DOCSLIB.ORG

Systemic Contact Dermatitis Dianne L

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Systemic Contact Dermatitis Dianne L ALLERGEN FOCUS SYSTEMIC CONTACT DERMATITIS DIANNE L. SILVESTRI, MD in time, even to something that the patient has been using regularly for a short period of time or intermit- tently for years. In certain cases, other related disorders such as irritant con- tact dermatitis (ICD) and contact ur- ticaria (CU) may be relevant; history, rather than patch testing, can point to these as the correct diagnosis for the patient. It is important to note that ICD, the most prevalent form of con- tact dermatitis, can, at times, precede or occur concomitantly with ACD.4,5 Unlike ACD, ICD is not immune- mediated. It occurs secondary to contact with an irritating or abrasive substance. CU, on the other hand, represents the least prevalent form of ICD. The wheal and flare reaction of CU is an IgE- and mast cell-mediated immune phenomenon of immediate- type hypersensitivity. Although this form of contact reaction is rare, it is important to recognize because of its potential to produce serious anaphy- lactic-type reactions.6–8 This column highlights ACD, focus- ing on significant allergens, regional llergic Con- to comply with allergen avoidance are presentations of dermatitis and top- tact Dermati- at risk for recurrent or sustained der- ic-based allergic manifestations and tis (ACD) is an matitis or progression to a systematized offers clinical tips for diagnosis and A 2,3 important disease that presentation. In fact, patient education treatment. This month, we feature an affects 14.5 million often begins before the diagnostic patch uncommon but especially important Americans each year.1 tests are ever placed, to ensure that ACD category of allergic dermatitis — sys- Dianne L. Slivestri, MD The economic im- patients have an appropriate under- temic contact dermatitis. pact of this condition standing of potential outcomes and the is high, whether mea- central role patients play in both their SYSTEMIC CONTACT DERMATITIS sured by patient morbidity, health care disease and treatment. Systemic contact dermatitis (SCD) is expenditures, loss of income or lost time During the initial consultation, an interesting subset of ACD that may from school and work.1 Once patch test- patients are often taught about the occur more often than clinically recog- ing is performed and an allergen source delayed presentation of ACD and its nized. SCD refers to the development has been identified, education becomes relationship with the immune system of dermatitis upon systemic exposure the critical intervention to ensure ad- (sensitization to a chemical and elici- to an allergen in someone previously herence to an avoidance regimen. With tation of a dermatitis with re-expo- sensitized to that chemical through cu- allergen avoidance, remission of the der- sure). Furthermore, they are instruct- taneous contact. Since this process was matitis ensues. Patients who are unable ed that it may develop at any point first recognized, several terms other than 22 January 2012 | SKIN & AGING | www.skinandaging.com ALLERGEN FOCUS SCD have been suggested to describe Table 1. ALTERNatIVE NAMES FOR SYSTEMIC CONtaCT DERMatITIS it.9–21 See Table 1. Elicitation of dermatitis by allergen Endogenic contact eczema9 Internal-external contact-type hypersensitivity10 exposure through routes other than trans-cutaneous contact was first de- Contact type dermatitis medicamentosa11 Mercury exanthem12 scribed by Jadassohn in 1895.22 He re- Hematogenous contact eczema13 Baboon syndrome14 ported that individuals topically sensi- tized to mercury developed dermatitis Systemic contact-type dermatitis15 Paraptic eczema16 after systemic mercury exposure. Dur- ing World War II, Park recognized Systemically induced contact dermatitis17 Systemic reactivation of allergic contact dermatitis19 