1/4. The baboon syndrome or intertriginous drug eruption: a report of eleven cases and a second look at its pathomechanism.Although drug eruptions can mimic a variety of idiopathic skin diseases, this has not been mentioned in the differential diagnosis of intertrigo. We draw attention to an unusual presentation of a drug eruption with a characteristic distribution pattern that is confined to the intertriginous areas. This condition has been given one of the most memorable names in dermatology, the baboon syndrome. Originally, the baboon syndrome was described as a special form of systemic contact-type dermatitis (SCTD) that occurs after ingestion or systemic absorption of a contact allergen in individuals previously sensitized by topical exposure to the same allergen in the same areas. We present eleven cases of intertriginous eruptions that resulted from adverse drug reactions. A flare-up of a previous contact with the same allergen (i.e., drug) on the same areas is not a reasonable explanation for the unusual localization of the eruption in our and others' cases. We believe that we are dealing with a type of recall phenomenon and that the characteristic localization and appearance of the eruption is determined by an earlier, unrelated dermatitis that had occurred in precisely the same areas. Adverse drug reactions should always be considered in the differential diagnosis of intertrigo, especially in atypical and therapy-resistant cases.- - - - - - - - - - ranking = 1keywords = dermatitis (Clic here for more details about this article) |
2/4. Intertriginous epidermal dysmaturation from pegylated liposomal doxorubicin.BACKGROUND: A new formulation of doxorubicin (pegylated liposomal doxorubicin) has been developed to attenuate the systemic side effects produced by this agent. Although pegylated liposomal doxorubicin has a much lower risk for cardiotoxicity, it has been associated with cutaneous side effects that differ from, and may also be more frequent than, those produced by the free form of the drug. methods: We report a case of interface dermatitis with keratinocyte dysmaturation, limited to the intertriginous areas, in a patient who received pegylated liposomal doxorubicin, and we review the literature. RESULTS: It is possible that the enhanced delivery of doxorubicin in liposomal form promotes cutaneous side effects of the drug. We consider the possible mechanisms for keratinocyte dysmaturation produced by this form of doxorubicin. CONCLUSIONS: Our findings further suggest that inflammatory changes seen on biopsy may not always allow a reliable histopathologic distinction between this chemotherapy effect and graft-versus-host disease.- - - - - - - - - - ranking = 0.5keywords = dermatitis (Clic here for more details about this article) |
3/4. Baboon syndrome resulting from systemic drugs: is there strife between SDRIFE and allergic contact dermatitis syndrome?The term 'baboon syndrome' (BS) was introduced 20 years ago to classify patients in whom a specific skin eruption resembling the red gluteal area of baboons occurred after systemic exposure to contact allergens. Thereafter, similar eruptions have been reported after systemic exposure to beta-lactam antibiotics and other drugs. In addition to the presentation of 2 of our own cases, we have reviewed and characterized the main clinical and histological aspects of published reports of drug-related baboon syndrome (DRBS) and compared the primary clinical signs from such cases to those found in other distinct drug eruptions. Of approximately 100 published baboon syndrome cases, 50 were identified as drug-induced. Of these, 8 were representatives of systemically induced contact dermatitis (SCD), and 42 were examples of drug eruptions elicited by systemic administration of either oral or intravenous drugs. The main clinical findings included a sharply defined symmetrical erythema of the gluteal area and in the flexural or intertriginous folds without any systemic symptoms and signs. 14 of 42 cases were elicited by amoxicillin, 30 of the 42 patients were male, and latency periods were between a few hours and a few days after exposure. DRBS is a rare, prognostically benign and often underdiagnosed drug eruption with distinct clinical features. The term baboon syndrome, however, does not reflect the complete range of symptoms and signs and is ethically and culturally problematic. Moreover, baboon syndrome is historically often equated with a mercury-induced exanthem in patients with previous contact sensitization. Symmetrical drug-related intertriginous and flexural exanthema, or SDRIFE, specifically refers to the distinctive clinical pattern of this drug eruption, and the following diagnostic criteria are proposed: 1) exposure to a systemically administered drug either at the first or repeated dose (excluding contact allergens); 2) sharply demarcated erythema of the gluteal/perianal area and/or V-shaped erythema of the inguinal/perigenital area; 3) involvement of at least one other intertriginous/flexural localization; 4) symmetry of affected areas; and 5) absence of systemic symptoms and signs.- - - - - - - - - - ranking = 2.5keywords = dermatitis (Clic here for more details about this article) |
4/4. An intertrigo-like eruption from pegylated liposomal doxorubicin.Pegylated liposomal doxorubicin (PLD) is a chemotherapeutic agent used in the treatment of solid tumors. It has a considerably lower risk of cardiotoxicity than its parent compound, doxorubicin. PLD also has a different cutaneous side effect profile than doxorubicin, and its cutaneous toxicity can be dose limiting. We report the case of a 60-year-old woman who developed erythema and erosions in the axilla and groin while on PLD for breast cancer. nystatin was ineffective. Biopsies revealed an interface dermatitis with epidermal dysmaturation. Bland emollients and reduction in the dose of PLD resulted in resolution of the eruption. An intertriginous eruption with histological features of epidermal dysmaturation and an interface dermatitis has been previously reported in the dermatopathology literature. This eruption appears to be a distinct cutaneous toxicity of PLD.- - - - - - - - - - ranking = 1keywords = dermatitis (Clic here for more details about this article) |