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A vesicular id reaction associated with tinea pedis. Maceration (arrow) between the toes (A) and multiple small vesicles (arrows) on the lateral margin of the palm (B) are shown. A potassium hydroxide examination of the specimens obtained from between the toes revealed hyphae. The hand and foot lesions were completely resolved using topical antifungal treatment to the foot. (See colour version of this figure online at www.informahealthcare.com/mby)
Source publication
Id reactions are a type of secondary inflammatory reaction that develops from a remote localized immunological insult. To date, id reactions caused by various fungal, bacterial, viral, and parasitic infections have been reported. Superficial fungal infections, especially tinea pedis, are the most common cause of id reactions. Id reactions exhibit m...
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Context 1
... are two main types of clinical manifestations of hand dermatophytids: (i) a dyshidrotic-eczematous or vesicular form and (ii) a scaling form that is commonly an end stage of the vesicular form ( Figure 1). However, the scaling form can occur primarily. Additionally, the scaling form sometimes resembles postscarlatiniform desquamation (Jadassohn & Peck, 1929;Peck, 1930). In adults with tinea pedis, which is usually caused by T. mentagrophytes, the most common type of id reaction is seen on the hands and sides of the fingers (Hall, 1956;Kaaman & Torssander, 1983;Veien et al., 1994). Some patients with tinea pedis develop acute, symmetrical, vesicular eruptions at a secondary site, usually on the fingers or palmar surfaces and the interdigital spaces. Lesions initially include vesicles and bullae; later pap- ules or pustules can form (Kaaman & Torssander, 1983;Veien et al., 1994;Gianni et al., 1996). Generalized folli- cular papules were rarely observed, and some bacteria, such as beta-hemolytic Streptococcus, may have been co- pathogens ( Iglesias et al., 1994). Additionally, a case of vesiculo-bullous tinea pedis with a dermatophytid reac- tion caused by anthropophilic T. violaceum was reported ( Romano et al., 2006b). Peck (1930) was the first to experimentally induce an id reaction. By infecting the toes of previously unaffected persons and producing trauma by friction between the toes, he caused vesicular eruptions on the hands that were typical of id reactions. The hands appear to be a locus minoris resistentiae for the development of the secondary lesions. Additionally, Peck (1930) dem- onstrated that primary localized dermatophytosis of the hands could produce dermatophytids on the feet, which reverses the usual course of events in sensitized patients. Moreover, Epidermophyton Kaufmann-Wolf (likely T. interdigitale) has been cultured not only from lesions on the feet but also from the circulating blood of a patient with a tinea pedis-associated dermatophytid. For personal use ...
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Background:
Erythema nodosum leprosum (ENL) classically presents with tender, coppery, evanescent nodules along with constitutional features and visceral involvement. However, uncommon morphological variants of ENL-like erythema nodosum necroticans, erythema multiforme (EM)-like ENL, Sweet's syndrome (SS)-like ENL, Lucio phenomenon, and reactive p...
Citations
... Als Overtreatment-Syndrom bezeichnet man eine Variante des Mykids, die nach Beginn einer intensiven systemischen antimykotischen Therapie auftritt: Die Hauterscheinungen können exanthematisch sein und sogar mit leichtem Fieber einhergehen. Es wird bei hochentzündlichen Tinea-Formen durch zoophile Dermatophyten beobachtet und beruht möglicherweise auf einer verstärkten Antigenfreisetzung [15,[17][18][19]. ...
Zusammenfassung
Id-Reaktionen im Rahmen von Infektionen der Haut durch Erreger von Dermatomykosen sind hierzulande wahrscheinlich weit unterdiagnostiziert. Bei einem 10-jährigen Mädchen kam es nach dem Kontakt mit einer Katze zu einer Tinea manus bullosa. Als Erreger wurde Trichophyton mentagrophytes identifiziert und mittels Sequenzierung als zoophiler Genotyp III* bestätigt. Behandelt wurde rein topisch mit Miconazol + Flupredniden-Creme. In den nächsten Tagen entwickelten sich volar an beiden Handgelenken und an den Beugeseiten der Unterarme pruriginöse Papeln und Vesiculae im Sinne eines Mykids oder Id-Reaktion als Folge der Dermatophytose. Behandelt wurde kurzzeitig mit topischen Glukokortikoiden, das Exanthem bildete sich schnell zurück. Die Tinea manus heilte zeitgleich und ebenfalls folgenlos ab.