cutaneous eruptions occurring in pa- 21 tients previously topically sensitized Symmetrical drug-related intertriginous and flexural Systemic allergic dermatitis exanthema20 to sulfonamides when those antibiot- ics were administered orally.23 In 1951, Leifer reported that ingestion of cin- namon oil precipitated a recurrence of Table 2. DIVERSE PRESENtatIONS OF SYSTEMIC CONtaCT DERMatITIS hand eczema in a patient allergic to Reactivation of patch test site Pompholyx (dyshidrotic eczema) cinnamon.24 In 1954, Sidi and Melki demonstrated flares of eczema in chro- Aggravated local allergic contact dermatitis Reactivation of a previously sensitized area mium-sensitive patients given an oral (recall reaction) challenge of potassium dichromate.25 Disseminated patchy dermatitis Generalized erythroderma Three years later, Pirila described both reactivation of a thiuram patch test Baboon syndrome (SDRIFE) Vulvar pruritus or dermatitis and widespread dermatitis appearing in a patient given oral antabuse (tet- Pruritus ani Cheilitis 25 raethylthiuram disulphide). In 1958, Lichen planus of the lip Hjorth reported a girl sensitized to thiamine through occupational con- tact who developed dermatitis after revealed sensitivity to dust mites. En- PATHOPHYSIOLOGY OF ingesting the vitamin.26 Similarly, after vironmental modifications were un- ALLERGIC CONTACT DERMATITIS handling streptomycin while treating dertaken to reduce dust mite exposure, The immunologic basis for SCD is tuberculosis patients, nurses subse- but symptoms persisted. She was then not completely understood and may not quently erupted with dermatitis when instructed to avoid common contact be identical for all allergens. As reviewed they received injections of the antibi- allergens, including formaldehyde re- recently by Jacob and Zapolanski,28 dur- otic.27 Describing another instance of leasers and fabric resins, but she resist- ing allergen sensitization, a hapten pen- medication-induced SCD, Pirila de- ed eliminating her favorite perfumes. etrates the skin and reacts with resident tailed in 1960 the development of a Biopsy showed perivascular lympho- antigen-presenting dendritic cells that widespread dermatitis from neomycin cytic infiltrate with prominent eo- transfer the bound antigen to T lym- inadvertently administered orally to a sinophils. Patch tests were performed phocytes. Once these cells are primed patient with previous contact sensiti- with a modified panel of 65 allergens and reproduce, they return to the skin, zation.9 Over the decades since these and read at 48 and 96 hours. Positives ready to act on target cells when the an- early reports, the scope of allergens has were found for propylene glycol, dis- tigen is encountered again. It seems that broadened and the reported routes of perse blue dyes 106 and 124, cocami- the immune system can be activated by exposure have multiplied. dopropyl betaine, oleamidopropyl di- allergen exposure as well through oral methylamine and vanillin. The patient and other systemic routes, triggering the CASE REPORT changed her brand of acetaminophen activated CD8+ effector T cells.29 A 13-year-old Asian female was re- after discovering propylene glycol ferred for a fingerprint-like dermatitis among its ingredients. She was no DIVERSE PRESENTATIONS OF covering her chest, abdomen and back longer wearing dance leotards, which SYSTEMIC CONTACT DERMATITIS present for 2 years. Her prominent may have been a source of previous Systemic provocation by allergen in nocturnal pruritus was only partially exposure to azo dye. She continued the allergic patient can produce many relieved by topical steroids. On exam, use of her desoximetasone ointment different types of dermatitis. See Table she had dozens of post-inflammatory and substitute shampoo, both free of 2. Reports often describe a reactivation hyperpigmented oval macules, as well her allergens. At follow-up