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First Case of Symmetric Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) Due to Rivastigmine?

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  • SDRIFE due to Rivastigmine?
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Abstract

The term ‘baboon syndrome’ was introduced in 1984 to describe a special form of systemic, contact-type dermatitis 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. Its clinical picture presents as an erythema of the buttocks and upper inner thighs resembling the red bottom of baboons. This reaction was originally observed with mercury, nickel, and ampicillin. In 2004, some authors proposed the acronym SDRIFE standing for ‘symmetric drug-related intertriginous and flexural exanthema’ specifically for cases elicited by systemically administered drugs. Since 1984, about 100 cases have been reported in the literature; for most of the concerned drugs, previous skin sensitization or possible cross-sensitization has not been shown.

We report the first case of SDRIFE due to rivastigmine, with the exception of an erythematous maculopapular eruption due to rivastigmine that was previously reported. Rivastigmine is a reversible and noncompetitive acetylcholinesterase inhibitor used for the treatment of Alzheimer disease.

SDRIFE is an important condition to keep in mind in order to avoid a misdiagnosis when dealing with other exanthematous disorders and to prevent re-exposure to the responsible allergen in the future.

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References

  1. Andersen KE, Hjorth N, Menné T. The baboon syndrome: systemicallyinduced allergic contact dermatitis. Contact Dermatitis 1984; 10: 97–100

    Article  PubMed  CAS  Google Scholar 

  2. Sánchez-Morillas L, Reaño Martos M, Rodríguez Mosquera M, et al. Baboon syndrome. Allergol Immunopathol (Madr) 2004; 32: 43–5

    Article  Google Scholar 

  3. Häusermann P, Harr T, Bircher AJ. Baboon syndrome resulting from systemic drugs: is there strife between SDRIFE and allergic contact dermatitis syndrome? Contact Dermatitis 2004; 51: 297–310

    Article  PubMed  Google Scholar 

  4. Helmbold P, Hegemann B, Dickert C, et al. Symmetric ptychotropic and nonpigmenting fixed drug eruption due to cimetidine (so-called baboon syndrome). Dermatology 1998; 197: 402–3

    Article  PubMed  CAS  Google Scholar 

  5. Barbaud A, Tréchot P, Granel F, et al. A baboon syndrome induced by intravenous human immunoglobulins: report of a case and immunological analysis. Dermatology 1999; 199: 258–60

    Article  PubMed  CAS  Google Scholar 

  6. Chowdhury MM, Patel GK, Inaloz HS, et al. Hydroxyurea-induced skin disease mimicking the baboon syndrome. Clin Exp Dermatol 1999; 24: 336–7

    Article  PubMed  CAS  Google Scholar 

  7. Audicana M, Bernedo N, Gonzalez I, et al. An unusual case of baboon syndrome due to mercury present in a homeopathic medicine [letter]. Contact Dermatitis 2001; 45: 185

    Article  PubMed  CAS  Google Scholar 

  8. Loze I, Milpied-Homsi B, Parent E, et al. The baboon syndrome, a particular cutaneous drug eruption: four case reports [in French]. Nouvelles Dermatologiques 2001; 20: 624–5

    Google Scholar 

  9. Monastero R, Lopez G, Mannino M, et al. Erythematous maculopapular eruption due to rivastigmine therapy. Am J Med 2001; 111: 583–4

    Article  PubMed  CAS  Google Scholar 

  10. Schmutz JL, Barbaud A, Tréchot P. Baboon syndrome: frontline new for the backside (letter) [in French]. Ann Dermatol Venereol 2001; 128: 1378

    PubMed  CAS  Google Scholar 

  11. Isaksson M, Ljunggren B. Systemic contact dermatitis from ethylenediamine in an aminophylline preparation presenting as the baboon syndrome. Acta Derm Venereol 2003; 83: 69–70

