Flexural Exanthema Research Articles

Symmetrical Drug-Related Intertriginous and Flexural Exanthema Caused by Oral Cefadroxil in a Patient with Hepatitis B-Induced Liver Cirrhosis and Psoriasis Vulgaris.

Symmetrical Drug-Related Intertriginous and Flexural Exanthema Caused by Oral Cefadroxil in a Patient with Hepatitis B-Induced Liver Cirrhosis and Psoriasis Vulgaris.

Epidermal Growth Factor Receptor Inhibitor-Induced Symmetrical Drug-Related Intertriginous and Flexural Exanthema: Should You Discontinue the Offending Agent?

Epidermal growth factor receptor (EGFR) inhibitors cause numerous cutaneous adverse events (AEs), including papulopustular eruptions, paronychia, acral fissures, xerosis, alopecia, and trichomegaly. Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a cutaneous reaction that has been uncommonly reported in association with EGFR inhibitors, though the optimal management strategy for this condition is unknown. We present 2 cases of SDRIFE secondary to EGFR inhibitor therapy in which the EGFR inhibitor was successfully continued while topical therapy was administered for effective control of symptoms. We also review the literature on EGFR inhibitor-related SDRIFE to assess the range of approaches to treating this condition. Our analysis suggests that the dermatologist is critical in diagnosing and treating this cutaneous AE, which may be supported with skin-directed therapy and may not require discontinuation of cancer treatment.

Drug Safety Alerts Issued by the National Coordination Centre for Pharmacovigilance Programme of India

Background: Adverse drug reactions (ADRs) due to drug therapy are inevitable and prior knowledge of their causative agents can avoid unnecessary economic burden on patients as well as on the health-care system. Objectives: To create awareness among health-care professionals about the drug safety alerts (DSAs) issued by the National Coordination Centre for Pharmacovigilance Programme of India (NCC-PvPI) till December 2022 and to reiterate the importance of spontaneous reporting of adverse events for better patient care. Methodology: A retrospective analysis of 141 DSAs issued from March 2016 to December 2022 was done. The ADRs were analyzed for the type of reactions, system organ class, and according to drug class. Microsoft Office 2007 was used to formulate the data and presented it in a descriptive manner using numbers and percentages. Results: Out of 141 DSAs under analysis, 101 individual drugs, 2 drug classes, and 7 drug combinations have developed 144 ADRs. These ADRs were compressed into 86 different types as similar ADRs were caused by more than one drug. Drug Reaction with Eosinophilia and Systemic Symptoms is the most common ADR noticed, followed by skin manifestations such as toxic epidermal necrolysis, acute generalized exanthematous pustulosis, skin hyperpigmentation, fixed drug eruption, symmetrical drug-related intertriginous and flexural exanthema, and photosensitivity reaction. The most common causative drugs for ADRs were antimicrobial agents, cephalosporins being the most commonly implicated medication class. Conclusions: Most of the ADRs advised to closely monitor by the NCC-PvPI through DSAs were treatable by early and appropriate management. Due to the high number of skin manifestations observed in the analysis, the role of dermatologists in taking detailed drug history is critical when making a differential diagnosis of skin lesions. Motivation and creating awareness among health-care professionals and patients to spontaneously report adverse events can only strengthen the pharmacovigilance system in India.

A case of symmetrical drug-related intertriginous and flexural exanthema

Symmetrical drug-related intertriginous and flexural exanthema (also known as Baboon syndrome) is a skin eruption in the intertriginous areas. It is believed to be a delayed-type hypersensitivity response to the drug which occurs secondary to systemic absorption of agents after cutaneous sensitization. Our case provides high quality clinical images to aid in clinical diagnosis of this uncommon skin eruption.

An asymmetric morbilliform eruption in an adult male

An asymmetric morbilliform eruption in an adult male

ABA supports AMA regarding monkeypox name change: A satire.

