Multivitamins as a Culprit of Fixed Drug Eruption.

Sir,

Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by recurrent well-demarcated lesions occurring in the same sites every time the culprit drug is taken.[1] These can be caused only by means of an exogenous substance (drug) and not spontaneously or after infection. A 32-year-old man presented to our dermatology clinic with skin eruptions over the wrist, dorsum of the hand, chest, and tongue that were well-demarcated, erythematous, edematous, and associated with burning sensation of 1-day duration [Figure 1]. The diagnosis of FDE was made clinically by the peculiar characteristics of the lesions. Before 2 days of the appearance of the lesions, the patient was started on multivitamin preparation for the treatment of diffuse hair loss. On detailed history, the patient recalled a similar episode in the past at the same sites 5 months back after administration of Vitamin B complex for oral aphthous ulcer with a latency period of 2 days. In addition, causal association between the drug and FDE was reached (Naranjo score = 9) by applying the Naranjo probability scale.[2] At this juncture, the multivitamin preparation was stopped and he was administered a short course of prednisolone 1 mg/kg orally for 5 days following which lesions cleared leaving behind hyperpigmentation. After further exploration of the culprit multivitamin preparations, we found that the common ingredients in both were folic acid, niacinamide, calcium pantothenate, Vitamin C, and biotin. Although we could not find the exact culprit component among these, it still makes for an interesting case as we usually miss multivitamin preparation or “over-the-counter” health supplementation while eliciting drug history in case of adverse drug events because there is a paucity of reported literature over this. Furthermore, patients can miss mentioning these at the time of history taking because they consider multivitamins to be food supplements instead of drugs. To the best of our knowledge, we only found two case reports and only one incident in a case series over this where the ingredients of the preparations were not described.[345] This makes it interesting and worth mentioning because of excessive prescriptions and “over-the-counter” availability of multivitamin preparations.

Figure 1

Clinical photograph showing lesions of fixed drug eruption over the (a) and (d) chest, (b) hands, and (c) tongue

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