visit, the or exacerbation at the original cutane- as slightly scaly small plaques, pink in patient reported that her symptoms ous location or acceleration to a more color and thin, covering her trunk but and rash improved when she began to widespread dermatitis, occasionally a sparing her face, neck and extremities. avoid her nightly vanilla ice cream; she generalized erythroderma. Frequently, Epicutaneous testing by the allergist flared if she resumed eating it. systemic exposure to a demonstrated January 2012 | SKIN & AGING | www.skinandaging.com 23 ALLERGEN FOCUS allergen incites reactivation of the rel- es.54 Veien also demonstrated provo- published since Hjorth first described evant patch test site.30,31 Recall of prior cation of dermatitis by an oral dose an association between balsam of Peru localized dermatitis has been described of balsam of Peru.55 He studied this patch test reactivity and sensitivity to by Giordano-Labadie and colleagues relationship further by demonstrating aromatic spices and flavorings.54 Bal- when perianal dermatitis, previously flares of eczema after oral challenge sam of Peru, a fragrant extract from the produced by a cream that contained with graduated doses of nickel, co- Latin American Myroxilon pereirae tree, is sorbic acid, was provoked in a patient balt, chromium and balsam of Peru in a composite of many sensitizing chem- by ingestion of sorbic acid-containing patch-test positive patients.56 He pro- icals. It is used as an allergen in patch foods, such as strawberries, candies, posed depletion diets to benefit indi- testing to detect fragrance sensitivity. margarine and cheeses.32 Fisher de- viduals with positive patch tests to or Veien and colleagues have demonstrated scribed a woman who, after previously history of aggravation by ingestion of dermatitis flares in patients orally chal- reacting to propylene glycol in vaginal these
Load more

Recommended publications
  • Symmetrical Intertriginous and Flexural Exanthema Due to Bortezomib (A Proteasome Inhibitor) Given for Myeloma
    Acta Derm Venereol 2016; 96: 995–996 SHORT COMMUNICATION Symmetrical Intertriginous and Flexural Exanthema due to Bortezomib (a Proteasome Inhibitor) Given for Myeloma Nausicaa Malissen1, Jean-Luc Bourrain1, Anca Chiriac2, Aline Montet1, Laure Vincent3, Olivier Dereure1 and Aurélie Du-Thanh1* 1Dermatology Department, 2Pneumology – Allergology Department, Montpellier University Hospital, and 3Clinical Hematology Department, Montpellier University Hospital, 80 avenue Augustin Fliche, FR-34295 Montpellier cedex 5, France. *E-mail: [email protected] Accepted Mar 17, 2016; Epub ahead of print Mar 22, 2016 Bortezomib is a selective proteasome inhibitor currently discovered, high-risk smouldering multiple myeloma. used as standard of care in the treatment of multiple my- He disclosed no other relevant medical background and eloma. Cutaneous side-effects are frequent, as reported in did not receive any other medication, except for the a phase 3 randomized study (1), in which 57% and 70% following regimen, implemented 15 days before occur- of patients experienced a grade 3 or higher skin toxicity rence of the skin eruption and combining subcutaneous with subcutaneous and intravenous administration, re- bortezomib, 1 mg/m2, on days 1, 4, 8 and 11, thalido- spectively. However, these adverse effects are usually mide, 100 mg daily, dexamethasone, 40 mg daily from poorly described in haematological-based reports, and day 1 to day 4, sulfamethoxazole trimethoprim (SMX- range from benign skin eruption to lethal epidermal TMP) and valaciclovir as prophylactic measures. Initial necrolysis (2), thus it is important to provide a more clinical survey revealed a pruritic and symmetrically specific description when they occur. distributed intertriginous, maculopapular exanthema, localized to the axillae, antecubital fossae, groin, neck and buttocks (Fig.
