References: When A Gin and Tonic Can Mean Trouble: Fixed Drug Eruption Due To Quinine
References: When A Gin and Tonic Can Mean Trouble: Fixed Drug Eruption Due To Quinine
References: When A Gin and Tonic Can Mean Trouble: Fixed Drug Eruption Due To Quinine
Table 1 Clinical Characteristics of Patients with Kaposi’s Sarcoma Treated With Topical Timolol.
Patient Age, y Sex Area Involved Clinical Type Size, cm Associated Disease Time to Remission, mo Follow-Up, mo
1 52 M Left leg Plaque 9×4 None 5 10
2 70 F Left foot Plaque 14 × 62.5 × 2.5 Hypertension 5 9
3 65 M Right leg Plaque 12 × 5 None 4 6
4 45 M Right arm Plaque 11 × 4 HIV-TB 6 4
5 78 M Right foot Nodular NA None 12 22
6 94 F Right leg Nodular NA None 12 20
7 89 M Both feet Nodular NA Hypertension 12 5
8 83 M Right hand Nodular NA None 18 4
9 71 M Penis Nodular NA None 24 10
Abbreviations: M indicates male; F, female; NA, not available; TB, tuberculosis; HIV, human immunodeficiency virus.
When a Gin And Tonic Can Mean recent years, cases due to the quinine in tonic water have
been reported. We report a case of FDE caused by quinine
Trouble: Fixed Drug Eruption after drinking a gin and tonic and we review the cases pub-
Due to Quinine夽 lished to date. We analyze the current legislation on the
amount of quinine allowed in drinks and the differences
Cuando tomarse un gin-tonic se convierte en between the different brands sold in Spain.
una mala experiencia: exantema fijo A 32-year-old woman visited our department with
medicamentoso por quinina repeated outbreaks of erythematous-violaceous lesions with
irregular, edematous margins in the perioral region, the 5th
To the Editor: finger of the left hand, and the lateral surface of the right
hand, compatible with FDE (Fig. 1). The patient occasion-
A fixed drug eruption (FDE) may be caused by different ally took diclofenac and metamizole but did not improve. On
drugs, especially NSAIDs, paracetamol, and antibiotics. In examining the patient’s full medical history, we discovered
that the lesions coincided with the consumption of gin and
tonic; quinine was therefore suspected.
A skin-patch test performed with Schweppes® tonic water
was negative, and epicutaneous tests with the tonic, with
夽 Please cite this article as: Castellanos-González M, et al. quinine in petrolatum at 20%, and in aqueous solution at 1%,
Cuando tomarse un gin-tonic se convierte en una mala experien- were also negative after 48 and 96 h. An oral provocation
cia: exantema fijo medicamentoso por quinina. Actas Dermosifiliogr. test was positive, with appearance of the lesions a few hours
2020;111:178---180.
CASE AND RESEARCH LETTERS 179
Author Year Age Sex Location Biopsy Patch tests Oral provocation Tonic water
test brand
Asero2 2003 23 Female Upper lip, arm, neck, No Negative +
back, and chest
Muso et al.3 2007 24 Female Lip, fingers No Positive + −
Muso et al.3 2007 37 Male Fingers and elbow No Positive + −
Gázquez et al.4 2009 34 Male Right hand, tongue, and Yes Positive + −
oral mucosa
Bel et al.5 2009 57 Female Hand, fingers, wrists, ear Yes Positive No Schweppes®
Gonzalo Garijo 2012 32 Female Lip, hand No Negative + −
et al.6
Ohira et al.1 2013 26 Male Perioral region, lumbar No Positive + Schweppes®
region, penis
Lonsdale-Eccles 2014 20 Male Tongue, lip, penis Yes No + −
et al.7
Genest et al.8 2014 25 Male Palate, finger, penis No Negative No Canada Dry®
Castellanos 2018 32 Female Lip, hand, and fingers Yes Negative + Schweppes®
González et al.
a Two more cases exist, for which we could find no data.