The names of organizations, teams, and medical conditions can elicit controversy when presumedly unintentional defamation of a subset of individuals is perceived. Indeed, this has recently resulted in changing the names of sports teams and diseases. Previously, the ABA (American Baboon Association) solicited the other ABA (American Bar Association), and the drug reaction initially described to as baboon syndrome is now appropriately referred to as symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). Currently, the AMA (American Monkey Association)-with the support of the ABA (American Baboon Association) -has notified the other AMA (American Medical Association) that they consider the name monkeypox unacceptable for this viral infection. The ABA (American Baboon Association) and the AMA (American Monkey Association) are fictional organizations created by the author for the purpose of this satire.

SYMMETRIC DRUG-RELATED INTERTRIGINOUS AND FLEXURAL EXANTHEMA (SDRIFE) INDUCED BY CIPROFLOXACIN

<h3>Introduction</h3> Symmetric Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) describes a symmetrical erythematous rash seen on gluteal and intertriginous areas after first or repeated exposure to systemic drugs. Although beta-lactam antibiotics are the most common causative agents, fluoroquinolones and topical medications have only rarely been implicated in SDRIFE. Here we describe a case of SDRIFE to ciprofloxacin. <h3>Case Description</h3> A 19-year-old male with microtia was treated for otitis externa. He had no prior history of reactions to antibiotics. He received one week of ciprofloxacin otic drops followed by the addition of oral amoxicillin and ciprofloxacin. After one dose of oral ciprofloxacin, he developed pruritus on his neck, chest, and ear and was subsequently admitted for intravenous (IV) sulfamethoxazole-trimethoprim and ciprofloxacin along with otic ciprofloxacin due to worsening otitis. After 2 doses of IV antibiotics, he developed a maculopapular pruritic rash over the decolletage and back with symmetrical eczematous plaques to bilateral axillae, posterior auricular folds, and neck. Despite discontinuing IV antibiotics, the rash initially worsened but rapidly improved after stopping otic ciprofloxacin. <h3>Discussion</h3> We report one of the few cases of flouroquinolone induced SDRIFE previously described only in patients receiving systemic therapy. In this case, exposure to topical fluoroquinolones continued to drive the hypersensitivity reaction despite discontinuing all systemic fluoroquinolones. Although fluoroquinolones and topically administered drugs remain less recognized culprits of SDRIFE, this case highlights the importance of avoidance of all forms of a culprit drug in patients with drug hypersensitivity.

First Report of Symmetrical Drug-related Intertriginous and Flexural Exanthema (SDRIFE or Baboon Syndrome) After Erenumab Application for Migraine Prevention.

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), formerly also called baboon syndrome, is characterized by symmetrical erythematous rash with typical localization in the gluteal and intertriginous areas. A typeIV delayed hypersensitivity immune response is thought to be responsible for its development. CGRP monoclonal antibodies (CGRP mAbs) are a new class of drugs for the prevention of migraine. We present the first case of SDRIFE occurring in temporal relation to the use of erenumab for migraine prevention. A 48-year-old female patient with migraine received erenumab 140mg subcutaneously in the thigh area for the prevention of migraine in repetitive cycles, each 1month apart. Initially, the patient experienced no side effects. After the third cycle, a masseuse incidentally noticed a reddish, circular rash in the buttock area during a back massage. There were no other symptoms. The skin changes resolved spontaneously. Two years later, approximately 40h after reapplication of erenumab 140mg, the patient experienced a severe pain in the buttock area centered over the anal crease. The area of pain extended in a circular pattern with approximately 20cm in diameter. The pain started abruptly and reached a severe intensity within about 30min. Sitting on the buttocks was no longer possible for the patient. There was marked allodynia and hyperpathia in the entire buttocks region. A flat, broad-based blister-like skin swelling developed in this region. The blisters began opening up on the fourth day after the onset of the skin reaction. In addition, there was a pronounced redness in the entire buttock area. Here, the patient felt a strong burning pain, similar to a scald. The symptoms lasted for a period of 10days. From this point on, they fully subsided under concomitant therapy with prednisolone. SDRIFE as a rare dermatological side effect should be considered in the monitoring of skin lesions during migraine prophylaxis. In view of the high migraine prevalence, knowledge of this uncommon syndrome is important. It is crucial to recognize the relationship between the medication and the circumscribed exanthema occurring distant from the injection site.