    [Show full text]
  • Symmetrical Drug-Related Intertriginous and Flexural Exanthema Secondary to Topical 5-Fluorouracil
    Symmetrical Drug-Related Intertriginous and Flexural Exanthema Secondary to Topical 5-Fluorouracil Roxann Powers, MD; Rachel Gordon, MD; Kenrick Roberts, MD; Rodney Kovach, MD We report the case of a 56-year-old man who fossae and axillae. His dermatologist stopped the developed a distinctive skin eruption after treat- 5-FU and started prednisone, erythromycin, hydro- ing actinic keratoses on the dorsal aspects of cortisone ointment, and fexofenadine hydrochloride. his right and left hands with topical 5-fluorouracil Over the next week, the areas became eroded and the (5-FU). The distribution of his rash was charac- pain worsened. A biopsy was performed. The hydro- teristic of symmetrical drug-related intertriginous cortisone was discontinued and he was referred for a and flexural exanthema (SDRIFE), also known as second opinion. baboon syndrome. Medications at presentation included erythromycin, Cutis. 2012;89:225-228. fexofenadine hydrochloride, acetaminophen-codeine, CUTISprednisone, petrolatum ointment, metformin Case Report hydrochloride, enalapril maleate, ranitidine hydro- A 56-year-old man with a history of diabetes mel- chloride, simvastatin, triamterene/hydrochlorothiazide, litus, hypertension, hyperlipidemia, reflux, squamous aspirin, and omeprazole. He reported no cell carcinoma in situ of his right hand, and actinic known allergies. keratoses of the right Doand left hands presentedNot with a PhysicalCopy examination revealed an overweight painful, burning, pruritic, erythematous, and blister- man who appeared agitated and reported substantial ing rash on his medial thighs, scrotum, penis, antecu- discomfort. He had well-demarcated, violaceous, red bital fossae, axillae, and dorsal hands. The patient had erosions on his medial thighs (Figure 1), scrotum, a successful history of treatment of actinic keratosis and penis; erythematous denuded patches in the on his right hand with topical 5-fluorouracil (5-FU) antecubital fossae (Figure 2) and axillae; and crusty 8 years prior to presentation.
    [Show full text]
  • Not Just Luck
    EDITORIAL Not Just Luck few months ago, I described a 52-year-old and encourage potential authors and reviewers. At a female patient’s puzzling rash to a colleague: memorable meeting last winter, during a howling snow- a striking symmetrical, bright-red, sharply- storm one dark Thursday night, I met Susan Busch and defined macular erythema of the genital/ Jane Tallent, the 2009Y2010 Lahey Clinic Dermatology inguinal and medial-gluteal areas, and much Nurse Practitioner Fellowship fellows, quintessential ex- less prominently, the axillae and inframmary folds. Sitting amples of individuals who heartily seek out learning op- Aon her desk was an article, just read, describing this un- portunities. We talked animatedly about ways they might usual drug eruption. Coined the Bbaboon syndrome[ be- contribute to the Journal, and I forgot how sweet it would cause of the resemblance to the red buttocks of baboons, it have been to stay home and light a fire in the fireplace. has been renamed the less colorful, less memorable, but less- When an uncanny opportunity presents itself to apply some- unnerving-to-be-diagnosed- thing we have just learned, we can remind ourselves that we with Bsymmetrical drug-related helped create this fortunate situation; we helped create our intertriginous and flexural exan- own luck. A dermatology nurse approached me at the 2009 thema[ (SDRIFE; Hausermann, Dermatology Nurses’ Association summer meeting in Boston, Harr, & Bircher, 2004). reporting that only a day or two after she was introduced to I said it was good luck that Merkel cell carcinoma by the JDNA article by Victoria she had just read this article, and Garcia-Albea (nee Beebe; Beebe, 2009), she heard colleagues a colleague commented, para- discussing a new patient diagnosed with Merkel cell cancer in phrasing Louis Pasteur, BChance their practice.
    [Show full text]
  • Clinical Communications Symmetrical Drug
    Clinical Communications Symmetrical drug-related intertriginous and flexural exanthema: A little-known drug allergy Tullia De Risi-Pugliese, Héloïse Barailler, Aurore Hamelin, Emmanuelle Amsler, Hafida Gaouar, Flore Kurihara, Marie Laure Jullie, Eric Dean Merrill, Annick Barbaud, Philippe Moguelet, et al. To cite this version: Tullia De Risi-Pugliese, Héloïse Barailler, Aurore Hamelin, Emmanuelle Amsler, Hafida Gaouar, et al.. Clinical Communications Symmetrical drug-related intertriginous and flexural exanthema: A little- known drug allergy. Journal of Allergy and Clinical Immunology: In Practice, Elsevier, 2020, 8 (9), pp.3185-3189.e4. 10.1016/j.jaip.2020.04.052. hal-02995700 HAL Id: hal-02995700 https://hal.sorbonne-universite.fr/hal-02995700 Submitted on 9 Nov 2020 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Clinical Communications Symmetrical drug-related intertriginous 2-7) large or small skin folds (especially inguinal, gluteal, axillary, and flexural exanthema: A little-known and mammary) (Figure 1, Table I) were observed. Four patients drug allergy had localized skin vesicles or bullae and 1 (no. 16) had mucosal Tullia de Risi-Pugliese, MDa,b, Héloïse Barailler, MDc, involvement. The eruption occurred shortly after drug exposure a a,b (median, 22 hours; mean, 34; range, 0.5-120).
