Published: 7 December 2023

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Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE)

Published: 7 December 2023
Prescriber Update 44(4): 83–84
December 2023

What is SDRIFE?

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a drug-induced rash involving the skin folds.^1,2

SDRIFE presents as a well-defined symmetrical V-shaped erythematous (red) rash of the gluteal region or groin, hence its original name of ‘baboon syndrome’. There is often involvement of at least one other skin fold or flexural area, such as the armpit and behind the knees.^1,2

The lack of systemic symptoms is a key characteristic of SDRIFE. Aside from the rash, the person is generally well with no other symptoms.¹

Which medicines are associated with SDRIFE?

SDRIFE is a type IV delayed hypersensitivity reaction to a systemic medicine, appearing a few hours to a few days after medicine exposure.^1,2

The most common medicines associated with SDRIFE are beta-lactam antibiotics (eg, penicillins, cephalosporins), which are implicated in about 50 percent of SDRIFE cases.¹

There are many other medicines associated with SDRIFE, including non-beta-lactam antibiotics, analgesics, antifungals and iodine-containing contrast agents.^1,2

How is SDRIFE treated?

SDRIFE is self-limiting and should resolve when the suspect medicine is withdrawn. Re-exposure to the suspect medicine usually causes SDRIFE to recur. Topical steroids may help to resolve the rash more quickly.¹

New Zealand case reports

We are aware of three recent cases of SDRIFE reported in New Zealand (report IDs: 146385, 147293, 147315). The suspect medicines in these cases were metoprolol, cetuximab, doxycycline and ceftriaxone.

More information

For more information about SDRIFE, including images, see the DermNet website.

References

1. Dufill M. 2008. Symmetrical drug-related intertriginous and flexural exanthema. In: DermNet updated January 2021. URL: dermnetnz.org/topics/symmetrical-drug-related-intertriginous-and-flexural-exanthema (accessed 10 October 2023).
2. Samel A and Chu C-Y. 2023. Drug eruptions. In: UpToDate updated 22 February 2023. URL: uptodate.com/contents/drug-eruptions (accessed 10 October 2023).