with a characteristic erythematous to violatious, sometimes edematous, macule or plaque, which may become bullous in the center. This lesion always occurs at the same localization in less than 2 days on reexposure to the culprit drug. The lesion heals typically leaving a residual hyperpigmentation The most characteristic findings of a fixed drug eruption are recurrence of similar lesions at the same sites and healing with residual hyperpigmentation. The residual hyperpigmentation serves as an indicator of site recognition

Fixed drug eruption (FDE) is a distinctive type of cutaneous drug reaction that characteristically recurs in the same locations upon reexposure to the offending drug. Acute FDE usually presents with a single or a small number of dusky red or violaceous plaques that resolve leaving postinflammatory hyperpigmentation (picture 1A-C) The term fixed drug eruption (FDE) describes the development of one or more annular or oval erythematous patches as a result of systemic exposure to a drug; these reactions normally resolve with.. Most drugs that cause labial hyperpigmentation are also associated with hyperpigmentation in other areas, such as the oral mucosa, skin, and nails. The drugs most associated with labial hyperpigmentation are minocycline, zidovudine, cyclophosphamide, doxorubicin, citalopram, levodopa, nicotine, and tacrolimus. 7 A fixed drug eruption (FDE) is a relatively common reaction associated with more than 100 medications. It is defined as a same-site recurrence with exposure to a particular medication. The primary approach and treatment for all types of FDEs are to identify and remove the causative agent, often acco

FDE resolves in a few days leaving purplish hyperpigmentation, then re-erupts in the same site on re-exposure to the causative drug, which is usually a medication taken intermittently such as paracetamol or antibiotics but may also be a food dye. Fixed drug eruptions (FDE) FDE due to tetracycline FDE due to cotrimoxazol With the initial fixed drug eruption attack, a delay of up to 2 weeks may occur from the initial exposure to the drug to the development of the skin lesion. [ 47] Skin lesions develop over a period..

Resolved but erythema/hyperpigmentation persisted Photosensitive Drug Eruptions(Phototoxic and Photoallergic) Due to the combination of a drug and ultraviolet radiation (UVR), either UVA (320-400 nm) and/or UVB (290-320 nm); however, UVA is most often implicate Clinically, fixed drug eruption (FDE) appears as sharply marginated round to oval violaceous or dusky erythematous and edematous single or multiple pruritic patches, resolving with marked post-inflammatory hyperpigmentation No deaths due to fixed drug eruption have been reported. Residual hyperpigmentation is very common, but this is less likely with the nonpigmenting variant. Widespread lesions may initially mimic..

Drug-induced hyperpigmentation DermNet N

Fixed Drug Eruption - an overview ScienceDirect Topic

  1. Fixed drug eruption is a cutaneous drug reaction that characteristically recurs in the same location on reexposure to the offending drug. It usually presents with dusky red or violaceous plaques that resolve, leaving postinflammatory hyperpigmentation. Rare severe atypical variants of fixed drug eruption include multiple, nonpigmenting, and.
  2. The most characteristic findings of a fixed drug eruption are recurrence of similar lesions at the same sites and healing with residual hyperpigmentation. The residual hyperpigmentation serves as an indicator of site recognition. Diagnosis is not always easy; for example, as is the case for nonpigmenting fixed drug eruptions, which do not have.
  3. Skin hyperpigmentation occurs after the initial lesions subside. Dyes and other inactive ingredients in drugs may trigger an allergic reaction. 18 Information on dye content is listed in the package insert. Drugs that are linked to fixed drug eruption appear in TABLE 1

A fixed drug eruption (FDE) is a common drug eruption with distinctive morphology and etiology that ranges from antibiotics to cryptic exposure such as to quinine in a gin and tonic. Generalized bullous FDE may resemble SJS/TEN and may prove to be as deadly Fixed drug eruption (FDE) is a unique reaction to a variety of drugs. The drug reaction is categorized as a delayed-type hypersensitivity reaction mediated by CD8+ memory T cells In fixed drug eruptions, red plaques or blisters form at the same site each time a drug is taken; residual postinflammatory hyperpigmentation usually persists. Typical lesions occur on the face (especially the lips), hands, feet, and genitals

Background: Determining the substance responsible for recurrent fixed drug eruption (FDE) may be difficult in the case of patients on multiple medication. Allergy testing may prove invaluable in such situations, as we demonstrate herein with an original case. Patients and methods: A 49-year-old man presented a rash on the seventh day of treatment with esomeprazole, clarithromycin and. There are four primary types of medication reactions that can lead to often troubling and disfiguring hyperpigmentation: fixed drug eruptions, photosensitivity reactions, drug-induced hyperpigmentation and drug eruptions with secondary post-inflammatory hyperpigmentation. A fixed drug eruption is a round, dark patch or eruption that results.