    [Show full text]
  • Skin Allergy to Azole Antifungal Agents for Systemic Use: a Review of the Literature
    Send Orders for Reprints to [email protected] Recent Patents on Inflammation & Allergy Drug Discovery 2019, 13, 1-14 1 REVIEW ARTICLE Skin Allergy to Azole Antifungal Agents for Systemic Use: A Review of the Literature Gianfranco Calogiuri1,3, Lene H. Garvey2, Eustachio Nettis3, Paolo Romita4, Elisabetta Di Leo5, Riccardo Caruso6, Lavjay Butani7 and Caterina Foti4,* 1Department of Pneumology and Allergy Hospital Sacro Cuore - Gallipoli, Lecce, Italy; 2Allergy Clinic, Department of Dermato-Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; 3Department of Biomedical Sciences and Human Oncology Unit of Internal Medicine "G. Baccelli", "Aldo Moro" University of Bari Medical School, Policlinico, Bari, Italy; 4Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Bari, Italy; 5Section of Allergy and Clinical Immunology, Unit of Internal Medicine-"F. Miulli" Hospital, Acquaviva delle Fonti, Bari, Italy; 6Clinica Salus - Brindisi, Brindisi, Italy; 7Section of Pediatric Nephrology, Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA, USA Abstract: Background: Antifungal azoles are the first-line agents used to treat topical and, above all, systemic mycosis. The latter could be life-threating infections in immunocompromised patients. Che- motherapeutic antibiotics, including antifungal azoles, may induce hypersensitivity reactions; however, such immunologic adverse reactions have not been defined and carefully investigated. Objective: The study aimed to provide an update on the evaluation and diagnosis of skin allergy to azole antifungal agents. Methods: This is a systematic review performed on PubMed and Google Schoolbarusing using the key terms “allergy, hypersensitivity, anaphylaxis, immediate-type reaction, delayed-type reaction, keto- conazole, fluconazole, posaconazole, voriconazole, itraconazole, triazoles, imidazoles, antifungals, A R T I C L E H I S T O R Y antimycotics”.
    [Show full text]
  • General Aspects 14 Niels K
    14_199_254* 05.11.2005 10:15 Uhr Seite 201 Chapter 14 General Aspects 14 Niels K. Veien Contents 14.1 Introduction . 201 14.4.2.1 Cement Ulcerations . 224 14.4.2.2 Pigmented Contact Dermatitis . 225 14.2 The Medical History of the Patient . 202 14.4.2.3 Caterpillar Dermatitis and Irritant Dermatitis 14.2.1 History of Hereditary Diseases . 202 from Plants and Animals . 225 14.2.2 General Medical History . 202 14.4.2.4 Head and Neck Dermatitis . 225 14.2.3 History of Previous Dermatitis . 203 14.4.2.5 Dermatitis from Transcutaneous Delivery 14.2.4 Time of Onset . 203 Systems . 225 14.2.5 History of Aggravating Factors . 204 14.4.2.6 Berloque Dermatitis . 226 14.2.6 Course of the Dermatitis . 205 14.4.2.7 Stomatitis due to Mercury or Gold Allergy . 226 14.2.7 Types of Symptoms . 205 14.5 Regional Contact Dermatitis . 226 14.3 Clinical Features of Eczematous Reactions . 206 14.5.1 Dermatitis of the Scalp . 226 14.3.1 Acute and Recurrent Dermatitis . 206 14.5.2 Dermatitis of the Face and Neck . 228 14.3.2 Chronic Dermatitis . 210 14.5.2.1 The Lips . 230 14.3.3 Nummular (Discoid) Eczema . 211 14.5.2.2 The Eyes and Eyelids . 230 14.3.4 Secondarily Infected Dermatitis . 211 14.5.2.3 The Ear . 231 14.3.5 Clinical Features of Contact Dermatitis 14.5.3 Dermatitis of the Trunk . 232 in Specific Groups of Persons . 212 14.5.3.1 The Axillary Region .
