fixed drug eruption ( fde ) is characterized by recurrent well - defined lesions in the same location each time the responsible drug is taken . we report here a rare case of fde induced by atenolol , a beta - adrenoreceptor - blocking agent . a 48-year - old tunisian woman was referred to our department for the appearance of five inflammatory plaques on both legs . she had been treated for hypertension with atenolol ( hypoten , al - hikma pharmaceuticals , jordan ) 100 mg once a day for six weeks . no other medications had been taken and she had not previously received beta - blocking agents . physical examination revealed five well - demarcated reddish and round plaques with an itching and burning sensation on both legs ( figure 1 ) . skin biopsy , taken from a lesion with no vesicular changes , showed focal necrosis of keratinocytes , hydropic degeneration of the basal cells , dermal edema and a perivascular lymphocytic infiltrate of the upper dermis . topical desonide ( locatop ) was applied twice a day and skin lesions resolved within two weeks with a residual pigmentation . 6 weeks after complete resolution , patch testing was carried out according to the international contact dermatitis research group ( jacobs et al 1999 ) recommendations with 10% atenolol in petrolatum on a previously affected site of the right leg ( figure 2 ) and on normal skin of the back . a positive reaction ( + + ) was seen at d2 and d3 on the left leg but no reaction was detected on the back . they mostly include nonsteroidal antiinflammatory drugs , nonopioid analgesics , sulphonamides , and tetracyclines ( savin 2001 ) . topical provocation testing has been reported to be useful and safe for the diagnosis of fde when applied on previously affected sites ( alanko et al 1987 ; alanko 1994 ; lee 1998 ; ozkaya - bayazit et al 1999 ) . different patch test methods ( open / occlusive ) and variations in their evaluation ( erythema of more than six hours duration / erythema and infiltration ) exist ( ozkaya 2008 ) . beta - blockers - induced fde are very rare ( palungwachira and palungwachira 1999 ; zaccaria et al 2006 ) . only two cases have been reported in the literature ( palungwachira and palungwachira 1999 ; zaccaria et al 2006 ) . they were induced by atenolol ( palungwachira and palungwachira 1999 ) and propranolol ( zaccaria et al 2006 ) . none of them was confirmed by patch testing or systemic provocation ( palungwachira and palungwachira 1999 ; zaccaria et al 2006 ) . thus , to the best of our knowledge , we report herein the first case of fde induced by atenolol and confirmed by a positive patch test on previously affected sites .
fixed drug eruption ( fde ) is characterized by recurrent well - defined lesions in the same location each time the responsible drug is taken . 
 we report here a case of multiple fde induced by atenolol in a 48-year - old woman confirmed by positive patch test in previously affected sites . 
 beta - blockers - induced fde are very rare . 
 only two cases had been reported in the literature . to the best of our knowledge , 
 this is the first case reported of atenolol - induced fde confirmed by a positive patch test .