Ann Dermatol.  2018 Oct;30(5):606-609. 10.5021/ad.2018.30.5.606.

Symmetrical Drug-Related Intertriginous and Flexural Exanthema: Two Cases and Brief Literature Review

• Seok J
• Kim JM
• Park KY
• Seo SJ

• KMID: 2419754
• DOI: http://doi.org/10.5021/ad.2018.30.5.606

Abstract

It has been reported that there are a range of causative drugs related to symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). The causative drugs reported so far include the following: antibiotics, intravenous immunoglobulin, chemotherapeutic agents, and biologics. In this study, we report two cases of SDRIFE and a review of the previous literature. We believe that our study makes a significant contribution to the literature because it demonstrates that intradermal injection of the Chinese herbal ball, and not its topical application, elicited a reaction that predicted the occurrence of SDRIFE. This finding is important for the diagnosis of SDRIFE in future studies. Our findings also provide evidence for a SDRIFE reaction after exposure to ranitidine and mosapride.

Keyword

Chinese herbal ball; Mosapride; Ranitidine; Symmetrical drug-related intertriginous and flexural exanthema; Urushiol

MeSH Terms

Anti-Bacterial Agents
Asian Continental Ancestry Group
Biological Products
Diagnosis
Exanthema*
Humans
Immunoglobulins
Injections, Intradermal
Ranitidine
Anti-Bacterial Agents
Biological Products
Immunoglobulins
Ranitidine

Figure

• 

  Fig. 1 (A~E) Symmetrical erythematous scaly patches on the antecubital fossa, flank, and inguinal area. Delayed intradermal test (F) immediately after injection. (G) Forty-eight hours later, there was a strong positive finding at the injection site of the 1:10 ratio solution. We received the patient's consent form about publishing all photographic materials.

• 

  Fig. 2 (A~E) Symmetrical erythematous, scaly patches involving the forehead, perioral area, neck, inguinal area, and flexural area. (F) Dermal edema with mixed inflammatory cell infiltration (H&E, ×100). (G) There were many eosinophils in the dermis (H&E, ×400). We received the patient's consent form about publishing all photographic materials.

Reference

1. Tan SC, Tan JW. Symmetrical drug-related intertriginous and flexural exanthema. Curr Opin Allergy Clin Immunol. 2011; 11:313–318.

2. Barbaud A. Skin testing in delayed reactions to drugs. Immunol Allergy Clin North Am. 2009; 29:517–535.

3. Häusermann P, Harr T, Bircher AJ. Baboon syndrome resulting from systemic drugs: is there strife between SDRIFE and allergic contact dermatitis syndrome? Contact Dermatitis. 2004; 51:297–310.

4. Wolf R, Orion E, Matz H. The baboon syndrome or intertriginous drug eruption: a report of eleven cases and a second look at its pathomechanism. Dermatol Online J. 2003; 9:2.

5. Valks R, Buezo GF, Daudén E, Fraga J, García-Díez A. Eccrine squamous syringometaplasia in intertriginous areas. Br J Dermatol. 1996; 134:984–986.

6. Pichler WJ, Beeler A, Keller M, Lerch M, Posadas S, Schmid D, et al. Pharmacological interaction of drugs with immune receptors: the p-i concept. Allergol Int. 2006; 55:17–25.

7. Barbaud A, Tréchot P, Granel F, Lonchamp P, Faure G, Schmutz JL, et al. A baboon syndrome induced by intravenous human immunoglobulins: report of a case and immunological analysis. Dermatology. 1999; 199:258–260.