    [Show full text]
  • A New Proposal for a Clinical-Oriented Subclassifi- Cation of Baboon Syndrome and a Review of Baboon Syndrome
    Original article A new proposal for a clinical-oriented subclassifi- cation of baboon syndrome and a review of baboon syndrome Atsushi Miyahara1, 2, Hisashi Kawashima2, Yukari Okubo3 and Akinori Hoshika2 drug-related intertriginous and flexural exanthema Summary (SDRIFE), classical baboon syndrome, topical Objective: To review baboon syndrome (BS). drug-induced baboon syndrome, systemic drug- Data Sources: Date sources were obtained from induced baboon syndrome, recall phenomenon, p-i PubMed and Google Scholar: Photographs of (pharmacologic interaction with immuno-receptors) baboon syndrome were obtained from our concept. patient. Study Selections: PubMed and Google Scholar Introduction were searched up to June 30, 2010. The search The term “baboon syndrome”(BS) was terms were “baboon syndrome”, “SDRIFE” and introduced in 1984 to describe a mercury-induced “thimerosal allergy”. Reverse references from characteristic eruption with previous sensitization to relevant articles and Google Scholar were also mercury1. It presents with a diffuse symmetrical used. As BS is a classical disease and cases of erythema, predominantly on major flexural areas, offending agents were relatively old, some and an inverted triangular or V-shaped erythema on references were more than five years old. In both upper antero-medial thighs1. BS was named order to gather as many cases of offending agents after the red bottomed baboon1. as possible, more than 50 references were Recently it has been revealed that an eruption collected. which resembles mercury-induced BS was due not Results and Conclusion: We divided BS into as 4 only to mercury but also other metals, drugs and groups; classical baboon syndrome, topical drug- natural products, with or without previous induced baboon syndrome, systemic drug- sensitization to offending or related drug(s).
    [Show full text]
  • Presenters: Philip R
    UC Davis Dermatology Online Journal Title Zoledronic acid-associated symmetrical drug-related intertriginous and flexural exanthema (SDRIFE): report of baboon syndrome in a woman with recurrent metastatic breast cancer after receiving zoledronic acid Permalink https://escholarship.org/uc/item/5kk0g864 Journal Dermatology Online Journal, 21(8) Author Cohen, Philip R Publication Date 2015 DOI 10.5070/D3218028425 License https://creativecommons.org/licenses/by-nc-nd/4.0/ 4.0 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Volume 21 Number 8 August 2015 Case report Zoledronic acid-associated symmetrical drug-related intertriginous and flexural exanthema (SDRIFE): report of baboon syndrome in a woman with recurrent metastatic breast cancer after receiving zoledronic acid Philip R Cohen MD Dermatology Online Journal 21 (8): 2 Department of Dermatology, University of California San Diego, San Diego, California. Correspondence: Philip R. Cohen, MD 10991 Twinleaf Court San Diego, CA 92131-3643 [email protected] Abstract Background: Baboon syndrome is a distinctive skin reaction in which the patient typically develops erythematous buttocks that appear similar to those of a baboon. The non-contact allergenic variant of baboon syndrome is also referred to as symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). Zoledronic acid is a bisphosphonate that is used in patients with metastatic cancer to prevent bone complications. Purpose: Zoledronic acid-associated baboon syndrome is described in a woman with recurrent metastatic breast cancer. Methods: PubMed was used to search the following terms, separately and in combination: baboon syndrome, breast cancer, symmetrical drug-related intertriginous and flexural exanthema, and zoledronic acid.