Three cases of symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) induced by proton-pump inhibitors.

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), previously termed drug-related baboon syndrome, is an uncommon drug eruption. It is characterized by symmetrical erythema involving the gluteal and/or inguinal area in association with one other intertriginous area in the absence of systemic involvement. It typically develops a few hours to days after drug exposure. The diagnosis is based on clinical presentation and drug history. The treatment consists mainly of withdrawal of the causative agent; corticosteroids (topical or systemic) are prescribed to accelerate the resolution. We present three cases that appeared after proton-pump inhibitors (PPIs) intake.

LB906 Characterization of cutaneous adverse events to enfortumab vedotin

Enfortumab vedotin (EV) is an antibody drug conjugate for patients with locally advanced or metastatic urothelial carcinoma. Clinical trials evaluating the efficacy of EV have reported treatment-related rash in 43.9% of patients. There is insufficient data characterizing cutaneous adverse events (CAEs) associated with this medication. We sought to characterize CAEs from EV including type of reaction, patient demographics, EV dose regimen, treatments, and disease outcomes. We compared these variables with a control group of patients who did not develop rashes to identify risk factors for CAEs. A retrospective review was performed at Mayo Clinic Health System from 2010-2021 to identify adult patients treated with EV. Patient demographics, EV treatment details, previous treatments, and tumor responses were compared between patients with CAEs and those without using Fisher’s Exact and Kruskal-Wallis tests. A total of 59 patients were identified. Fifteen (25.4%) were reported to have a CAE to EV including maculopapular rash (46.7%), macular rash (20.0%), bullous dermatoses (6.7%), generalized pruritus (6.7%), and symmetric drug-related intertriginous and flexural exanthema (6.7%) with grade severity of 1-2. Mean time of onset from first infusion to CAE was 19.9 days (SD=14.7). Mean number of treatment cycles before AEs was 1.1 (SD=0.5). 9/16 patients (60%) did not require change in EV regimen. Treatments for CAEs included topical or systemic corticosteroids and anti-histamine medications with 80% response. Previous cisplatin (RR 4.61) or radiation therapy (RR 4.76) were associated with development of CAEs. Most CAEs to EV are low grade and occur after first cycle of infusion. Previous cisplatin or radiation therapy is associated with development of CAEs. Treatment response for CAEs is high and EV dose regimen may often remain unchanged.

“Baboon” Syndrome

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), previously known as Baboon syndrome, is a symmetrical erythematous rash on the gluteal and intertriginous areas observed after exposure to systemic drugs. This was the case of a 35-year-old woman who presented to medicine OPD (outpatient department) of Assam Medical College and Hospital (AMCH), Dibrugarh with a history of a macular rash over the right and left armpit and right upper back, buttocks and inner aspect of the left thigh.

Symmetric drug-related intertriginous and flexural exanthema-like eruption related to coronavirus disease 2019 vaccine.

Symmetric drug-related intertriginous and flexural exanthema-like eruption related to coronavirus disease 2019 vaccine.

A rare case of symmetrical drug‐related intertriginous and flexural exanthema due to pantoprazole

A rare case of symmetrical drug‐related intertriginous and flexural exanthema due to pantoprazole

Covishield™ (ChAdOx1 nCoV-19) Vaccine-Induced Systemic Drug-Related Intertriginous and Flexural Exanthema in a Young Girl: A Case Report and Literature Review.