... Id reaction or autosensitization dermatitis is an acute skin reaction that develops at a site distant from a primary inflammatory focus. 1,2 It is frequently associated with skin infections. It can clinically show various presentations, such as eczematous, urticarial, lichenoid, morbilliform, psoriatic, or as erythema nodosum and erythema multiforme, or rosacea. ...
... The larvae penetrate the skin after contact with soil and cause a typical creeping eruption and the disease is self-limiting. [1][2][3] The treatment is based on the systemic or local formulations of anti-nematodes drug, such as albendazole or ivermectin. In our patient, the most likely diagnosis was an id reaction. ...
... There are several differential diagnoses to consider for AD in patients with skin of colour (Table 1). [23][24][25][26][27][28][29][30][31][32][33][34][35][36] Psoriasis is important to consider in individuals of Asian ethnicity given its overlapping phenotypic features with AD in this cohort, and the possible overlap of inflammatory pathways as suggested in Part 1 in this ethnic group. A nationwide population-based cohort study in Taiwan suggested that patients with AD were found to have a higher risk of psoriasis and vice versa. ...
... Associated longitudinal nail fissuring, ridging, brittleness, dorsal pterygium or separation of the nail plate New lesions can form skin trauma (koebnerization) Variable morphological presentations with a variety of subtypes involving all areas of the body Lichen planus pigmentosus subtype presenting with bilateral greyish-brown plaques over sun-exposed sites is common in individuals with skin of colour Actinic lichen planus subtype presenting with nummular plaques with a hyperpigmented centre and surrounding hypopigmented halo across sun-exposed sites is common in individuals with skin of colour Drug-induced eczematous eruptions 28 Variable clinical presentation based on drug type Ill-defined, pruritic, erythematous papules, vesicles and plaques, often over the face, trunk or upper extremities. Surrounding xerosis, dyspigmentation and scale may be present Clinical improvement following cessation of the offending medication Id reactions 29 Heterogeneous presentations, including a variant that resembles AD and presents with highly pruritic grouped or scattered follicular papules. May have overlying crust. ...
Recent advances in atopic dermatitis (AD) present the condition as a heterogenous disease of distinct endotypes across ethnic groups. AD in people with skin of colour may appear psoriasiform, lichenoid, scaly, or papular, with a violaceous colour and there is a higher prevalence of post-inflammatory dyspigmentation compared to affected individuals of Caucasian ethnicity. These differences in clinical presentation may limit the use of AD assessment tools in people with skin of colour, leading to potential for misdiagnosis and underestimation of severity, particularly in relation to assessment of erythema. Recent targeted therapies for AD have been studied in multiple ethnic groups, however ethnicity-based subgroup analysis is often not performed. Further research is required to understand whether treatment responses or safety may differ among ethnic groups.
... Id reaction is also known as an auto eczematous response, as there must be an identifiable initial inflammatory or infectious skin problem that leads to generalized eczema. Josef Jadassohn, a German dermatologist who coined the term Id, observed a dermatophytosis infection causing secondary allergic skin dermatitis [5]. Alex et al. observed infants who developed erythema multiforme and psoriasiform-type Id reactions due to a Candida spp. ...
Id reactions are secondary inflammatory reactions that develop from a remote, localized immunological insult. They may be caused by various fungal, bacterial, viral, and parasitic infections. Diaper dermatitis with psoriasiform Id eruptions is a rarely reported phenomenon. Herein, we report the case of an infant who developed candidal diaper
dermatitis followed by generalized psoriasiform Id eruptions. Most authors report the resolution of diaper area lesions with topical antifungals with or without steroids and Id eruptions with topical steroids alone. Our patient showed complete resolution of all lesions with oral fluconazole alone.
... Local fungal infections induce the production of circulating antibodies and activate T lymphocytes, leading to various localized or generalized inflammatory reactions (44). Humoral immunity has no protective effect against fungal infections (44). ...
... Local fungal infections induce the production of circulating antibodies and activate T lymphocytes, leading to various localized or generalized inflammatory reactions (44). Humoral immunity has no protective effect against fungal infections (44). Host T lymphocyte repertoires mediate either immediate or delayedtype hypersensitivity (45). ...
... Mononuclear cells in the blood of tinea patients can release interferon-gamma (IFN-γ) following stimulation with dermatophyte components, and elevated TNF-α serum levels are detected in tinea pedis. These cytokines can cause cutaneous reactions even in nonlesioned skin (44). The cutaneous findings caused by these cytokines are known as immune dermal (id) reactions (44). ...
