Symmetrical Drug-Related Intertriginous and Flexural Exanthema Caused by Valacyclovir

Abstract

Drug-related eruptions that appear only on intertriginous or flexural folds and in gluteal areas have recently been termed symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). We report a case of a 56-year-old woman with acute erythematous rash in the intertriginous areas after treatment with the L-valine ester of acyclovir, valacyclovir. Oral-challenge tests resulted in erythematous pruritic rash in the intertriginous area by valacyclovir. The patient was diagnosed as having SDRIFE due to valacyclovir.

A case of symmetrical drug-related intertriginous and flexural exanthema caused by valacyclovir

“…Although patch testing is essential for the diagnosis of SDRIFE, the rate of positive tests is not high and estimated at approximately 50% [1,3]. In our case, results of patch testing with valacyclovir 10% pet on involved arm skin was positive, which was however negative on the uninvolved back skin.…”

“…In our case, results of patch testing with valacyclovir 10% pet on involved arm skin was positive, which was however negative on the uninvolved back skin. In the previous report of valacycrovir-induced SDRIFE [3], the patch testing with valacyclovir 20% pet on the uninvolved back skin resulted in negative. Although there has been no evidence on the most suitable site for patch testing in SDRIFE, we showed the usefulness of skin patch test on the lesional skin to provoke a positive response as in fixed drug eruption.…”

Current understanding of Baboon syndrome

“…Examples of systemic absorption following topical exposure Inhalation of mercury vapor mainly from broken thermometer [16] or nickel vapor from paints [65]; ingestion of food containing nickel [65] or nickel-chelating agents [1] or accidental ingestion of mercury-containing cream [62]; suppositories containing balsam of Peru [5] Contact with poison ivy [202] Contact allergenic druginduced BS Yes Yes Aminophylline [93,94], neomycin [95], nystatin [96], corticosteroids [77,97], erythromycin[18], amoxicillin [29], ampicillin[1], 5-aminosalycilic acid [72], bufexamac [73], cinchocaine [24,74] Oral [44,103], clindamycine [104], roxithromicin [105], allopurinol [38], contrast media [32,46], cimetidine [106], deflazacort [41], hydroxyurea [36], heparin [39], intravenous immunoglobulin [45], mitomycin C [71,107], naproxen [32], oxycodone [32], salsalate [25], terbinafine [58], cetuximab [35], valacyclovir [108] Oral (the majority); intravenous [32,35,39,45,46]; intravesical …”

“…Amoxicillin was the leading eliciting agent [17,19,21,22,26,27,29,31,32,43,59,[98][99][100], followed by ampicilllin [101], pivampicillin [102], penicillin V [33], ceftriaxone [32], cefuroxime [17,32] and cephalexin [32]. Several other drugs have also been involved, such as pseudoephedrine [44,103], clindamycin [104], roxithromycin [105], allopurinol [38], barium sulfate-containing contrast media [32], iodinated radiocontrast media [46], cimetidine [106], oral deflazacort [41], hydroxyurea [36], heparin [39], IVIg [45], mitomycin C (intravesical instill ation) [71,107], naproxen [32], oxycodone [32], salsalate [25], terbinafin [58], cetuximab [35] and valacyclovir [108]. A pediatric patient developed BS 1 day after ingestion of cefadroxil, paracetamol and a cough mixture, but further ana lysis of the causative agent could not be performed [109].…”

“…Moreover, delayed prick test reading was positive with amoxicillin [99], allopurinol [38] and heparin [39], delayed reading of an intradermal test with ampicillin and benzyl penicillin [22], iodinated radiocontrast media [46], penicillin V and G [33], mast cell degranulation test with clindamycine [104] and oral provocation test (OPT) with amoxicillin [17], clindamycine [104], cimetidine [106], IVIg [45], terbinafin [58], iodinated contrast media [46], valacyclovir [108] and crossreactive phenoxymethylpenicillin in a patient with amoxicillin-induced BS [59].…”