Symmetrical Drug-related Intertriginous And Flexural Exanthema Research Articles

Symmetrical drug-related intertriginous and flexural exanthema with high-risk systemic features: a unique clinical phenotype in hospitalized patients.

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is classically considered a low-risk, self-limiting eruption lacking systemic manifestations and sparing facial and mucosal areas. We present 7 inpatients meeting diagnostic criteria for SDRIFE with concomitant systemic manifestations ± high-risk facial involvement acutely after antibiotic exposure (mean latency 6.71days). These cases deviate from classic, self-limited SDRIFE and represent a unique phenotype of SDRIFE, characterized by coexisting extracutaneous manifestations. Onset of systemic stigmata coincided with or preceded cutaneous involvement in 4 and 3 patients, respectively. All patients developed peripheral eosinophilia and 6 patients had ≥ 2 extracutaneous systems involved. Facial involvement, a high-risk feature associated with severe cutaneous adverse reactions but atypical in classic SDRIFE, occurred in 4 cases. Patients had favorable clinical outcomes following drug cessation and treatment with 4-6week corticosteroid tapers. We suggest that baseline labs be considered in hospitalized patients with antibiotic-induced SDRIFE. These patients may also necessitate systemic therapy given extracutaneous involvement, deviating from standard SDRIFE treatment with drug cessation alone.

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) after administration of corticosteroids: Case series and review of literature.

Cutaneous manifestations of drug-induced type IV reactions vary widely, with symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) being a less common presentation. Corticosteroids (CS), primarily known for their anti-inflammatory effects, rarely induce hypersensitivity reactions. The aim of this case series is to report four cases of SDRIFE following systemic prednisolone therapy and to review existing CS classification proposals to better understand cross-reactivity of CS. Patients recruited at a German dermatology centre underwent allergologic evaluation including prick and patch testing with various CS. Positive cases underwent oral challenge testing with alternative agents. The classification systems of Coopman et al. and Baeck et al. were taken into account. Despite a paucity of literature, CS-induced type IV reactions do occur, including SDRIFE. Classification systems based on chemical structure provide insight into cross-reactivity patterns. Provocation tests with alternative CS highlight the complexity of managing CS hypersensitivity. SDRIFE may develop following systemic prednisolone therapy. Classification systems are helpful in understanding cross-reactivity and help in the selection of alternative preparations but are not always reliable. Individualised assessment is crucial for managing CS hypersensitivity, with consideration of alternative agents and emergency use of CS when necessary.

Antitubercular medications and levetiracetam-induced symmetric drug-related intertriginous and flexural exanthema

Symmetric drug-related intertriginous and flexural exanthema (SDRIFE) is a rare, distinctive cutaneous adverse reaction associated with various medications. Here, we present the case of a 48-year-old male, admitted with complaints of slurring of speech with a deviation of face with abnormal movements and posturing of hands and limbs and loss of consciousness for about 15 min. Magnetic resonance imaging (MRI) brain with angiography was done which was suggestive of a ring-enhancing lesion with perilesional edema hinting toward the possibility of tuberculoma. A contrast MRI brain was done which was suggestive of leptomeningeal and pachymeningeal left frontal region with perilesional edema suggestive of tuberculoma so the patient was started on antitubercular therapy and dexamethasone and levetiracetam. The patient developed redness over the lower abdomen which gradually progressed to involve the lower back, bilateral axilla, and upper back. Potential suspected drugs such as antitubercular therapy and levetiracetam were stopped and the patient improved. The patient was started on another antiepileptic injection lacosamide. Antitubercular therapy was started again, on starting isoniazid 75 mg the patient started developing itching again, which was managed by giving antihistaminic. This case report highlights the importance of recognizing and managing SDRIFE as a potential complication of combination drug therapy and the need for vigilant monitoring of patients receiving such medications.

Characterization of T-Helper Immune Phenotype in Symmetrical Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) Endorses a Delayed-Type Hypersensitivity Reaction.

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a cutaneous drug eruption with a characteristic distribution of erythema on the gluteal/inguinal region and intertriginous areas with unclear pathogenesis. In this study, we aimed to characterize the T-helper immune phenotype in SDRIFE in comparison with psoriasis and eczema to further the understanding of the pathophysiology and immune response of this rare disorder. Immunohistochemical staining was performed on 9 skin biopsies each from SDRIFE, psoriasis, and eczema using immunohistochemistry for CD3 and dual CD4/T-bet, CD4/GATA3, and CD4/RORC to quantify the percentage of Th1, Th2, and Th17 cells, respectively. A significant difference was detected in the average percentage of Th1 between all 3 groups with the highest percentage of Th1 cells seen in psoriasis, followed by SDRIFE and eczema. SDRIFE showed significantly lower Th2 expression as compared to both psoriasis and eczema. There was a trend towards a higher average percentage of Th17 in psoriasis and SDRIFE, and the ratio of Th17:Th2 was significantly higher in samples of SDRIFE compared with both eczema and psoriasis. The findings characterize SDRIFE as a Th1 and possibly Th17-driven process, which could inform future therapeutic options and substantiate the model of SDRIFE as a delayed-type hypersensitivity reaction.

