Fixed drug eruption caused by tadalafil - Case report
A 30-year old man referred to City Institute for Skin and Venereal Diseases complaining\nof recurrent red spots on the skin and genitalia. They appeared on the same skin sites\nand resolved three times consecutively during 6 months. The subjective symptom was only\nmild pruritus. Physical examination during the first visit revealed a solitary\nerythematous patch, 2cm in diameter, on the penile shaft. Treatment with topical\ncorticosteroid cream resulted in complete resolution of the lesion in a few days. Apart\nfrom the clinically suggestive patch, at first visit the diagnosis of erythema\nfixum could not be complemented with the appropriate anamnestic data since\nthe patient denied oral ingestion of any drug preceding the onset of the lesion. He was\nadvised to carefully look for skin and genital lesions if using oral antibiotics or\nnonsteroid anti-inflammatory drugs. The next episode of disseminated patches developed\nsuddenly on the penis, right forearm and left periorbital region, nevertheless the\npatient did not come to the clinic for examination. Instead, he applied topical\ncorticosteroid cream on his own, for a couple of days. Few weeks after the complete\nresolution of all patches they reappeared on identical sites of the skin, with one new\nlesion on the buccal mucosa. Upon referral, the third episode clinically presented with\nmultiple erythematous violaceous disseminated patches on the penile shaft, right elbow,\nleft periorbital region as well as patches and erosions on buccal mucosa and hard palate\n(, and ). The patient was worried and\nmotivated for cooperation so his thorough medical history revealed that each episode was\nelicited by the same event - recreational use of tadalafil for enhancement of coital\nexcitement and pleasure, approximately once every 3 months during the previous year. The\npatient denied any other concurrent symptoms and diseases; complete blood count,\nbiochemical parameters, serum aminotransferase values and urine analysis were all within\nnormal physiological ranges.\nA short course of topical corticosteroid therapy once again resulted in complete\nresolution of all lesions leaving residual hyperpigmentation of the involved skin sites.\nMucosal oral lesions were effectively treated with gingival hyaluronic acid 0.2%\ngel.