Symmetrical intertriginous drug-related flexural exanthema-like presentation in paediatric patients following bone marrow transplant: think graft-versus-host disease

Graft-versus-host disease (GVHD) is a common immune complication of haematopoietic stem cell transplantation (HSCT). GVHD is classified as acute or chronic, depending on the clinical characteristics. In acute cutaneous GVHD, the most common feature is a maculopapular rash. Some less frequently occurring clinical features have also been described, such as acquired ichthyosis, pityriasis rubra pilaris type II and eczema craquelé. Symmetrical intertriginous drug-related flexural exanthema (SDRIFE) is, on the other hand, a cutaneous reaction to medications characterized by symmetrical involvement of the flexion areas, which occurs in the absence of systemic involvement. We describe five paediatric patients with skinfold involvement after HSCT, mimicking SDRIFE. SDRIFE-like presentation, although rare, should be considered as a cutaneous manifestation of acute cutaneous GVHD in the context of patients post-HSCT.