Celecoxib and Bullous Symmetrical Drug-Related Intertriginous and Flexural Exanthem (SDRIFE)

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a nonimmediate, T-cell–mediated hypersensitivity drug reaction, characterized by symmetrical erythema involving the gluteal and intertriginous areas without systemic involvement. It occurs after systemic administration of a drug in an individual with/without prior sensitization.1 We report a case of celecoxib-induced bullous SDRIFE. Informed consent was obtained from the patient to publish the case report along with accompanying images.

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.

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.

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.

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.

“BABOON” syndrome: A case report

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.

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.

Symmetric drug-related intertriginous and flexural exanthema: Clinicopathologic study of 19 cases and review of literature.

Symmetric drug-related intertriginous and flexural exanthema (SDRIFE) is a cutaneous drug reaction characterized by gluteal/anogenital erythema and symmetric involvement of other intertriginous location(s) without systemic signs. Clinicopathologic characterization has been limited to case reports and small series. We describe 19 new cases and review the literature to better define the clinical and histopathologic spectrum of SDRIFE. Pathology archives were searched for "SDRIFE" and "baboon syndrome." Cases meeting clinical criteria were included. Clinical and histopathologic features were recorded. Previous reports of SDRIFE with histopathologic descriptions were reviewed. Nineteen new cases were included, over half triggered by antibiotics. Six new causative medications were identified. Median onset was 7 days. Typical lesions were erythematous plaques or papules with or without scale. The most common histopathologic finding was superficial perivascular lymphocytic infiltrate followed by dermal eosinophils, spongiosis, and orthokeratosis. Basal vacuolization and apoptotic keratinocytes were less common. Interstitial histiocytes were present in almost half of our cases. Other findings included atypical lymphocytes and "flame figure." Appreciation of the range of inciting medications and clinicopathologic features in SDRIFE will improve recognition of this condition. Although many histopathologic features overlap with other common dermatitides, biopsy may assist in excluding key clinical mimics.

COVID‐19‐related cutaneous manifestations associated with multiple drug sensitization as shown by lymphocyte transformation test

Patients with novel coronavirus disease 2019 (COVID-19) can present with a wide variety of cutaneous manifestations.1, 2 Drug-induced eruptions, however, are often indistinguishable from the COVID-19-related rash. Because many patients (~20%) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been shown to develop cutaneous manifestations,3 the rash may have been reported as COVID-19-related rash without excluding the possibility of drug eruptions. Here, we report a case suspected of COVID-19-related rash, in which lymphocyte transformation tests (LTTs) to the culprit drugs were positive. A 44-year-old man presented with fever (38.5°C). He denied cough, sore throat or shortness of breath, and had no history of drug eruptions. On the 17th day of symptoms, he developed erythematous macules and petechiae on his both legs; erythematous macules suddenly appeared in the knee, flexural thigh and popliteal fossae (Fig. 1). Significant laboratory findings are as follows: white blood cell count, 5300/mm3; lymphocyte count, 715/mm3; platelets, 118 000/mm3; and C-reactive protein (CRP), 4.95 mg/dL. CT images displayed ground-glass opacification patterns and bilateral lung involvement. His COVID-19 reverse transcription–polymerase chain reaction test result was positive. About 6 days before the eruption appeared, he had received loxoprofen sodium hydrate, acetaminophen and favipiravir. He recalled that he had used loxoprofen and acetaminophen in the past but only on few occasions. Loxoprofen was withdrawn, and despite the use of acetaminophen and favipiravir, the eruption spontaneously involuted over 4 days without a trace (Fig. 2). LTTs were performed and showed positive reactions to all drugs used. He was discharged 7 days later and has no long-term sequelae. The main difficulty in assigning a pathogenic role to SARS-CoV-2 infection in any cutaneous manifestation is that there were no or few standard laboratory methods to distinguish between virally induced rash and drug-induced rash. The identification of the causative drug appears to rely on the time interval between the beginning of drug use and onset of rash.4 In our patient, loxoprofen was the most likely causative drug for cutaneous manifestations. In view of our observation that positive LTT reactions were detected not only to loxoprofen but also to other two drugs (Stimulation Index to each drug, 2.03–2.10), it is likely that our patient was sensitized to all the drugs. Such 'multiple drug hypersensitivity' can be most efficiently proven by LTTs.5 Interestingly, such 'multiple drug hypersensitivity' was often observed associated with mycoplasma pneumoniae infection.6 No previous reports, however, described the occurrence of multiple drug hypersensitivity in patients with SARS-CoV-2 infection. A straightforward interpretation is that our patient could be immunologically sensitized to multiple medications probably due to preceding or underlying SARS-CoV-2 infection, although it remains unknown whether SARS-CoV-2 infection could serve to enhance the activation of drug-specific T cells with cross-reactive reactivity.7 Nevertheless, we cannot totally exclude the possibility that multiple drug sensitization proven solely by LTTs may be a mere epiphenomenon of the underlying SARS-CoV-2 infection. In conclusion, we recommend that LTT tests be utilized in any patient with cutaneous manifestations of SARS-CoV-2 to exclude the possibility of drug sensitization. Multiple drug hypersensitivity is apparently under-reported because the diagnosis of SARS-CoV-2-induced rash is usually made without performing LTTs. If cutaneous symptoms were viewed as a mere manifestation of SARS-CoV-2 infection with no further search to identify drug hypersensitivity, then the disease would remain regarded as SARS-CoV-2-induced rash. Indeed, the presentation of our patient was consistent with symmetrical drug-related intertriginous and flexural exanthema (SDRIFE).8 Although SDRIFE-like skin lesions have been reported as a cutaneous manifestation of COVID-19,9 a drug aetiology could have caused SDRIFE-like skin lesions in patients with SARS-CoV-2 infection. The patient in this manuscript has given written informed consent to publication of his case details. The authors have no conflict of interest to declare. The article has no founding source.

