Symmetrical drug-related intertriginous and flexural exanthema

Tan, Seng C.; Tan, J.

doi:10.1097/aci.0b013e3283489d5f

Cited by 73 publications

(78 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…2 PATCH tests, lymphocyte transformation test (LTT) and drug provocation tests (DPTs) can be used for diagnosis but DPTs remain the gold standard for the determining the offending drug. 3 Although the histopathology of SDRIFE typically shows a superficial mononuclear perivascular infiltrate with neutrophils and eosinophils, other features, including subcorneal pustules, vacuolar changes and hydropic degeneration in the basal cell layer with subepidermal bullae, and necrotic keratinocytes were also reported. 2 In our case, the diagnosis of infliximab-associated SDRIFE was based on a typical clinical picture, the histopathology, exclusion of other possible medications, and also a positive provocation test.…”

Section: Discussionmentioning

confidence: 99%

“…SDRIFE is thought to result from a type IV delayed hypersensitivity immune response and acute/delayed hypersensitivity reactions may occur during the treatment period with infliximab. 3,6,7 Infliximab contains murine sequences at a rate of 25% and these sequences may be the cause of the immunological reactions. 8,9,10 We also think that TNF-α inhibitor therapy may lead to aberrant IFN-α expression and SDRIFE lesions could be induced with a mechanism similar to that of pustular dermatitis.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Symmetrical drug-related intertriginous and flexural exanthema (Baboon syndrome) associated with infliximab

Bulur¹,

Keseroglu²,

Saraçoğlu³

et al. 2015

J Dermatol Case Rep

View full text Add to dashboard Cite

Background: Symmetrical drug related intertriginous and flexural exanthema (SDRIFE or Baboon syndrome) is a symmetrical contact dermatitis on inverse regions of the body. The disorder is easily differentiated from other drug eruptions by its typical appearance and lack of other concurrent findings. Observation:A 50-year-old male patient presented to our clinic complaining of a rash that had developed two days after the tenth infliximab infusion for psoriasis and reoccurred after consecutive infusions. The physical examination revealed a bilateral intergluteal, inguinal, abdominal, axillary, antecubital and neck region macular erythematous rash. There were no other systemic findings. The laboratory values were within normal range. The patient was diagnosed with symmetrical drug-related intertriginous and flexural exanthema associated with infliximab treatment based on dermatological findings, histopathology and the results of the provocation test. The lesions resolved permanently after the patient was swiched from infliximab to adalimumab. Conclusion:Various cutaneous adverse events of anti-tumor necrosis factor alpha treatment have already been reported. The increased use of these agents can lead to a wider variety of drug-induced skin lesions, such as the reported Baboon syndrome.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Symmetrical drug-related intertriginous and flexural exanthema (Baboon syndrome) associated with infliximab

Bulur¹,

Keseroglu²,

Saraçoğlu³

et al. 2015

J Dermatol Case Rep

View full text Add to dashboard Cite

show abstract

“…‘Baboon syndrome,’ or symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) as it is more correctly termed, is a rare type IV hypersensitivity reaction causing a maculopapular rash 9 10. The original name ( baboon syndrome ) stems from the rash of the patient's buttocks being reminiscent of the buttocks of a baboon.…”

Section: Introductionmentioning

confidence: 99%

Baboon syndrome: an unusual complication arising from antibiotic treatment of tonsillitis and review of the literature

2013

View full text Add to dashboard Cite

A 40-year-old man presented with sore throat and fevers associated with bilaterally enlarged and inflamed tonsils. A clinical diagnosis of tonsillitis was made and the patient received intravenous benzylpenicillin. Over subsequent days, the patient developed a macular rash over both groins, buttocks and axillae, with necrotic patches in the groins. An assumptive diagnosis of necrotising fasciitis was made. The patient underwent urgent groin biopsy and was started on broad spectrum antibiotics. No organisms were seen on Gram stain. Following a multidisciplinary discussion, the patient was diagnosed with baboon syndrome (symmetrical drug-related intertriginous and flexural exanthema). He was treated with oral steroid along with topical agents. Baboon syndrome can develop following penicillin administration. Given the widespread use of penicillin antibiotics to treat tonsillitis and many other conditions, it is important that medical staff recognise the side effects of these medications.

