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!
- Anti-epileptic Drugs
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
- 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
- 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 M1, Shear 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.