RESUMO
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.
Assuntos
Toxidermias , Exantema , Intertrigo , Humanos , Inibidores da Bomba de Prótons/efeitos adversos , Toxidermias/diagnóstico , Exantema/induzido quimicamente , Exantema/tratamento farmacológico , Intertrigo/induzido quimicamente , Intertrigo/complicações , Eritema/complicaçõesAssuntos
Anti-Inflamatórios/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Glucocorticoides/efeitos adversos , Osteoartrite/tratamento farmacológico , Triancinolona Acetonida/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/administração & dosagem , Reações Cruzadas , Dermatite Alérgica de Contato/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Glucocorticoides/administração & dosagem , Humanos , Injeções Intra-Articulares , Masculino , Triancinolona Acetonida/administração & dosagem , Óxido de Zinco/uso terapêuticoRESUMO
BACKGROUND: Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) refers to an uncommon cutaneous adverse reaction that symmetrically involves the buttock and intertriginous areas after systemic exposure to the offending drug and is previously known as baboon syndrome. SDRIFE related with traditional Chinese medicine (TCM) has not been reported. OBJECTIVE: We presented a case of SDRIFE /baboon syndrome induced by TCM, Xi-Huang capsule. METHODS: A 57-years-old man presented with macular erythematous rash mainly on his intergluteal, inguinal, axillary, popliteal regions for a duration of 5 days. The lesions appeared a day after an oral Chinese patent medicine Xi-Huang capsule for arthralgia. Drug eruption was diagnosed. The rash disappeared completely within a week with immediate discontinuation of Xi-Huang capsule and a short term of systemic therapy with glucocorticosteroids. Patch testing was performed on the patient 1 month after complete resolution. He was patch tested with Xi-Huang capsule (5% and 10% in petroleum) using Finn Chambers on Scanpor tape and T.R.U.E. test system. Five heathy volunteers were also patch tested with the same Xi-Huang capsule. RESULTS: Patch testing to 20 common contact allergens including nickel and fragrance were negative. TCM patch test was positive. No positive results were found in five volunteers. Months later, the patient relapsed after an oral herbal Chinese medicine challenge for arthralgia. To avoid the rash recurrence, he stopped taking any Chinese herbal medicine and had complete resolution of disease. CONCLUSION: The Chinese patent drugs for external and oral have unique advantages and have been widely used in many diseases. It is important that dermatologists monitor for clinically significant manifestations of TCM, such as baboon syndrome. Patch testing could help make a definitive diagnosis.