The intermittent nature of the flares and the macular hyperpigmentation were clinically suggestive of a fixed drug eruption (FDE). For further diagnosis, the patient was tested intradermally with intravenous preparations of fluconazole, voriconazole and metronidazole on the left volar lower arm, with late readings at 24 and 48 hours Fixed drug eruptions are one of the most common adverse drug reactions encountered by the dermatologist. Usually, they present as a solitary, well-defined patch which heal with residual hyperpigmentation; thus causing cosmetic embarrassment for the patient

Fixed drug eruptions

Diagnosis is not always easy; for example, as is the case for nonpigmenting fixed drug eruptions, which do not have any residual hyperpigmentation. The development of molecular biology may help to clarify the pathogenesis of fixed drug eruptions, but the reason for their recurrence on the same sites is still unknown heal with residual hyperpigmentation. However, other types of FDE have been reported (Table 1. ) Page 16 MARIJUANA: AN UNUSUAL CAUSE OF FIXED DRUG ERUPTION Marijuana: An Unusual Cause of Fixed Drug Eruption Christina Steinmetz-Rodriguez, DO,* Brent Schillinger, MD*

The hyperpigmentation caused by fixed drug eruption is due to melanophages in the dermis, and is known as dermal hypermelanosis. It also occurs in lichen planus, cutaneous lupus erythematosus, and other post-inflam- matory hyperpigmented dermatoses. In dermal hyperme- lanosis, there is a destruction of basal keratinocytes [6] Labial mucosa is the most frequent location of fixed-drug eruptions in the mouth.41 gingival pigmentation, medication-induced hyperpigmentation, drug-induced hyperpigmentation, oral. Background: A fixed-drug eruption (FDE) is a unique cutaneous adverse drug effect in the form of recurrent lesions at the same site after re-exposure to the offending agent.Aim: The aim of the study was to identify changes in trends in fixed drug eruptions with regard to causative drug or patient risk factors.Methods: Cases of FDEs encountered between March 2014 to May 2017 during routine. Key words: Fixed drug eruption. JRMS September 2011, 18(3): 16-20 . Introduction . Adverse drug reactions are very common. They range in severity and type. In the general population drug-related problems occur in about 5%, and in hospitalized patients this figure rises to 20 %.(1) The most commonly involved organ by drug reactions is the skin

Fixed drug eruption - UpToDat

  1. Fixed drug eruption DermNet NZ. Drugs (3 days ago) Fixed drug eruption can be categorised by clinical morphology. The most common form is the localised pigmenting type; other presentations include bullous (localised or generalised), mucosal, non-pigmenting, or generalised
  2. A fixed drug eruption may worsen for a few days after the responsible agent is discontinued and then resolve slowly over 1 or more weeks. As the lesion heals, crusting and scaling develop, leaving a persistent, dusky brown discoloration. The hyperpigmentation--which may be more pronounced in persons with brown skin--usually fades over time
  3. Drug eruptions with secondary post-inflammatory hyperpigmentation. A fixed drug eruption is a round, dark patch or eruption that results from a reaction to a drug (usually a prescription medication). This type of reaction leaves a grey-blue, round patch on the skin
  4. istration of the causative drug and heals with postinflammatory residual hyperpigmentation
  5. The term fixed drug eruption (FDE) describes the development of one or more annular or oval erythematous patches as a result of systemic exposure to a drug; these reactions normally resolve with hyperpigmentation and may recur at the same site with reexposure to the drug. Repeated exposure to the offending drug may cause new lesions to develop.
  6. Fixed drug eruption (FDE) is a distinctive skin reaction characterized by development of ≥1 round or oval erythematous patch, which characteristically recurs at the same sites as a result of systemic exposure to the same drug. The lesions eventually resolve with postinflammatory hyperpigmentation
  7. utes to hours of exposure to the inciting drug