    [Show full text]
  • Systemic Drug Related Intertriginous and Flexural
    Available online at www.sciencedirect.com www.jdds.org ScienceDirect Journal of Dermatology & Dermatologic Surgery xxx (2016) xxx–xxx Systemic drug related intertriginous and flexural exanthem (SDRIFE) due to clindamycin Dear Editor, Discussion A 50-year-old male was referred to us for a symmetric, confluent, erythematous, pruritic eruption of a three day Systemic drug-related intertriginous and flexural exan- duration involving the flexures, which appeared two days thema (SDRIFE) is a distinctive drug eruption typically after starting intravenous clindamycin for chronic involving the flexural folds and gluteal areas, commonly osteomyelitis. There was no past history of any similar observed after exposure to beta-lactam antibiotics, such rash. Cutaneous examination revealed the presence of well as penicillins and cephalosporins, with amoxicillin being defined maculopapular eruption involving the axillae, cubi- implicated in the majority of cases (Ha¨usermann et al., tal fossa, inguinal regions and buttocks (Fig. 1a, b). There 2004). was no associated fever or lymphadenopathy. The mucosae SDRIFE is thought to result from a type IV delayed and other system examination were normal. Blood counts, hypersensitivity immune response to the offending drug. liver and renal function tests were normal as were the chest Occlusion, sweating or frictional injury and recall X-ray and abdominal ultrasound. There was no atypical phenomenon of past dermatitis have also been presumed lymphocytosis or eosinophilia. A biopsy was advised but to play a role in its pathogenesis (Kardaun and Tupker, was refused by the patient. 2012). Few authors have also postulated recall phe- Causality assessment was carried out using the Naran- nomenon as a cause of SDRIFE.
    [Show full text]
  • Malignant Intertrigo: a Subset of Toxic Erythema of Chemotherapy Requiring Recognition
    CASE SERIES Malignant intertrigo: A subset of toxic erythema of chemotherapy requiring recognition SabrinaM.Smith,MD,a Philip B. Milam, MD,a Stephanie K. Fabbro, MD,a AlejandroA.Gru,MD,b and Benjamin H. Kaffenberger, MDa Columbus, Ohio and Charlottesville, Virginia Key words: chemotherapy; drug eruption; graft-versus-host disease; intertrigo; pathogenesis; toxic erythema of chemotherapy. INTRODUCTION Abbreviations used: Toxic erythema of chemotherapy (TEC) encom- passes a broad spectrum of cytotoxic effects on the MI: malignant intertrigo 1 PPE: palmoplantar erythrodysesthesia skin. Despite increasing awareness of TEC, such SDRIFE: symmetrical drug-related intertriginous, eruptions may remain unrecognized and subse- flexural exanthema quently result in unnecessary hospitalizations. Of TEC: toxic erythema of chemotherapy the different variants of TEC, intertriginous eruptions have been reported using many terms, such as intertrigo dermatitis, intertriginous eruption of REPORT OF CASES chemotherapy, flexural erythematous eruption, and Six patients with various malignancies undergo- intertrigo-like eruption associated with chemo- ing chemotherapy presented with intertriginous therapy.1 Intertrigo is a broad term that refers to rashes (Table I and Fig 1). Involved areas included any inflammatory rash of closely opposed skin, cervical, inframammary and inguinal folds, and typically presenting with varying degrees of ery- axillae, abdomen, antecubital fossae, perineum, thema and maceration, and this particular type of buttocks, and thighs. Physical examination found TEC has not been identified with consistent nomen- sharply demarcated, erythematous-to-dusky patches clature. We present 6 cases of this distinct subset of and plaques with focal scaling, crusting, and ero- TEC, all occurring within a 7-month period at a single sions. These lesions were painful and exquisitely institution; these cases were initially unrecognized, tender.
