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Case report
peer-reviewed

Symmetrical Drug-related Intertriginous and Flexural Exanthema Induced by Doxycycline



Abstract

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a cutaneous drug reaction characterized by erythema over the buttocks, thighs, groin, and flexural regions most commonly associated with the use of beta-lactam antibiotics. Although the exact pathophysiology of this disease remains unknown, it is theorized to be the result of a delayed hypersensitivity response presenting as a cutaneous eruption days to weeks after exposure to the drug. The treatment involves discontinuation of the suspected medication, symptomatic control of pruritus, and topical steroid therapy. A 51-year-old woman with homocystinuria and fibromyalgia was admitted with fevers, pancytopenia (later diagnosed to be acute myelogenous leukemia), and a targetoid cutaneous eruption in the setting of a recent tick bite. She was subsequently noted to have symmetric, pruritic, erythematous papules over the lateral neck, retroauricular regions, lateral aspects of the inframammary regions, medial upper arms, axillae, and the lower abdomen two weeks after starting doxycycline. Considering the morphology, distribution, and intense pruritis associated with the eruption, a diagnosis of SDRIFE was made. Doxycycline discontinuation along with topical steroid therapy resulted in the resolution of the eruption and pruritus. Given the widespread use of doxycycline, clinicians should be aware of this possible side effect.



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Case report
peer-reviewed

Symmetrical Drug-related Intertriginous and Flexural Exanthema Induced by Doxycycline


Author Information

David G. Li Corresponding Author

Department of Dermatology, Brigham and Women's Hospital

Cristina Thomas

Department of Dermatology, Brigham & Women’s Hospital, Harvard Medical School

Gil S. Weintraub

Department of Dermatology, Brigham & Women’s Hospital, Harvard Medical School

Arash Mostaghimi

Department of Dermatology, Brigham & Women’s Hospital, Harvard Medical School


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Partners Healthcare IRB issued approval n/a. IRB not applicable to clinical case reports and case series. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Symmetrical Drug-related Intertriginous and Flexural Exanthema Induced by Doxycycline


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Case report
peer-reviewed

Symmetrical Drug-related Intertriginous and Flexural Exanthema Induced by Doxycycline

David G. Li">David G. Li , Cristina Thomas">Cristina Thomas, Gil S. Weintraub">Gil S. Weintraub, Arash Mostaghimi">Arash Mostaghimi

  • Author Information
    David G. Li Corresponding Author

    Department of Dermatology, Brigham and Women's Hospital

    Cristina Thomas

    Department of Dermatology, Brigham & Women’s Hospital, Harvard Medical School

    Gil S. Weintraub

    Department of Dermatology, Brigham & Women’s Hospital, Harvard Medical School

    Arash Mostaghimi

    Department of Dermatology, Brigham & Women’s Hospital, Harvard Medical School


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Partners Healthcare IRB issued approval n/a. IRB not applicable to clinical case reports and case series. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: November 10, 2017

    DOI

    10.7759/cureus.1836

    Cite this article as:

    Li D G, Thomas C, Weintraub G S, et al. (November 10, 2017) Symmetrical Drug-related Intertriginous and Flexural Exanthema Induced by Doxycycline. Cureus 9(11): e1836. doi:10.7759/cureus.1836

    Publication history

    Received by Cureus: October 25, 2017
    Peer review began: November 01, 2017
    Peer review concluded: November 05, 2017
    Published: November 10, 2017

    Copyright

    © Copyright 2017
    Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a cutaneous drug reaction characterized by erythema over the buttocks, thighs, groin, and flexural regions most commonly associated with the use of beta-lactam antibiotics. Although the exact pathophysiology of this disease remains unknown, it is theorized to be the result of a delayed hypersensitivity response presenting as a cutaneous eruption days to weeks after exposure to the drug. The treatment involves discontinuation of the suspected medication, symptomatic control of pruritus, and topical steroid therapy. A 51-year-old woman with homocystinuria and fibromyalgia was admitted with fevers, pancytopenia (later diagnosed to be acute myelogenous leukemia), and a targetoid cutaneous eruption in the setting of a recent tick bite. She was subsequently noted to have symmetric, pruritic, erythematous papules over the lateral neck, retroauricular regions, lateral aspects of the inframammary regions, medial upper arms, axillae, and the lower abdomen two weeks after starting doxycycline. Considering the morphology, distribution, and intense pruritis associated with the eruption, a diagnosis of SDRIFE was made. Doxycycline discontinuation along with topical steroid therapy resulted in the resolution of the eruption and pruritus. Given the widespread use of doxycycline, clinicians should be aware of this possible side effect.



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David G. Li

Department of Dermatology, Brigham and Women's Hospital

For correspondence:
dgli@bwh.harvard.edu

Cristina Thomas

Department of Dermatology, Brigham & Women’s Hospital, Harvard Medical School

Gil S. Weintraub

Department of Dermatology, Brigham & Women’s Hospital, Harvard Medical School

Arash Mostaghimi

Department of Dermatology, Brigham & Women’s Hospital, Harvard Medical School

David G. Li

Department of Dermatology, Brigham and Women's Hospital

For correspondence:
dgli@bwh.harvard.edu

Cristina Thomas

Department of Dermatology, Brigham & Women’s Hospital, Harvard Medical School

Gil S. Weintraub

Department of Dermatology, Brigham & Women’s Hospital, Harvard Medical School

Arash Mostaghimi

Department of Dermatology, Brigham & Women’s Hospital, Harvard Medical School