Covishield™ (ChAdOx1 nCoV-19) Vaccine-Induced Systemic Drug-Related Intertriginous and Flexural Exanthema in a Young Girl: A Case Report and Literature Review.

Systemic allergic dermatitis (systemic contact dermatitis) from pharmaceutical drugs: A review.

The literature on systemic allergic dermatitis (SAD; also known as systemic contact dermatitis) is reviewed. Both topical drugs (from absorption through mucosae or skin) and systemic drugs (oral, parenteral, rectal) may be responsible for the disorder. The topical route appears to be rare with 41 culprit topical drugs found to cause SAD in 95 patients. Most reactions are caused by budesonide (especially from inhalation), bufexamac, and dibucaine. SAD from systemic drugs is infrequent with 95 culprit drugs found to cause SAD in 240 patients. The drugs most frequently implicated are mitomycin C, methylprednisolone (salt, ester), and hydrocortisone (salt). The largest group of culprit drugs consisted of corticosteroids (19%), being responsible for >30% of the reactions, of which nearly 40% were not caused by therapeutic drugs, but by drug provocation tests. The most frequent manifestations of SAD from drugs are eczematous eruptions (scattered, widespread, generalized, worsening, reactivation), maculopapular eruptions, symmetrical drug-related intertriginous and flexural exanthema (SDRIFE [baboon syndrome]) and widespread erythema or erythroderma. Therapeutic systemic drugs hardly ever cause reactivation of previously positive patch tests and infrequently of previous allergic contact dermatitis. The pathophysiology of SAD has received very little attention. Explanations for the rarity of SAD are suggested.

First Case of Symmetric Drug-Related Intertriginous and Flexural Exanthema Induced by Meropenem.

First Case of Symmetric Drug-Related Intertriginous and Flexural Exanthema Induced by Meropenem.

Symmetrical Drug-related Intertriginous and Flexural Exanthema (Baboon Syndrome).

Baboon syndrome, also called symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), is an erythematous maculopapular rash that presents in skin folds in a symmetrical pattern. This condition may develop after the patient starts a particular agent. Treatment consists of stopping the associated trigger and medicating with topical or systemic corticosteroids.A 30-year-old man with odynophagia, otalgia and fever was prescribed amoxicillin. He developed erythematous and pruriginous lesions in the cubital fossa and inguinal regions. He attended the emergency department (ED) where he was prescribed penicillin. Lesions continued to progressively worsen with a bilateral symmetrical pattern in the axillary region and later in the nape folds, popliteal regions, and on the perineum and buttocks. The patient presented to the ED for a second time, where he was diagnosed with baboon syndrome and prescribed topical steroids with clear improvement.LEARNING POINTSIt is important to identify adverse drug effects.Baboon syndrome is rare and secondary to the use of particular drugs.The diagnosis is based mainly on the patient’s clinical presentation.

Symmetrical Drug-Related Intertriginous and Flexural Exanthema Induced by Cellulitis Prophylaxis

Penicillin VK and hydroxyzine are typically well-tolerated antipruritic agents that are indicated in the prophylaxis of cellulitis. We herein report a case of a unique rash occurring during penicillin VK and hydroxyzine treatment in combination with the ingestion of cashews.

26667 Symmetrical intertriginous and flexural exanthema (baboon syndrome) induced by alcohol deterrent drug

Baboon syndrome refers to a clinical manifestation of a drug-related condition. It usually affects the intertriginous and flexural areas of the body, where a specific macular exanthema can be observed, including the gluteal area which can be similar to the buttocks of a baboon. It is considered a type IV hypersensitivity reaction due to the administration of systemic drugs such as beta-lactam antibiotics, omeprazole, clozapine, antihypertensive medication, or exposure to chemical substances such as mercury or nickel.

Symmetrical intertriginous and flexural exanthema related to the use of paracetamol

Symmetrical intertriginous and flexural exanthema related to the use of paracetamol