Histopathological Spectrum and Immunophenotypic Characterization of Symmetrical Drug-Related Intertriginous and Flexural Exanthema.

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a clinically very well-defined drug eruption, but the histopathological findings are still considered to be nonspecific. To characterize the histopathological and immunophenotypical features of SDRIFE. We performed a retrospective study that identified 11 biopsies from 9 patients with SDRIFE. The histopathological features were analyzed in conjunction with the immunohistochemical findings. The most common histopathological feature was basal cell vacuolization, which was often associated with necrotic keratinocytes and focal spongiosis. TIA1+ T cells and neutrophils were frequently detected in the epidermis and at the dermoepidermal junction. The dermal inflammatory infiltrate was mixed, consisting of CD3+ T cells, macrophages, granulocytes, low numbers of CD20+ B cells, and plasma cells. A combination of histopathological patterns was observed in 5 cases. The most frequent combined histopathological patterns were interface dermatitis, spongiotic dermatitis, and psoriasiform dermatitis. Other histopathological patterns found in different combinations were pustular dermatitis, perivascular and interstitial neutrophilic dermatitis, and interstitial granulomatous dermatitis. In the other 4 cases, a single histopathological pattern predominated, such as psoriasiform dermatitis, vacuolar interface dermatitis of erythema multiforme-like type, or superficial and deep perivascular and interstitial dermatitis with eosinophils and neutrophils. SDRIFE is characterized histologically by a vacuolar interface dermatitis induced by cytotoxic T lymphocytes and neutrophilic granulocytes. This pattern may be obscured by accompanying spongiotic, psoriasiform, or pustular features combined with a mixed superficial and sometimes deep dermal infiltrate.

Are the cutaneous manifestations during or due to SARS-CoV-2 infection/COVID-19 frequent or not? Revision of possible pathophysiologic mechanisms.

BackgroundSARS-Cov-2 is a single-stranded RNA virus, a Betacoronavirus, composed of 16 non-structural proteins, with specific roles in replication of coronaviruses. The pathogenesis of COVID-19 is not yet fully understood. The virus and host factors interplay among distinct outcomes of infected patients.MethodsUsing MeSH (Medical Subject Headings) in PubMed, authors searched for articles cotaining information on COVID-19 and the skin.ResultsThe pathophysiology of the disease is multifactorial: association with innate immune response, hypercoagulability state, lung tissue damage, neurological and/or gastrointestinal tract involvement, monocytic/macrophage activation syndrome, culminating in exaggerated cytokine secretion, called “cytokine storm”, which leads to worsening and death. These systemic conditions may be associated with cutaneous lesions, that have polymorphic aspects, where at histopathological level show involvement in different skin changes. These lesions may be associated with multisystemic manifestations that could occur due to angiotensin-converting enzyme 2 receptor and transmembrane serine protease action, allowing the pulmonary infection and possibly skin manifestation. Several reports in literature show cutaneous lesions similar to chilblain, urticarial eruptions, diffuse or disseminated erythema, livedo racemosa, blue toe syndrome, retiform purpura, vesicle trunk, purpuric exanthema or exanthema with clinical aspects of symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) and others.ConclusionsThis review describes the complexity of Covid-19, pathophysiological and clinical aspects, dermatological finding and other dermatological conditions associated with SARS-CoV-2 infection or COVID-19.

