1/16. Interdigital intertrigo of the feet due to therapy-resistant fusarium solani. We report a case of bilateral intertrigo of the third and fourth interdigital spaces of the feet in a 34-year-old immunocompetent Senegalese male. A diagnosis of fusarium solani infection was made. Systemic and topical therapy with terbinafine led to clinical but not mycological recovery. As this mould is potentially dangerous for immunodepressed subjects, early diagnosis and rigorous follow-up of skin diseases caused by this agent are advisable. ( info) |
2/16. Acute genitocrural intertrigo: a sign of primary human immunodeficiency virus type 1 infection. We describe a 49-year-old male patient who presented with an acute illness associated with a widespread maculopapular eruption and eroded lesions in the inguinal folds consistent with an acute intertrigo, for which search of mycological and bacteriological causes remained negative. Serological tests disclosed a high viral hiv-1 load and p24 antigenemia, while anti-hiv-1 antibodies were absent, a profile typical of acute hiv-1 infection. Since the maculopapular eruption regressed concomitantly with the orogenital lesions as well as the eroded inguinal lesions prior to specific therapy, our observation indicates that intertriginous lesions may constitute one of the early cutaneous markers of primary hiv-1 infection. ( info) |
3/16. 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. ( info) |
4/16. Intertriginous drug eruption. Presented are two patients who developed an unusual, and as yet unreported eruption due to amoxycillin. They exhibited an eruption confined to the intertriginous areas, which mimicked intertrigo. Although drug eruption can mimic a variety of idiopathic skin diseases, intertrigo is easily distinguished from drug eruption and has not been mentioned in the differential diagnosis of this reaction. It is suggested that drug reactions should be considered in the differential diagnosis of intertrigo, in particular of atypical and therapy-resistant cases. Early detection of these cases has practical importance since the elimination of the causative drug is essential for therapy success. Case 2 showed a response of the toxic epidermal neurolysis (TEN) type, which could have been very severe and dangerous had the diagnosis not been made in an early stage before the development of generalized TEN. ( info) |
5/16. 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. ( info) |
6/16. Streptococcal intertrigo: an underrecognized condition in children. Group A beta-hemolytic streptococci have been implicated in a variety of common childhood cutaneous infections. Infants and young children may be particularly susceptible to a form of streptococcal intertrigo that has heretofore been underrecognized in this population. Manifesting as intense, fiery-red erythema and maceration in the intertriginous folds of the neck, axillae, or inguinal spaces, the condition is characterized by a distinctive foul odor and an absence of satellite lesions. Specific clinical features help differentiate this condition from its clinical mimics. Topical and oral antibiotic therapy with or without concomitant low-potency topical steroid application is generally curative. ( info) |
7/16. Plaque-type intertriginous cutaneous calcification. Cutaneous calcification is classified into four types: dystrophic, idiopathic, tumoral, and metastatic. We present a patient with systemic lupus erythematosus undergoing hemodialysis who noted large plaque-like cutaneous calcifications in the axillae and groin. Some plaques occurred in association with striae related to prior corticosteroid therapy for the patient's underlying systemic disease. This case is unusual because of the clinical presentation, its demonstration of both dystrophic and metastatic types of calcification, and histologic calcification of elastic fibers simulating pseudoxanthoma elasticum. ( info) |
8/16. 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. ( info) |
9/16. 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. ( info) |
10/16. collagen implant in management of perleche (angular cheilosis). Perleche (angular cheilosis) is often caused by the presence of saliva on skin adjacent to mucous membranes. In some cases saliva escapes from the mouth through deep grooves that extend inferolaterally from oral commissures. If the sulci are secondary to a decreased vertical dimension of the lower one third of the face (determined by described measurements), corrective dental measures may be curative. When this approach is not practical and in other cases when the grooves are produced by other causes, the defects can be corrected by use of injections of collagen implant. This has been done successfully in two patients, and angular cheilosis has not reoccurred. ( info) |