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. A 77-year-old male presented with new onset rash. Eleven days after the administration of penicillin VK and hydroxyzine for cellulitis prophylaxis, he developed a symmetric, erythematous, scaling rash on his buttocks and perineal region with associated pruritus and bleeding without fevers, chills, adenopathy, night sweats, or any other symptoms. He was diagnosed with symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) secondary to systemic treatment, an adverse drug reaction that presents as an erythematous rash involving the skin folds. The condition is also known as “baboon syndrome,” as it predominately affects the buttocks. A good outcome was achieved due to a thorough history and physical, timely diagnosis, and cessation of the offending agents

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

The role of drug, dose and the tolerance/intolerance of new drugs in multiple drug hypersensitivity syndrome (MDH).

BACKGROUND Multiple drug hypersensitivity syndrome (MDH) is used to describe persons with a drug hypersensitivity reaction (DHR) to at least two chemically unrelated drugs, confirmed by skin test or in vitro assay. METHODS Medical records of 25 patients with MDH, tested and confirmed at our allergy division were retrospectively evaluated in terms of clinical course, involved drugs, daily drug dose, latency periods, test results of skin test and cellular assays and tolerated drugs in subsequent pharmacological treatments. RESULTS MDH almost exclusively appeared as a delayed, often severe DHR and started in 14/25 with a drug reaction with eosinophilia and systemic symptoms (DRESS). Penicillins (13/25, 52.0%) and cephalosporins (6/25, 24.0%), typical high dose drugs, were most often identified as elicitors of MDH, especially at the first DHR, followed by aromatic antiepileptics (7/25, 28.0%), vancomycin (4/25, 16.0%) and antibiotic sulfonamides (4/25, 16.0%). Cephalosporins, clindamycine and radio contrast media (RCM) were mainly involved in subsequent DHR. The median daily drug dose of all drug trigger was 1875.0 mg (662.5; 2100.0) at the first DHR and 600.0 mg (300.0; 1300.0) at subsequent DHR, p=0.0420. CONCLUSION High dose drugs, especially betalactam antibiotics, RCM and clindamycin are common elicitors of subsequent DHR in patients with MDH. Macrolides, quinolones, doxycycline, non-aromatic antiepileptics and paracetamol were often tolerated. As the same drugs elicited both flare-up reactions and real DHR, drug induced flare-up reactions may be precursors of a possible second DHR and MDH. The administration of highly dosed drugs should be avoided in patients at risk for MDH

Clinico pathological study of adverse cutaneous drug reactions

INTRODUCTION: Adverse cutaneous drug reactions are commonly encountered in modern day clinical practice. They range from benign cutaneous reactions to severe cutaneous adverse drug reactions (SCAR). With a wide range of new drugs entering the market, the possibility of new drug reactions or different presentation of a common drug reaction should be considered. AIMS AND OBJECTIVES: To assess the epidemiology of adverse cutaneous drug reactions in our set up, the drugs commonly involved, various clinical presentations, and to correlate the clinical, histological and biochemical investigations. MATERIALS AND METHODS: The study was conducted in Department of Dermatology, RGGGH & MMC, Chennai, in patients, during November 2016 to September 2017. Patients who were more than 12 years of age and were willing for follow up were included in the study after getting approval from institutional ethics committee. Study Design: Prospective observational study. Study Population: A total of 36 patients with signs and symptoms of adverse drug reactions, who attended the OPD during the study period. Method: Details regarding the history, duration and course of the disease and co morbidities were collected, complete dermatological and systemic examination was done and the results were tabulated and analysed. OBSERVATIONS AND RESULTS: The incidence of adverse cutaneous drug reactions in our study population was 0.949 per 1000 person years. Mean age at presentation was 39.33± 20.13 years with a male to female ratio of 1.25:1. 69% of patients presented with benign cutaneous reactions and 31% with SCAR. Itching (64%) was the most common symptom. Fixed drug eruption (28%) was the commonest presentation and NSAIDs (33%) were the commonest offending drug. SJS / TEN (19%) was the commonest SCAR and anticonvulsants were the commonest offending drug in SCAR. Absolute eosinophil counts of more than 1000/mm³ were seen in 82% and abnormality in liver parameters in 30.5% of patients with SCAR. Spongiosis, necrotic keratinocytes and basal cell degeneration were the commonest histopathological finding with extensive changes seen in cases of SCAR. CONCLUSION: Adverse drug reactions should be diagnosed and managed early to prevent the morbidity and mortality, especially in cases of SCAR. Elevated eosinophil counts might have a prognostic significance in severe cases and histopathological examination can be helpful when the clinical presentation mimics common dermatological disorders