- Pseudoephedrine-induced Fixed Drug Eruption in a Scuba Diver With Recurrent Palmoplantar Exfoliation
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Pimpreeya Kajornchaikul, Pattarawat Thantiworasit, Jettanong Klaewsongkram
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J Prev Med Public Health. 2024;57(6):595-599. Published online August 8, 2024
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DOI: https://doi.org/10.3961/jpmph.24.319
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 Abstract
Summary
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- This report presents a case of pseudoephedrine-induced non-pigmented bullous fixed drug eruption (NBFDE) manifesting as recurrent palmoplantar exfoliation in a scuba diver. It emphasizes the importance of considering drug allergies in the differential diagnosis when divers present with peeling hands and soles. A 38-year-old female scuba diver experiencing recurrent palmoplantar exfoliation underwent a clinical evaluation, patch testing, an interferon-gamma enzyme-linked immunospot (ELISpot) assay, and graded drug challenges with pseudoephedrine and phenylephrine. Patch testing yielded negative results; however, the ELISpot assay indicated a strong immune response to pseudoephedrine. A graded challenge involving pseudoephedrine successfully reproduced the symptoms, confirming a diagnosis of pseudoephedrine-induced NBFDE. Subsequently, a challenge with phenylephrine elicited a milder reaction, suggesting it as a potential alternative medication for the patient. This case highlights NBFDE as a potential cause of skin peeling in scuba divers who are allergic to pseudoephedrine. It emphasizes the importance of considering drug allergies when diagnosing palmoplantar exfoliation in divers and underscores the need for a thorough evaluation of medication use in this group. Alternative medications and management strategies should be considered for divers with a pseudoephedrine allergy to prevent ear barotrauma while minimizing the risk of adverse skin reactions.
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Summary
Key Message
This case report describes a 38-year-old female scuba diver who experienced recurrent palmoplantar exfoliation due to pseudoephedrine-induced non-pigmented bullous fixed drug eruption. The diagnosis was confirmed based on her clinical history, results of an interferon-gamma ELISpot assay, and a graded drug challenge. The report underscores the importance of considering drug allergies as a cause of skin reactions in divers and suggests phenylephrine as a potential alternative for managing ear barotrauma in patients with pseudoephedrine hypersensitivity, highlighting the need for individualized care in drug allergy management.
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