Fixed Drug Eruptions: Background, Pathophysiology, Etiolog

Fixed drug eruptions. These occur when lesions recur in the same area when the same drug is given. Plaques are circular, violaceous and oedematous and they resolve with macular hyperpigmentation. The latent period is half an hour to eight hours after taking the drug. Perioral and periorbital lesions may occur but the hands, feet and genitalia. Majority of reaction was 7-11.2% of ADRs result in hospitalization.5-7 Every year developed within one week of taking drug. Fixed drug eruption so many new drugs are included in the prescribing list and (FDE) was present in 18.5% cases followed by maculo-papular, the prescription pattern are changing as well as physicians Stevenson-Johnson.

Drug-Induced Hyperpigmentation: Review and Case Series

We describe a case of a suspected cutaneous hypersensitivity reaction to ticagrelor. The patient displayed a localized bullous fixed drug eruption after being loaded with ticagrelor, which resolved with oral antihistamines and topical steroids after one week. Clopidogrel and rivaroxaban were successfully administered as alternative antithrombotic therapy without any apparent further. Fixed drug eruption (FDE) is a mucocutaneous drug reaction located most often on the lips, genitalia or extremities. FDE characteristically reoccurs in the same locations upon re-exposure to the causing drug. In most cases the FDE leaves a post inflammatory hyperpigmentation after resolving. FDEs are immune-mediated Fixed drug eruption was also ruled out based on her history. Lichen planus pigmentosus is a member of a family of acquired macular hyperpigmentary disorders of uncertain etiology that also includes ashy dermatosis (AD), erythema dyschromicum perstans (EDP), and idiopathic eruptive macular pigmentation (IEMP)

Fixed Drug Eruptions: An Update, Emphasizing the

Fixed drug eruption (FDE) is commonly seen in children and adolescent age groups. It is defined as a cutaneous drug eruption that recurs at the same site upon administration of the same drug and heals with residual hyperpigmentation. Although FDE may occur anywhere on the skin or mucous membranes, isolated involvement of the eyelid and. Fixed drug eruption is a cutaneous drug reaction noted to recur in the same anatomical locations on recurrent exposure to the offending agent. Lesions usually resolve with cessation of the culprit drug, but may leave postinflammatory hyperpigmentation. Supportive treatment ma A drug provocation test confirmed that fixed drug eruption on both hands had occurred after administration of erdosteine, suggesting that erdosteine was the cause of the allergic reaction. However, she also experienced angioedema, isolated wheal, and laryngeal edema; thus, IgE-mediated type I hypersensitivity could also be concurrently. Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by the development of erythematous itchy or asymptomatic macules caused by intake of a variety of drugs. often leaving postinflammatory hyperpigmentation. Apart from the classical FDE, generalized, bullous, extensive bilateral symmetrical, pulsating, wandering, and. The term fixed drug eruption describes the development of one or more annular or oval erythematous patches as a result of systemic exposure to a drug; these reactions normally resolve with hyperpigmentation and may recur at the same site with reexposure to the drug. Repeated exposure to the offending drug may cause new lesions to develop in.

Drug eruptions DermNet N

Fixed drug eruption (FDE) is a unique type of cutaneous drug reaction that typically recurs in the identical locations on re-exposure to the attributed drug. FDE is characterized by the appearance of a single or multiple sharply demarcated violaceous erythematous plaques which heal with residual hyperpigmentation Fixed drug eruption. This is the correct diagnosis. The acute lesion of a fixed drug eruption tends to occur very rapidly, within 30 minutes to eight hours after administration of the culprit medication. The lesions are characteristically tender, dark red macules and plaques that produce a sore or burning sensation and may blister Fixed drug eruption (FDE) is a common drug side effect constituting about 10% of all skin drug eruptions. 1 Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most common causes of FDE. 2 Mefenamic acid (anthracitic acid derivative) and diclofenac (phenylacetic acid) both have a chemically distinct structures. Cross-reactivity between NSAIDs occurs frequently in patients with skin.