show abstract

“…However, corticosteroids, biologics and chemotherapeutic agents may also cause the eruption. 3 Acetaminophen may induce urticaria, maculopapular eruption, fixed drug eruption, angioedema, and toxic epidermal necrolysis, 4 but only one case of SDRIFE has been associated with acetaminophen. 5 It is important to be aware of SDRIFE as an unusual drug reaction since the connection between the skin eruption and drug exposure may easily be overlooked and thus result in misdiagnosis.…”

mentioning

confidence: 99%

“…Patch tests are useful in identifying the culprit drug in SDRIFE, but the positive rate is reportedly low. 3 A reliable examination to reach the diagnosis is the provocation test. 3 The most common causative drugs in SDRIFE were beta-lactam antibiotics.…”

mentioning

confidence: 99%

A case of symmetrical drug‐related intertriginous and flexural exanthema induced by acetaminophen

Obara

Maejima

Katayama

et al. 2014

The Journal of Dermatology

View full text Add to dashboard Cite

A case of symmetrical drug-related intertriginous and flexural exanthema induced by acetaminophen Dear Editor, A 53-year-old man was treated with radiation therapy for prostate cancer. After radiation therapy, acute prostatitis developed.Cefcapene pivoxil and acetaminophen were administrated. One day after commencement of the two drugs, he noticed a sharply defined, symmetrical erythema on both legs, axillae, and buttocks without systemic symptoms (Fig. 1a,b). No mucosal lesions were seen. Laboratory tests revealed mild leukocytosis (9600/lL) and an increased level of C-reactive protein (8.84 mg/dL). The skin biopsy specimen from the cutaneous lesions on the buttocks showed small subcorneal neutrophilic pustules, numerous lymphocytes, and some eosinophilic infiltrates around upper dermal small vessels (Fig. 1c). After discontinuing cefcapene pivoxil and acetaminophen, oral prednisolone at 20 mg daily was administrated, and the erythema disappeared without pigmentation. Patch tests were negative. The lymphocyte transformation test for acetaminophen was positive at 140 cpm and the stimulation index (S.I.) was 218% (control was 64 cpm and the normal limit of S.I. is <180%). Oral provocation testing with acetaminophen resulted in an identical flexural rash on the right leg that appeared a few hours after provocation. A diagnosis of SDRIFE induced by acetaminophen was made based on the above findings.The baboon syndrome is a particular form of systemic contact dermatitis caused by systemic exposure to mercury, nickel, or other agents. 1 Drug-related baboon syndrome is also known as SDRIFE. The proposed criteria are: (i) exposure to a systemically administered drug (classical contact allergens have to be excluded); (ii) sharply demarcated erythema of the gluteal/perianal area and/or V-shaped erythema affecting the inguinal/perigenital area; (iii) involvement of at least one other intertriginous/flexural fold; (iv) symmetry of eruption; and (v) absence of systemic symptoms and signs. 2 Although our patient met all of these criteria, he did not have the characteristic inguinal erythema. The common histopathological finding is a superficial perivascular infiltrate of lymphocytes, sometimes with neutrophils and eosinophils. Other findings include epidermal spongiosis, subcorneal pustules, and vacuolar change in the basal layer. 3 SDRIFE is primarily a clinical diagnosis, and laboratory investigations and histopathological features are not strictly required for the diagnosis. The differential diagnosis of SDRIFE is fixed drug eruption and acute generalized exanthematous pustulosis (AGEP). Fixed drug eruption presents with a small number of violaceous plaques that leave postinflammatory hyperpigmentation. AGEP is characterized by (a) (b) (C) Figure 1. Sharply demarcated and symmetrical erythema on the (a) buttocks and (b) axillae. (c) Histopathological examination revealed a subcorneal neutrophilic pustule and perivascular infiltrate of lymphocytes and eosinophils in the upper dermis (hematoxylin-eosin stain, original magnif...

show abstract

Symmetrical drug-related intertriginous and flexural exanthema

Cited by 73 publications

References 31 publications

Symmetrical drug-related intertriginous and flexural exanthema (Baboon syndrome) associated with infliximab

Symmetrical drug-related intertriginous and flexural exanthema (Baboon syndrome) associated with infliximab

Baboon syndrome: an unusual complication arising from antibiotic treatment of tonsillitis and review of the literature

A case of symmetrical drug‐related intertriginous and flexural exanthema induced by acetaminophen

Contact Info

Product

Resources

About