The drug toxidermias are the skin side effects of drugs [1]. These toxidermias may display in the particular aspect as a fixed pigmented erythema (FPE). The most commonly used drugs, including barbiturates, carbamazepine, paracetamol, phenazone, and other pyrazole derivatives [2], might induce a lonely [3,4] or a polymorphic FPE with diverse causes [5-8]. We described a case observed at the University Teaching Hospital of Bouake.

A 43-year-old man, with no medical background and HIV negative, consulted at the Dermatology Department at the University Teaching Hospital of Bouake for an itching pigmented macule which occurred five days after taking cimetidine. The patient consulted for an epigastralgia five days earlier during a medical consultation sponsored by the Member of Parliament of his region and received free care of cimetidine (1 tablet of 300 mg per day). On the fifth day of treatment, the patient had chest itching and burning sensation. The physical examination showed several inflammatory and pigmented erythemas on the thorax at the top and bottom of the right and left breasts, which indicated the diagnosis of FPE (Figs. 1a and 1b). The relief of symptoms occurred on the seventh day when he stopped using the drug. However, the subsequent administration of cimetidine resulted in the reappearance of the initial symptoms. As a result, the final withdrawal of cimetidine led to the complete relief of signs. The treatment of the patient was extended for a further four weeks with omeprazole without any incident.

The FPE is the exclusive dermatosis caused by drugs. The most commonly used drugs are some anticonvulsants (barbiturate and carbamazepine), phenazone, acyclovir, hydroxyzine, non steroidal anti-inflammatory drugs [1] and certain antibiotics (cyclins, sulphonamides, ampicillin, antituberculosis drugs) [2]. Cimetidine was initially verified to induce the FPE in Tokyo in 1985 [3] and in California in 1998 [4]. The leading role of cimetidine in the occurrence of the FPE seems to be certain within our patient since it is the unique systemic drug taken. In addition, dietary risk factors are rarely responsible for FPE even though our patient’s eating habits were unchanged. The regression of the symptoms after stopping the use of cimetidine followed by early reappearance (< 24 hours) of these initial signs due to the experimental administration of the drug strongly confirm the diagnosis certainty of FPE. In this case, the lesions appeared on the fifth day of the antisecretory treatment. Generally, the time to onset of the FPE is very short (24-48 h) [2] and much shorter in the case of reintroduction of the drug, which is similar to that of our patient.

The diagnosis of FPE requires a rigorous etiological approach. Besides the most frequently used drugs, cimetidine can be responsible for FPE. Therefore, the practitioner should initially consider the potential role of cimetidine.