Fixed Drug Eruptions Clinical Presentation: History

  1. The diagnosis of fixed drug eruption is not always easy; as in the case of nonpigmenting fixed drug eruptions, which do not have any residual hyperpigmentation. The development of molecular biology may help to unfold the exact pathogenesis of fixed drug eruptions but as of now the reason for their recurrence on the same sites is still unknown
  2. Fixed drug eruption is a cutaneous drug reaction that characteristically recurs in the same location on reexposure to the offending drug. It usually presents with dusky red or violaceous plaques that resolve, leaving postinflammatory hyperpigmentation. Rare severe atypical variants of fixed drug eruption include multiple, nonpigmenting, and generalized bullous variants
  3. Rare (0.01% to 0.1%): Alopecia, erythema multiforme, erythema nodosum, fixed drug eruptions, hyperpigmentation (brownish or bluish-black pigmentation) of skin, photosensitivity, rash, vasculitis Very rare (less than 0.01%): Angioedema , exfoliative dermatitis, hyperpigmentation of nails/nail beds, Stevens-Johnson syndrome, toxic epidermal.
  4. ocycline, amiodarone, or chemotherapy) Fixed drug eruption; Drug-induced flagellate pigmentation (from bleomycin) Erythema multiforme and Stevens-Johnson syndrome (from antibiotics, antiepileptic drugs, antituberculosis drugs, and NSAIDs) Physical injury Minor abrasions and cuts; Burns; Frictio

Summary. Erythema multiforme (EM) is a rare, acute hypersensitivity reaction most commonly triggered by herpes simplex virus (HSV) infections.Other triggers include M. pneumoniae infection, certain drugs, and immunizations. EM is mainly seen in adults between 20-40 years of age. Clinical features include a rash of varied appearance, beginning as macules and papules, which evolve into. Post-inflammatory hyperpigmentation is a frustrating problem afflicting many dermatology patients, particularly on the face. Here we report a case of successful cosmetic camouflage using the theory of complementary colors of light in a patient with post-inflammatory hyperpigmentation of the face caused by fixed drug eruption Importance of fixed drug eruption lies in the fact that they are caused by commonly used drugs. Antibiotics followed by non-steroidal anti-inflammatory drugs are most common culprits. If the drug is not avoided, recurrent episodes can be more severe and extensive with residual postinflammatory hyperpigmentation Fixed Drug Eruptions (FDEs) are a localized response to medications that typically appear as Well-Demarcated erythematous dusky patches or plaques. They may be solitary, multiple, or generalized. The initial eruption of a FDE appears 1 week Post-Drug exposure, whereas subsequent exposures to the same drug lead to development of lesions within.

  1. Fixed drug eruptions: Lesions recur in the same area when the offending drug is given (see Image 7). Circular, violaceous, edematous plaques that resolve with macular hyperpigmentation is characteristic
  2. g 2 MD, Sarah J Grekin 3 MD, Carina A Wasko 4 MD Dermatology Online Journal 18 (11): 10 1. MSTP Program, Baylor College of Medicine, Houston, Texas 2. Department of Dermatology, UCLA Medical Center, Santa Monica, California 3
  3. imal post inflammatory hyperpigmentation were unusual features
  4. * A reliable differentiation between lichenoid drug eruption an drug induced lichen planus cannot be made, therefore the term lichenoid drug eruptions (LDE) is used [8]. The current observation describes the association between statins and lichenoid drug eruptions in 13 patients. A previous report regarding this association in
Fixed drug eruption associated with aspirin | BMJ Case Reports

Azithromycin-Induced Linear Fixed Drug Eruption: A Rare

  1. Fixed drug eruption (FDE) usually appears as a solitary or a small number of pruritic, well circumscribed, erythematous macules that evolve into edematous plaques; these lesions typically resolve after discontinuation of the offending drug, leaving hyperpigmentation at the site of lesions. Fixed drug eruption has been mentioned previously as a.
  2. Fixed drug eruption (FDE) is a distinctive drug eruption that is characterized by its unique morphology, namely a round shape. There may be pruritus, burning, or pain at involved sites. Dysuria may be experienced in periurethral cases. Systemic symptoms are rare, but fever and malaise have been reported
  3. alize possession of all drugs includin
  4. istration of the causative drug and heals with postinflammatory residual hyperpigmentation. It usuall
  5. A drug eruption is an adverse skin reaction to a drug. Many medications can cause reactions, especially antimicrobial agents, sulfa drugs, NSAIDs, chemotherapy agents, anticonvulsants, and psychotropic drugs. violaceous plaques that fade with macular hyperpigmentation as seen in fixed drug eruptions
  6. • Fixed drug eruption (FDE) is a distinctive variant of drug-induced dermatoses with characteristic recurrence at the same site of the skin or mucous membranes. The clinical and laboratory features of FDE are reviewed herein and possible pathogenetic mechanisms are discussed. (Arch Dermatol 1984;120:520-524