Symmetrical drug-related intertriginous and flexural exanthema: A little-known drug allergy

Symmetrical drug-related intertriginous and flexural exanthema: A little-known drug allergy

Targeted tumour therapy induced papulopustular rash and other dermatologic side effects: a retrospective study

Background: Papulopustular rash is the most common cutaneous adverse effect during targeted tumour therapy particularly with epidermal growth factor receptor inhibitors (EGFRIs).Objective: To evaluate the adverse skin reactions, mainly papulopustular rash, caused by targeted tumour therapy.Materials and methods: We retrospectively analysed the data of patients who were diagnosed papulopustular rash due to targeted chemotherapeutic agents between January 2016 and August 2018. Demographic characteristics of the patients, the type of malignancy, chemotherapeutic agents causing papulopustular rash, clinical features and grade of the rash, treatment modalities used for the rash, other associated cutaneous adverse reactions, and the need for dose-modification or discontinuation of the chemotherapy were recorded.Results: A total of 39 patients (26 males, 13 females) with a median age of 60 (range 32–86) years were included in the study. EGFRIs such as erlotinib, lapatinib, cetuximab, and panitumumab were the main drugs causing papulopustular rash in 2 (5.1%), 3 (7.6%), 18 (46.1%), and 13 (33.3%) patients, respectively. Imatinib, bevacizumab in combination with oxaliplatin, and everolimus in combination with exemestane and goserelin were responsible in three patients. The most commonly affected area was the face (87.1%) followed by the trunk (56.4%), scalp (25.6%), and extremities (23%). The rash was recorded as grade 1, 2, and 3 in 18, 13, and 6 of the patients, respectively. Grade 3 rash was lead to dose interruptions in 5 (12.8%) patients with subsequent reintroduction at a lower dose in 4 (10.2%) of them and discontinuation of the therapy in 1 (2.5%) patient. Pruritus, xerosis, paronychia, increased growth of the eyelashes, mucositis, hand-foot syndrome (HSF), and symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) are other skin toxicities associated with the targeted tumour therapy.Conclusions: With the increasing use of targeted therapies, dermatologists are now confronted with extensive spectrum of skin toxicities. Therefore, it is critical for dermatologists to be aware of these toxicities so as to develop the best approach without discontinuation of cancer therapy.

Case report-baboon syndrome with paracetamol

Adverse drug reaction (ADR) is defined as “any response to drug which is noxious or unintended and occurs at a dose normally used in man for prophylaxis, diagnosis or treatment of diseases or for modification of physiological function”. Among the ADRs reported, cutaneous drug reactions are most common. Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), also known as baboon syndrome (BS), is included in the spectrum of systemically induced allergic contact dermatitis. Characteristics of SDRIFE include a sharply defined symmetric erythema in the gluteal area and in the flexural or intertriginous folds without any systemic symptoms or signs. We present a case of 30-year-old female with baboon syndrome after taking the combination of paracetamol and diclofenac. Awareness of SDRIFE (BS) as an unusual drug reaction is especially important since the connection between skin eruption and drug exposure may easily be overlooked or misdiagnosed.

Systemic Contact Dermatitis.

Systemic contact dermatitis (SCD) traditionally refers to a skin condition where an individual who is cutaneously sensitized to an allergen will subsequently react to that same allergen or a cross reacting allergen via a different route. It occurs to allergens including metals, medications, and foods. The exact pathophysiology underlying this disease remains unknown, although it appears to be mediated by type 4 hypersensitivity reactions and possibly type 3 hypersensitivity reactions. The p-I concept (pharmacologic interaction with immunoreceptors) hypothesized that drugs are able to bind directly to a T cell receptor without first being presented by MHC (major histocompatibility complex) molecules and without prior metabolism, which would help explain why SCD can be seen on first exposure to medications. Nomenclature remains a challenge as SCD can be subcategorized using terms such as ACDS (allergic contact dermatitis syndrome) and its four clinical stages, Baboon syndrome, and SDRIFE (symmetrical drug-related intertriginous and flexural exanthema), which share many overlapping features. Food allergens may be responsible for uncontrolled or persistent symptoms in patients with contact dermatitis who do not respond to topical avoidance. With medications, symptoms may be induced by topical application versus systemic administration. Patch testing (PT) may be beneficial in diagnosing SCD caused by metals and many topical medications including corticosteroids, antimicrobials (ampicillin, bacitracin, erythromycin, neomycin, nystatin), NSAIDs (diclofenac, ibuprofen), anesthetics, and antihistamines (chlorphenamine, piperazine). Current treatment options include topical steroids and oral antihistamines for symptom relief and dietary avoidance to causative foods or metals.