Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a type of drug eruption favoring the intertriginous and flexural skin. Systemic symptoms are typically absent. The onset of the rash follows systemic exposure to a medication, most commonly antibiotics (eg, penicillins, beta-lactams, macrolides, trimethoprim-sulfamethoxazole). Other known culprits include antifungals (eg, nystatin), monoclonal antibodies (eg, golimumab, infliximab), everolimus, paracetamol, NuvaRing, zoledronic acid, intravenous immunoglobulin G, NSAIDs (eg, celecoxib), hydroxyzine, cimetidine, rivastigmine, barium sulphate, mitomycin C, opioids (codeine, oxycodone), allopurinol, erenumab, and radiocontrast media. It can occur with initial administration and without prior sensitization to the culprit medication. See Drug Reaction Data.

The latency period could range from hours to days after exposure. The pathogenesis is unknown. It is speculated that a T cell-mediated delayed-type hypersensitivity reaction may mitigate the eruption. Increased drug excretion on the skin folds, which have a high density of eccrine glands, could explain the distribution of the rash.

Related topic: systemic contact dermatitis