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A 41-year-old woman presented with a 2-day history of burning, stinging, itchy blisters on the lower lip. She had experienced a similar eruption at the same site with spontaneous resolution 1 year previously, after she had taken a cold medication containing ibuprofen. Her medical history was otherwise unremarkable. She took no prescription medications; however, she did occasionally take over-the-counter ibuprofen. On examination, she was well-appearing and afebrile. There were tense confluent blisters in a 4-cm area on and around the lower lip (Figure 1) and no other skin or mucosal lesions.
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Bullous nonpigmenting fixed drug eruption
C. Discontinue ibuprofen
The key to the correct diagnosis in this case is the recurrence of local blisters at the same anatomical site after ibuprofen administration. A fixed drug eruption is a skin or mucosal adverse drug reaction that occurs at the same site each time the causative drug is taken.1 Common sites include the hands, feet, lips, and genitals.2,3 The lesion typically appears as solitary or multiple oval erythemas, which can evolve to become blisters (bullous fixed drug eruption). This sometimes causes residual postinflammatory hyperpigmentation; however, there sometimes may be cases without pigmentary change (nonpigmenting fixed drug eruption), as in this instance.
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Corresponding Author: Mitsuhito Ota, MD, PhD, Department of Dermatology, Chitose City Hospital, Hokkou 2, Chitose 066-8550, Japan (firstname.lastname@example.org).
Published Online: December 13, 2019. doi:10.1001/jama.2019.17568
Conflict of Interest Disclosures: None reported.
Additional Contributions: I thank the patient for providing permission to share her information.
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