    Article  PubMed  CAS  Google Scholar 

  12. Gallo R, Parodi A. Baboon syndrome from 5-aminosalicylic acid [letter]. Contact Dermatitis 2002; 46: 110

    Article  PubMed  CAS  Google Scholar 

  13. Amichai B, Grunwald MH. Baboon syndrome following oral roxithromycin [letter]. Clin Exp Dermatol 2002; 27: 523

    PubMed  CAS  Google Scholar 

  14. Sánchez-Morillas L, Reaño Martos M, Rodríguez Mosquera M, et al. Baboon syndrome due to pseudoephedrine [letter]. Contact Dermatitis 2003; 48: 234

    Article  PubMed  Google Scholar 

  15. Wolf R, Orion E, Matz H. The baboon syndrome or intertriginous drug eruption: a report of eleven cases and a second look at its parthomechanism. Dermatol Online J 2003; 9: 2

    PubMed  Google Scholar 

  16. Moreno-Ramírez D, García-Bravo B, Rodríguez Pichardo A, et al. Baboon syndrome in childhood: easy to avoid, easy to diagnose, but the problem continues. Pediatr Dermatol 2004; 21: 250–3

    Article  PubMed  Google Scholar 

  17. Jankowska-Konsur A, Kolodziej T, Szipietowski J, et al. The baboon syndrome: report of two first cases in Poland. Contact Dermatitis 2005; 52: 289–90

    Article  PubMed  Google Scholar 

  18. Armingaud P, Martin L, Wierzbicka E, et al. Baboon syndrome due to a polysensitization with corticosteroids [in French]. Ann Dermatol Venereol 2005; 132: 675–7

    Article  PubMed  CAS  Google Scholar 

  19. Dhingra A, Grover C. Baboon syndrome [letter]. Indian Pediatr 2007; 44: 934

    Google Scholar 

  20. Arnold AW, Häusermann P, Bach S, et al. Recurrent flexural exanthema (SDRIFE or baboon syndrome) after administration of two different lodinated radio contrast media. Dermatology 2007; 214: 89–93

    Article  PubMed  CAS  Google Scholar 

  21. Garcia-Menaya JM, Cordobés-Durán C, Bobadilla P, et al. Baboon syndrome: 2 simultaneous cases in the same family. Contact Dermatitis 2008; 58: 108–9

    Article  PubMed  CAS  Google Scholar 

  22. Handisurya A, Stingl G, Wöhrl S. SDRIFE (baboon syndrome) induced by penicillin. Clin Exp Dermatol 2009; 34: 355–7

    Article  PubMed  CAS  Google Scholar 

  23. Barbaud A. Global management of cutaneous adverse drug reactions [in French]. Ann Dermatol Venereol 2007; 134: 391–401

    Article  PubMed  CAS  Google Scholar 

  24. Häusermann P, Bircher AJ. SDRIFE: another acronym for a distinct cutaneous drug exanthema: do we really need it? Dermatology 2007; 214: 1–2

    Article  PubMed  Google Scholar 

  25. Bryant CA, Ouldred E, Jackson SH, et al. Purpuric rash with donazepil treatment. BMJ 1998; 317: 787

    Article  PubMed  CAS  Google Scholar 

  26. Herfs H, Schirren CG, Przybilla B, et al. Baboon syndrome: a particular manifestation of hematogenous contact reaction [in German]. Hautarzt 1993; 44: 466–9

    PubMed  CAS  Google Scholar 

  27. Weiss JM, Mockenhaupt M, Schopf E, et al. Reproducible drug exanthema to terbinafine with characteristic distribution of baboon syndrome [in German]. Hautarzt 2001; 52: 1104–6

    Article  PubMed  CAS  Google Scholar 

  28. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30: 239–45

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Gwenaëlle Allain-Veyrac.

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Allain-Veyrac, G., Lebreton, A., Collonnier, C. et al. First Case of Symmetric Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) Due to Rivastigmine?. Am J Clin Dermatol 12, 210–213 (2011). https://doi.org/10.2165/11318350-000000000-00000

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