Prognosis of generalized bullous fixed drug eruption: comparison with Stevens–Johnson syndrome and toxic epidermal necrolysis


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  • Conflicts of interest
    M.M., J.-C.R. and B.S. have been experts for drug causality of severe cutaneous adverse drug reactions for several pharmaceutical companies, as well as expert witnesses for trials related to drug causality of severe cutaneous adverse reactions.

Jean-Claude Roujeau.


Background  Generalized bullous fixed drug eruption (GBFDE) is a rare cutaneous adverse reaction to drugs, and may resemble Stevens–Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), but is usually considered less severe.

Objectives  To compare the severity and mortality rate in cases of GBFDE and control cases of SJS or TEN of similar extent of skin detachment.

Methods  This was a case–control analysis of 58 patients with GBFDE matched by age and extent of skin detachment to 170 control patients with a validated diagnosis of SJS or SJS/TEN overlap. Data for cases and controls were extracted from the EuroSCAR and RegiSCAR databases resulting from two population-based studies of severe cutaneous adverse reactions conducted in Europe. Preselected outcome criteria were death (primary), and fever, duration of hospitalization and transfer to an intensive care or burn unit (secondary).

Results  GBFDE affected mainly older patients (median age 78 years, interquartile range 68–84 years); 13 of 58 cases died (22%). The mortality rate was slightly but not significantly lower for patients with GBFDE than controls [28%, multivariate odds ratio 0·6 (95% confidence interval 0·30–1·4)]. Patients with GBFDE and controls did not differ in other preselected criteria for severity.

Conclusions  Although our study featured limited statistical power, we were not able to confirm that GBFDE had better prognosis than SJS or SJS/TEN of similar disease extent in older patients. Severe cases of GBFDE deserve the attention and active management given to patients with SJS or TEN.