Symmetrical drug-related intertriginous and flexural exanthem with itraconazole: The unusual reaction with a frequently used drug

Symmetrical drug-related intertriginous and flexural exanthem (SDRIFE) is a rare, benign and self-limiting cutaneous adverse drug reaction. It presents as an erythematous rash distributed symmetrically on the gluteal and intertriginous areas with no systemic affection. SDRIFE is most commonly reported after exposure to antibiotics, particularly those in the penicillin group. Here, we present a case of SDRIFE associated with itraconazole. A 15-year-old boy presented with a dermatophytic infection for which itraconazole was prescribed. After 10 days of drug intake, he presented with diffuse erythema and scaling over the buttocks. The rash continued to progress to other intertriginous areas and was associated with itching and a burning sensation. On examination, an erythematous scaly macular rash symmetrically involving groins, thighs, neck, axilla, flexural aspect of arms, popliteal fossa and upper part of chest was noted. There was complete resolution of the lesions after 2 weeks of stopping itraconazole. The patient was, thus, diagnosed with SDRIFE due to itraconazole, based on the drug history and clinical profile. Although SDRIFE caused by itraconazole is exceedingly rare, increasing awareness among dermatologists can facilitate early identification and prompt discontinuation of the medication.