Systemic drug-related intertriginous and flexural exanthema from radio contrast media: A series of 3 cases

Systemic drug-related intertriginous and flexural exanthema (SDRIFE) is a cutaneous reaction, characterized by 5 diagnostic criteria (Table I).1 We report on 3 patients with SDRIFE induced by radio contrast media (RCM) and describe the dermatologist's role in the treatment and prevention of SDRIFE. Table I Five diagnostic criteria for SDRIFE Case series Patient 1 A 41-year-old African-American woman with a history of uncontrolled hypertension, diabetes mellitus type II, and chronic kidney disease secondary to diabetic nephropathy was admitted for a progressive pruritic eruption shortly after undergoing computed tomography angiography using intravenous (IV) iodinated dye for evaluation of pulmonary thromboembolism. A painful pruritic eruption developed within 12 hours of the procedure with erythematous plaques on the pannus, inframammary, and inguinal folds along with vesicles on the back and edematous palms. She had a similar rash 7 years ago from IV iodinated RCM. During the current admission, a very similar eruption developed despite her being premedicated with systemic steroids (oral prednisone, 50 mg, and IV hydrocortisone, 200 mg), diphenhydramine, and cimetidine.