Exudative Erythema Multiforme With Hydroxyzine

RATIONALE: H1-antihistamines are widely used to relieve symptoms of allergic disorders. A few skin reactions to H1-antihistamines have been described in the literature.We report the case of a 51 years old woman with history of allergy rhinitis, who experienced well demarcated violaceas-erythematous plaques located in trunk and extremities, oral mucosal lesions and shivers, 12 hours after taking one tablet of hydroxyzine. The patient continued taking hydroxyzine and the lesions worsed to target lesions and became widespread. The skin lesions disappeared in one month after clearing hydroxyzine.METHODS: Skin biopsy was performed. We made patch test with hydroxyzine, ebastine, loratadine, and fexofenadine with a concentration of 1% and 5% in petrolatum. Oral challenge with fexofenadine was carried out.RESULTS: A skin biopsy specimen revealed moderate hyperkeratosis and spongiosis, and showed perivascular lymphohistiocytic infiltration in the dermis with eosinophils and necrotic keratinocytes. These features were compatible with exudative erhytema multiforme. Patch tests (read after 48 and 96 hours) with hydroxyzine were positive. Patch tests with ebastine, loratadine and fexofenadine were negative.180 mg of fexofenadine was tolerated by the patient.CONCLUSIONS: We report, up to our knowledge, the first case of hydroxyzine exudative erythema multiforme. Patch test with hydroxyzine may be a useful tool for diagnosing these patients since the oral challenge test could involve severe reactions.The fexofenadine could be an alternative treatment in patients with hydroxyzine exudative erythema multiforme. RATIONALE: H1-antihistamines are widely used to relieve symptoms of allergic disorders. A few skin reactions to H1-antihistamines have been described in the literature. We report the case of a 51 years old woman with history of allergy rhinitis, who experienced well demarcated violaceas-erythematous plaques located in trunk and extremities, oral mucosal lesions and shivers, 12 hours after taking one tablet of hydroxyzine. The patient continued taking hydroxyzine and the lesions worsed to target lesions and became widespread. The skin lesions disappeared in one month after clearing hydroxyzine. METHODS: Skin biopsy was performed. We made patch test with hydroxyzine, ebastine, loratadine, and fexofenadine with a concentration of 1% and 5% in petrolatum. Oral challenge with fexofenadine was carried out. RESULTS: A skin biopsy specimen revealed moderate hyperkeratosis and spongiosis, and showed perivascular lymphohistiocytic infiltration in the dermis with eosinophils and necrotic keratinocytes. These features were compatible with exudative erhytema multiforme. Patch tests (read after 48 and 96 hours) with hydroxyzine were positive. Patch tests with ebastine, loratadine and fexofenadine were negative. 180 mg of fexofenadine was tolerated by the patient. CONCLUSIONS: We report, up to our knowledge, the first case of hydroxyzine exudative erythema multiforme. Patch test with hydroxyzine may be a useful tool for diagnosing these patients since the oral challenge test could involve severe reactions. The fexofenadine could be an alternative treatment in patients with hydroxyzine exudative erythema multiforme.