SDRIFE – Another Acronym for a Distinct Cutaneous Drug Exanthema: Do We Really Need It?

benefits of the precise definition of such drug reaction subtypes are the introduction of validated scores, e.g. by the EuroSCAR study group for AGEP [4] , SCORTEN for TEN [5] as well as the implementation of recently proposed criteria for DRESS [3, 6] . Overall, these scores and diagnostic criteria enhance the diagnostic accuracy of these distinct drug eruptions and help to evaluate patient groups more precisely in retrospective and prospective studies. In 1984, Andersen et al. [7] published 3 cases showing a sharply demarcated gluteal and intertriginous erythema with positive patch tests to amoxicillin, nickel and mercury, respectively. Based on the resemblance of the bright red gluteal erythema to the back side of the baboon, they coined the term baboon syndrome (BS). This term – and meanwhile approximately 10 other terms (table 1) that have been used in such cases – are applied to patients systemically exposed to contact allergens, such as mercury [8] , as well as to individuals reacting with this particular pattern to systemic drugs [9] . In this issue, Arnold et al. present another educational BS case report [10] . The reaction, proven by skin and provocation tests and accidental reexposure, occurred after exposure to iodinated contrast media. In our recent review, we proposed SDRIFE (symmetrical drug-related intertriginous and flexural exanthema) as an acronym for this relatively uncommon but distinct cutaneous adverse drug reaction [9] . This term is easily memorized, and SDRIFE is diagnosed based on only 5 The correct morphological diagnosis of cutaneous adverse drug reactions is as critical for general practitioners as for specialists. Discrimination between mild and severe, potentially life-threatening conditions is crucial to initiate appropriate steps with respect to diagnosis, treatment and prophylaxis [1] . Accordingly, early detection and differentiation of potentially lethal conditions, such as toxic epidermal necrolysis (TEN) from common exanthematous (i.e. morbilliform) drug eruptions, is of vital importance. During the last few years, better understanding and characterization of such drug-induced syndromes has led to the use of acronyms based mainly on clinical symptoms and signs, evolution and some laboratory features. Maculopapular and pustular exanthema may be mild or associated with organ involvement or hematological disorders. On the other hand, bullous exanthema encompasses a spectrum from multilocular fixed drug eruptions (FDE) and Stevens-Johnson syndrome (SJS) to potentially life-threatening TEN. Other severe reactions are drug hypersensitivity syndrome , also known as drug rash with eosinophilia and systemic symptoms (DRESS), with potentially lethal hepatopathy and acute generalized exanthematous pustulosis (AGEP), both associated with high fever and leukocytosis. It is important to recognize these severe reactions early to ensure adequate treatment and better prognosis. Such acronyms help physicians to memorize the different types of adverse drug reactions [2, 3] . Additional