... More common complications of milker's nodule include systemic symptoms of fever, lymphadenopathy, as well as possible bacterial superinfection. Bullous pemphigoid-like eruption has been reported as a rare sequela of orf and other parapoxviruses [4]. ...
... In viral-associated EM, viral fragments are phagocytosed by Langerhans cells and transferred to epidermal keratinocytes, triggering the recruitment of CD4+ 1 cells. Proinflammatory mediators such as IFN-c are Case Reports in Dermatological Medicine upregulated and induce an inflammatory cascade that promotes lysis of the infected keratinocytes and epidermal damage [4]. Viral triggers of EM include herpes simplex virus, Epstein-Barr virus, adenoviruses, enteroviruses, hepatitis viruses, influenza, and parapoxviruses [3]. ...
... Viral triggers of EM include herpes simplex virus, Epstein-Barr virus, adenoviruses, enteroviruses, hepatitis viruses, influenza, and parapoxviruses [3]. While it is most commonly related to herpes simplex virus type 1, there are only scant reports describing EM reactions in pseudocowpox virus or milker's nodule [4,7]. Within the Parapoxvirus genus, EM is again most commonly associated with orf infection rather than milker's nodule [4]. ...
Milker’s nodule is caused by the pseudocowpox virus following inoculation from infected cattle. We report the case of erythema multiforme induced by pseudocowpox infection in an 18-year-old female from regional Australia. While erythema multiforme has been described as a complication of orf, it is rare as a sequela of pseudocowpox infection. Greater clinical knowledge of this disease and potential complications aid in guiding appropriate management of this phenomenon.
1. Introduction
Milker’s nodule is a disease caused by pseudocowpox virus of the genus Parapoxvirus that is prevalent in non-metropolitan areas. The infection is of bovine source, typically involving infected teats and mouth of cattle. The disease typically manifests as localised erythematous-violaceous nodules at the site of inoculation after a brief incubation period of 5–15 days [1, 2]. Erythema multiforme (EM) is a hypersensitivity reaction of the skin or mucosa against specific antigens with ninety percent of cases induced by infections [3]. It is most commonly associated with herpetic infections, but scant reports have described EM reaction as a rare complication of pseudocowpox virus. We herein describe a case of pseudocowpox virus presenting with secondary erythema multiforme.
2. Case Description
An 18-year-old female from rural Australia with no medical history, presented to the emergency department with a three-day history of spreading, papulovesicular, pruritic eruption on bilateral knees, hands with preferential involvement of the right hand, as well as a superficial crusting of the lips. She reported being bitten on the right hand by her pet calf 2 weeks prior. She remained systemically well and denied constitutional symptoms including fevers or arthralgias. She denied any new or regular medications or preceding illness. She denied exposure to sheep, goats, gardening, or fish tanks.
On examination, there was a violaceous, eroded nodule on the dorsal aspect of her right middle finger with an associated erythematous-yellow papulovesicular eruption (Figure 1). Erythematous papules and nodules were present on the dorsal and palmar surfaces of her left hand (Figure 2) and on bilateral knees with no pustules (Figure 3). Superficial yellow crusting was present on the lips (Figure 4). There were no bullae observed and no lymphadenopathy.
... Orf olgularının %4-13'ünde erythema multiforme reaksiyonu bildirilmiştir (5,7,8). Bununla birlikte tüm Poxviridae ailesi içinde erythema multiforme benzeri sekonder immünolojik reaksiyonlar en sık orfla ilişkilendirilmiştir (10). ...
... La dysidrose est une forme particulière d'eczéma limité au niveau des faces latérales des doigts et des orteils ainsi qu'aux paumes et aux plantes [1]. Sa fréquence et son caractère handicapant et récidivant retentissent sur la qualité de vie [2]. Elle pose un problème d'étiopathogénie, rendant son diagnostic étiologique et se prise en charge difficiles [3]. ...
... Bryld et al. ont montré que le risque relatif de dysidrose palmaire chez ceux ayant un intertrigo interorteil était de 3,58. Une étude castémoin a mis en évidence l'intertrigo mycosique comme facteur associé de façon statistiquement significative à la dysidrose en analyse univariée et multivariée [2]. La dysidrose peut être en relation avec une allergie fongique (ide : lésion allergique à distance d'un foyer fongique) que ce soit un dermatophyte (mycide) ou une levure (levuride) Il s'agirait alors d'éruptions secondes (" ides ") à topographie palmo-plantaire, consécutives à un eczéma de contact allergique à des antigènes d'origine dermatophytique. ...
