Eyelid hyperpigmentation: Rare involvement following intake of common drug
Year: 2025
Type: article
Study design: Case Report
Abstract: A 2-year-old female presented with complaints of multiple blackish discoloration of skin on eyes, perioral region, and angle of jaw, torso, and back [Figures 1-3]. The onset of lesions was traced to a year back and was associated with fever. Mother gave a history of onset of erythematous itchy lesions on administration of fever medicine (acetaminophen) on the same place every time within 30–60 min of administration of paracetamol (acetaminophen). The lesions healed and progressed to hyperpigmented lesions on discontinuation of medication. This was the first visit of the patient in hospital, and the child was on over-the-counter medications till now, leading to an increase in the number of lesions over the year. Systemic examination was normal. Complete hemogram and biochemistry profile were normal. Skin biopsy and oral provocation tests were deferred due to denial of consent by parents. The drug allergy test showed allergy to paracetamol. Naranjo adverse drug reaction (ADR) probability score was (+9). Based on the patient’s medical history, a diagnosis of fixed drug eruption (FDE) caused by paracetamol was made. The patient was counseled against using paracetamol for further fever episodes.Figure 1: Hyperpigmentation over the right eyelidFigure 2: Hyperpigmentation over lipsFigure 3: Hyperpigmented lesions on the backA cutaneous ADR known as FDE is characterized by the appearance of erythematous, itchy, or asymptomatic macules that are brought on by the consumption of various medicines.[1] Paracetamol-induced FDE is rare in children and has been reported only in a few number of cases. It is reported in <1.5% of all FDEs.[2] Acetaminophen-induced cutaneous responses are rare and typically unique, exhibiting symptoms such as anaphylaxis, urticarial, a diffuse maculopapular eruption, and infrequently, FDE.[3] Using the Naranjo ADR likelihood scale, a causal link was found (score of +9). The lesion was diffuse in the present case with an unusual location in the eyelids. Eyelids involvement has been reported previously by Kimmatkaar et al. in 2018.[4] The present case highlights an unusual site of involvement following the prescription of very commonly prescribed drug, paracetamol. This general awareness among treating clinicians will prevent subjects from unnecessary investigations and complications. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Source: Indian Journal of Pharmacology
Institutions: Institute of Medical Sciences, Banaras Hindu University
Language: English
Subfield: Pharmacology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4411256953