What is the prognosis of fixed drug eruption (FDE)

Lesions typically appear and/or are exacerbated during the summer months and may improve spontaneously in the winter. The differential diagnosis of ALP includes photosensitive lichenoid drug eruptions, discoid lupus erythematosus, actinic prurigo, fixed drug eruption and polymorphous light eruption. Treatment includes sun-protective measures Fixed drug eruptions are characterized by well-circumscribed, sharply demarcated erythematous patches or edematous plaques that appear after exposure to medications or foods. Lesions can resemble erythema multiforme, Stevens-Johnson syndrome, or arthropod assault. On the genitals they can resemble herpes simplex or lichen planus When a patient is reexposed to the offending agent, fixed drug eruptions typically recur at the sites of the initial lesions. 1 Marked hyperpigmentation develops because the damaged basal layer of the epidermis permits melanin to infiltrate the dermis, where the pigment remains for many months. Thus, hydroquinone topical bleaches have little. Fixed drug eruption (FDE) is a cutaneous drug reaction which occurs repeatedly at a given mucocutaneous site after exposure to the causative agent. Lesions typically occur on extremities, oral mucosa and genital skin. Quinine is a common food additive and is recognised as a rare cause of FDE. We report a case of FDE with oral and genital lesions presenting to a sexual health clinic due to.

records to prevent future events. Multiple recurrences of fixed drug eruption may result in postinflammatory hyperpigmentation[5]. In summary, fixed drug eruptions of the penis, although rarely reported, are not uncommon and clinicians need to consider it as a diagnosis. Other diagnoses are excluded by taking a thorough histor Fixed-Drug Eruptions Fixed-drug eruptions are drug-mediated reactions that can be characterized by rapidly appearing lesions after intake, which can be small or large in size and quantity; they are red and may blister or give a burning sensation fixed drug eruptions (FDE) are allergic hypersensitivity responses to a drug exposure, characterized by localized well-circumscribed, erythematous plaques of the skin or bulla on mucous membranes that reappear in the same location upon reexposure to the same drug 1,2,3. FDE typically manifest as a solitary lesion, but multiple lesions may presen Fixed drug eruption (FDE) is a common adverse drug reaction that occurs and recurs with exposure to the offending agent. 1 Its exact pathogenesis remains mostly misunderstood. 2 We report a case of FDE on the penile shaft of a patient caused by ingestion of diclofenac by the sexual partner. CASE. A 37-year-old man presented with a 7-day history of a penile lesion Fixed drug eruption to laxatives (phenolphthalein), trimethoprim-sulfamethoxazole, NSAIDs, tetracyclines Exogenous pigment exposure: carotenemia, argyria, gold, tattooing, arsenic Berloque hyperpigmentation (phototoxicity from citrus or celery

Drug Eruptions: Practice Essentials, Background

Fixed Drug Eruption to Trimethoprim-Sulfamethoxazole and

PubMe

Fixed Drug Eruption Due to Afloqualone: The First Reported Case Fixed Drug Eruption Due to Afloqualone: The First Reported Case Demitsu, Toshio; Tomita, Yasushi 1998-02-01 00:00:00 To the Editor: We present a case of fixed drug eruption due to afloqualone with a positive provocation test. It is well known that afloqualone can cause drug-induced photosensitivity (1-4) Bullous fixed drug eruption (FDE), being one of them, is very important to watch for. blackening of skin on these parts. However, body areas such as face, chest, abdomen, soles, and palms were spared from hyperpigmentation. Soon, there was the development of widespread blisters measuring 2-2.5 cm in diameter, well circumscribed having an. Fixed drug eruption ( C0221242 ) Round areas of red-purple reaction in the skin that result after drug exposure; these recur in the same location when the medication is readministered. (NICHD) Erupción fija medicamentosa, dermatitis medicamentosa fija (trastorno), dermatitis medicamentosa fija