    [Show full text]
  • Symmetric Drug-Related Intertriginous and Flexural Exanthema
    CASE LETTER Symmetric Drug-Related Intertriginous and Flexural Exanthema Dylan Haynes, MD; Zachary Pena, MD; Kevin White, MD; Tracy Funk, MD; Jesse J. Keller, MD A 39-year-old woman who was otherwise healthy PRACTICE POINTS presented to the emergency department after developing a rapidly evolving andcopy blistering rash on the left flank. • Symmetric drug-related intertriginous and flexural exanthema (SDRIFE) appears in the Hours later, the rash had progressed to a sharply demar- absence of systemic signs and symptoms such cated, confluent, erythematous plaque with central ulcer- as fever, which may help differentiate it from infec- ation and large flaccid bullae peripherally, encompassing tious causes. 18% of the total body surface area and extending from the gluteal cleft to the tip of the scapula along the left • β-Lactam antibiotics, particularly amoxicillin, not are common offenders in the pathogenesis of flank (Figure 1) with no vaginal or mucosal involvement. SDRIFE, but new drug relationships frequently are The patient recently had completed a 10-day course of being described. amoxicillin–clavulanic acid 2 days prior for a cat bite on • Symmetric drug-related intertriginous and the right dorsal wrist. Additional history confirmed the flexural exanthema commonly follows a benign Doabsence of prodromal fever, fatigue, or chills. Inciting course but warrants respect, as it may have devas- trauma including chemical and thermal burns was denied. tating potential. Potential underlying psychosocial confounders were explored and were unrevealing. Laboratory test results including a complete blood cell count and metabolic panel as well as vital signs were unre- To the Editor: markable except for slight leukocytosis at 14,000/µL (refer- Symmetric drug-related intertriginous and flexural exan- ence range 4500–11,000/µL).
    [Show full text]
  • The Use of Glycopyrrolate in Aquagenic Wrinkling of the Palms Helia Eragi, D.O., Mayha Patel, B.S., MSIV, David Horowitz, D.O., F.A.O.C.D
    V Journal of the American Osteopathic College of Dermatology PRSRT STD OLUME U.S. POSTAGE Volume 25 2902 North Baltimore Street PAID 25 MASON CITY, IA P.O. Box 7525 PERMIT NO. 429 Kirksville, Missouri 63501 Journal of the American Osteopathic College of Dermatology J OURNAL OF THE A MERICAN O STEOPATHIC C OLLEGE OF D ERMATOLOGY What Dermatologists Need to Know About Interferon- gamma Testing for Tuberculosis 1 ournal of the American Osteopathic J College of Dermatology 2012-2013 OFFICERS PRESIDENT David L. Grice, D.O., FAOCD PRESIDENT-ELECT Suzanne Sirota-Rozenberg, D.O., FAOCD FIRST VICE-PRESIDENT Rick J. Lin, D.O., FAOCD SECOND VICE-PRESIDENT Alpesh Desai, D.O., FAOCD THIRD VICE-PRESIDENT Karthik Krishnamurthy, D.O., FAOCD IMMEDIATE PAST-PRESIDENT Editor-in-Chief Bradley Glick, D.O., FAOCD Karthik Krishnamurthy, DO TRUSTEES Danica Alexander, D.O., FAOCD Reagan Anderson, D.O., FAOCD Mark A. Kuriata, D.O., FAOCD Sponsors: Daniel Ladd, D.O., FAOCD Bayer John P. Minni, D.O., FAOCD Bryan Sands, D.O., FAOCD Global Pathology Laboratory SECRETARY-TREASURER Medicis Jere J. Mammino, D.O., FAOCD EXECUTIVE DIRECTOR Ranbaxy Marsha A. Wise, B.S. JAOCD Founding Sponsor AOCD • 2902 N. Baltimore St. • Kirksville, MO 63501 800-449-2623 • FAX: 660-627-2623 www.aocd.org COPYRIGHT AND PERMISSION: Written permission must be obtained from the Journal of the Ameri- can Osteopathic College of Dermatology for copying or reprinting text of more than half a page, tables or figures. Permissions are normally granted contingent upon similar permission from the author(s), inclusion of acknowledgement of the original source, and a payment of $15 per page, table or figure of reproduced material.
    [Show full text]