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The New England Journal of MedicineSymmetric Drug-Related Intertriginous and Flexural Exanthema

Unraveling the Symmetry: Drug-Induced Exanthema and Its Underlying Mechanisms

In the realm of clinical medicine, the case of a 42-year-old woman presenting with a distinct rash following NSAID usage offers pivotal insights into the diagnosis and management of Symmetric Drug-Related Intertriginous and Flexural Exanthema (SDRIFE). This condition, characterized by symmetric erythematous patches in flexural areas, underscores the critical role of medication history in dermatological diagnoses. The comprehensive analysis of this case not only illuminates the pathophysiology of SDRIFE but also emphasizes the importance of awareness among healthcare providers regarding potential drug reactions, thereby facilitating timely and effective patient care.

Key Points:

  • Incident Overview: A healthy 42-year-old woman developed a reddish-purple rash in axillae, groin, and abdomen regions 10 days post-initiation of dexketoprofen for knee pain, with no accompanying systemic symptoms such as fever or mucosal lesions.
  • Physical Examination Findings: Symmetric patches with peeling borders observed in cervical, axillary, abdominal, inguinal, and intertriginous areas of the back.
  • Diagnosis: Symmetric Drug-Related Intertriginous and Flexural Exanthema (SDRIFE), attributed to the use of dexketoprofen, an NSAID.
  • Pathophysiology: SDRIFE is a type of drug-induced eruption, distinct for its symmetric erythema in intertriginous and flexural areas without systemic symptoms. Common triggers include beta-lactam antibiotics, macrolides, and NSAIDs.
  • Treatment and Management: Initiation of topical glucocorticoids and recommendation to discontinue dexketoprofen resulted in rash abatement within a month.
  • Clinical Implications: The case highlights the necessity for clinicians to consider medication history in patients presenting with dermatological symptoms and the importance of recognizing SDRIFE as a potential adverse reaction to common medications.

NSAIDs are among the most common causes of drug-induced skin reactions, affecting approximately 1% to 2% of patients undergoing treatment with these medications.

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