... Criteria for the diagnosis of a dermatophytid include: (1) evidence of a (frequently) inflammatory dermatophytosis at another site of the body (here, TC); (2) no evidence of fungal elements in the dermatophytid lesions; (3) initially, there is frequently a clinical flare-up upon starting highly effective systemic antifungal therapy (release of large amounts of fungal antigens). It is essential to distinguish this phenomenon from a drug eruption caused by the systemic antifungal agent; (4) the lesions resolve once the fungal infection has been treated [39,40]. While dermatophytids usually occur on the trunk, extremities and face, generalized eruptions are also possible. ...
... Some authors believe that the significant inflammatory component of some TC variants (kerion) is in part due to a strong (delayed-type) immune response to the causative organism; this is also reflected by the common occurrence of dermatophytids [39,40]. Given this view, it has been recommended to use oral or intralesional corticosteroids to speed up the healing process and to minimize the risk of persistent alopecia [111,112]. ...
Zusammenfassung
Die Tinea capitis ist eine durch Dermatophyten hervorgerufene, vor allem im Kindesalter auftretende Mykose der behaarten Kopfhaut. Die Diagnostik erfolgt mittels mikroskopischer, kultureller und/oder molekularer Methoden. Die Therapie sollte systemisch und begleitend topisch erfolgen und ist abhängig von dem jeweiligen Erreger. Das Ziel des Updates dieser interdisziplinären deutschen S1‐Leitlinie ist es, vor allem Dermatologen, Kinderärzten und Allgemeinmedizinern eine Entscheidungshilfe für die Auswahl sowie Durchführung einer geeigneten und suffizienten Diagnostik und Therapie für Patienten mit Tinea capitis zur Verfügung zu stellen. Die Leitlinie wurde unter Berücksichtigung aktueller internationaler Leitlinien, insbesondere der Leitlinien der European Society for Pediatric Dermatology 2010 sowie der British Association of Dermatologists 2014 und den Ergebnissen einer Literaturrecherche durch die Leitlinienkommission erstellt. Diese Kommission ist multidisziplinär und besteht aus Vertretern der Deutschen Dermatologischen Gesellschaft (DDG), der Deutschsprachigen Mykologischen Gesellschaft (DMykG), der Deutschen Gesellschaft für Hygiene und Mikrobiologie (DGHM), der Deutschen Gesellschaft für Kinder‐ und Jugendmedizin e.V. (DGKJ) und der deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI). Methodisch wurde die Leitliniengruppe durch die Division of Evidence‐based Medicine (dEBM) begleitet. Die Leitlinie wurde nach einem umfangreichen internen und externen Review durch die beteiligten Fachgesellschaften freigegeben.
... Criteria for the diagnosis of a dermatophytid include: (1) evidence of a (frequently) inflammatory dermatophytosis at another site of the body (here, TC); (2) no evidence of fungal elements in the dermatophytid lesions; (3) initially, there is frequently a clinical flare-up upon starting highly effective systemic antifungal therapy (release of large amounts of fungal antigens). It is essential to distinguish this phenomenon from a drug eruption caused by the systemic antifungal agent; (4) the lesions resolve once the fungal infection has been treated [39,40]. While dermatophytids usually occur on the trunk, extremities and face, generalized eruptions are also possible. ...
... Some authors believe that the significant inflammatory component of some TC variants (kerion) is in part due to a strong (delayed-type) immune response to the causative organism; this is also reflected by the common occurrence of dermatophytids [39,40]. Given this view, it has been recommended to use oral or intralesional corticosteroids to speed up the healing process and to minimize the risk of persistent alopecia [111,112]. ...
Tinea capitis describes a dermatophyte infection of scalp and hair that predominately occurs in children. The diagnostic workup includes microscopic examination, culture and/or molecular tests. Treatment is guided by the specific organism involved and should consist of systemic agents as well as adjuvant topical treatment. The aim of the present update of the interdisciplinary German S1 guidelines is to provide dermatologists, pediatricians and general practitioners with a decision tool for selecting and implementing appropriate diagnostic and therapeutic measures in patients with tinea capitis. The guidelines were developed based on current international guidelines, in particular the 2010 European Society for Pediatric Dermatology guidelines and the 2014 British Association of Dermatologists guidelines, as well as on a review of the literature conducted by the guideline committee. This multidisciplinary committee consists of representatives from the German Society of Dermatology (DDG), the German‐Speaking Mycological Society (DMykG), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence‐based Medicine (dEBM) provided methodological assistance. The guidelines were approved by the participating medical societies following a comprehensive internal and external review.
