Reactions 2001, p143 - 30 Mar 2024 1

Fexofenadine/terbinafine S

Exfoliative dermatitis
A 49-year-old man developed exfoliative dermatitis during treatment with terbinafine for mild onychomycosis.
The man, who presented with discoloured greater toenail, was diagnosed with mild onychomycosis. Subsequently, he started
receiving oral terbinafine pill [dosage not stated]. After 11 days of terbinafine initiation, he reported a red, non-itching macular rash
on his chest and axillary region, indicating a mild allergic reaction.
Thus, terbinafine was stopped and the man started receiving fexofenadine 180mg once a day.Four days later, despite receiving
fexofenadine, his condition did not improve. Therefore, lack of efficacy to fexofenadine was considered. His upper body was noted
to be completely red. During the examination, he was noted to have a confluence erythematosquamous rash. Thereafter, he
received prednisolone. Further examination showed a diffuse erythematosquamous rash with collarette-shaped desquamations,
extending from the neck over the entire torso, to the arms and thighs. Additionally, his lower legs and hands had smaller
erythematosquamous papules. Further, elevated erythrocyte sedimentation rate at 25 mm/h and leukocytosis at 27.8×109/L was
noted.Subsequently, he was diagnosed with exfoliative dermatitis secondary to terbinafine. Following this, he received
betamethasone, lactic acid/urea [Calmurid] and petrolatum [vaseline paraffin] along with prednisolone. At a follow-up, three weeks
later, the rash was fully resolved and the skin had returned to normal.
Watjer RM, et al. Severe drug eruption from oral terbinafine for mild onychomycosis-A case report from family practice and literature review: "Just an innocent little pill?".
SAGE Open Medical Case Reports 12: Mar 2024. Available from: URL: https://dx.doi.org/10.1177/2050313X241235823 803849640