Wandering fixed drug eruption: a mucocutaneous reaction to

A clinical diagnosis of fixed drug eruption (FDE) was made. She was treated with an antihistamine and topical corticosteroids with which the lesions became nonpruritic and hyperpigmented. Later, she gave a positive result to a re-challenge with fluconazole. It used to subside within 3 days resulting in hyperpigmentation. A diagnosis of FDE. Ashy dermatosis. Ashy dermatosis also called erythema dyschromicum perstans, dermatosis cinecienta or erythema chronicum figuratum melanodermicum, is a form of acquired dermal macular hyperpigmentation characterized by well-circumscribed round to oval or irregular patches on the face, neck and trunk that are grey in color 1).Ashy dermatosis is a typically asymptomatic disease of unknown origin. Fixed Drug Eruptions: An Update, Emphasizing the Potentially Lethal Generalized Bullous Fixed Drug Eruption. A fixed drug eruption (FDE) is a relatively common reaction associated with more than 100 medications. It is defined as a same-site recurrence with exposure to a particular medication Fixed Drug Eruption A fixed drug eruption is a less common type of drug induced cutaneous eruption is the fixed drug eruption. A solitary erythematous macule will appear during treatment with agents such as tetracycline , phenolphthalein (laxative), or non-steroidal anti-inflammatory agents as well as other drugs Although fixed drug reactions are relatively inconsequential, it is important to know that these eruptions may clear when the patient is given uninterrupted therapy of a human immunodeficiency virus-1 protease inhibitor, with only post-inflammatory hyperpigmentation

Ustekinumab-induced fixed drug eruptio

(b) Fixed drug eruption (FDE)-like presentation: localized erythematous, inflammatory plaques at the infusion site, also showing vesicular changes. (c) Persistent serpentine supravenous hyperpigmentation/eruption presentation: non-inflammatory, linear hyperpigmentation following the infusion vein Linear Fixed-Drug Eruption. The diagnosis of fixed drug eruption is the basis of the historical, clinical, and histological findings. 60 Linear erythematous and hyperpigmented macular lesions following a neural distribution have been reported secondary to an intramuscular cephazolin injection. 61. Flagellate Hyperpigmentation

A persistent submammary rash | Medicine TodayDrug-Induced Hyperpigmentation: Review and Case SeriesDrug EruptionsMedicine by Sfakianakis G

Fixed drug eruption manifests as pruritic, well-circumscribed and erythematous macules, after exposure to a specific medication. On re-exposure to culprit drug, lesions recur at the same site and heal with characteristic hyperpigmentation. History of recurrences can be there, but typical clinical morphology of fixed drug eruption is often. Naproxen sodium is a non-steroidal anti-inflammatory drug (NSAID) commonly used to alleviate pain, fever, or inflammation. NSAIDs are a commonly reported cause of fixed drug eruptions (FDEs), but the bullous and generalized variants are relatively rare. We present a case of a generalized bullous FDE due to naproxen Drug eruptions are a common dermatologic problem faced by pediatricians. Among the most distinctive of these is the fixed drug eruption, a cutaneous inflammatory reaction manifested by solitary or multiple, well-defined, erythematous macules that may become bullous.1,2 Lesions usually occur within a few hours of ingesting the drug, characteristically recur in the same location with each. Fixed drug eruption, Pseudoephedrine. Introduction. Fixed drug eruptions (FDE) is characterized by recurrent, welldefined and distinctive lesions in the same location each time the offending drug is ingested. Two different clinical forms have been described: A classic pigmenting form and a less commonly seen non-pigmenting form Fixed drug eruption (FDE) is a cutaneous hypersensitivity reaction that tends to recur at the same site upon re-exposure to the offending drug. FDE usually presents as single or multiple erythematous plaques that resolve, leaving post-inflammatory hyperpigmentation multiple fixed drug eruptions a few hours following iverme ctin intake that worsened with repeated drug consumption. Discontinuation of the drug, counselling, systemic steroids, and orally administered antihistamines were the treatment modalities employed. Marked regression of the lesions en sued with residual hyperpigmentation and dyschromia

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