Impromptu derm report: SDRIFE and intertriginous rashes

Thank you to Chuka and Kenny for spearheading an impromptu and super interesting dermatology report.
From the pearl archives: the 6 A’s of drug reactions
 6 “A” Classes of Common Drug Reactions – always take a history of these drugs!
  • Allopurinol
  • NS(A)IDs
  • Anti-epileptic Drugs
  • ARVs
  • Sulf(A)
  • Antibiotics
Uncomplicated (non-lifethreatening) drug reactions
  • Most drug reactions (90%) are uncomplicated exanthems, classically maculopapular, sparing the palms and soles
    • usually within 5-14 days of starting the offending drug
    • can have rare bullae or pustules like this patient did
This patient had a reaction in an intertriginous distribution after surgery. Ddx for intertriginous eruptions includes
  • Common
    • contact dermatitis (irritant or allergic)
    • intertrigo (usually staph, strep or corynebacterium)
    • tine cruris
  • can’t miss
    • inverse psoriasis
    • early Acute Generalized Exanthematous pustulosis
    • staph scalded skin syndrome
  • Zebras
    • Systemic drug-related intertrigenous and flexural exanthema (SDRIFE)
    • eccrine shamus syringometaplasia
    • pemphigus vegetans
    • Hailey-Hailey disease
Systemic, drug-related intertriginous and flexural exanthema AKA SDRIFE
  • SDRIFE is a drug reaction that has a predilection for the buttocks and inguinal area. It is relatively rare, but has a classic distribution.
  • usually morbiliform, sometimes with bullae or pustules. While it’s rare, this is one of those diagnoses the dermatologists can make from the door.
  • it looks like this:
  • SDRIFE used to be called baboon syndrome due to the red buttocks. But that’s not a very nice thing to call a person, so the name was changed.
  • Treatment is supportive with topical corticosteroids and discontinuation of the offending agent.
Winnicki M1Shear NH. A systematic approach to systemic contact dermatitis and symmetric drug-related intertriginousand flexural exanthema (SDRIFE): a closer look at these conditions and an approach to intertriginous eruptions. Am J Clin Dermatol. 2011 Jun 1;12(3):171-80.

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