ABSTRACT
The id reaction, which is also known as autoeczematisation or autosensitisation dermatitis, refers to the acute development of dermatitis at a site distant from the site of the primary inflammatory cutaneous reaction. Many stimuli have been reported as causes of id reactions, including allergic contact dermatitis. The exact prevalence of id reaction is unknown, however, id reactions have been found to occur in 4%-5% of cases of dermatophyte infections and in up to 37% of patients with stasis dermatitis. This condition has no known predilection for any race, sex or age groups. Shoe dermatitis is a type of contact dermatitis developed following the contact of the foot’s skin with shoe’s parts that contain different chemical substance that harbor the potentiality to be an immune trigger. Among the potential allergens, rubber is found to be the most common shoe-related allergen reported in the literature. Other known allergens include: cements, dichromats used in tanning, dyes, anti-mildew agents, formaldehyde, and nickel eyelets or nickel arch supports. The pathogenesis of allergic contact dermatitis is a type IV, delayed-type immune response that provoked by cutaneous contacts with different material that have the ability to stimulate antigen-specific T-helper 1 (TH1) in a sensitized individual. The clinical presentation of id reaction includes acute onset of pruritic erythematous eruption with symmetrical distribution that follows the primary dermatitis by one to two weeks. Authors report a 27-year-old male who presented with generalized, symmetric pruritic and eczematous eruption following localized shoe dermatitis.
ABSTRACT
A 7 year-old boy visited our hospital with a 2 week history of inflammatory, pustular, tender patches and plaques on the right scalp and face area. He had been treated with topical steroid and antibiotics in a private clinic. In a KOH smear mount, multiple hyphaes and spores appeared on stratum corneum of the outer root sheath layer of his hair. The diagnosis of kerion celsi induced by dermatophytes was made. The patient was treated with oral griseofulvin, and on the 2nd day after starting treatment, multiple erythematous and tendered subcutaneous nodules occurred on his shin. A photosensitive dermatitis like lesion also occurred on his periorbital area. Griseofulvin changed to terbinafine. On the 6th day after treatment, the skin lesions on his face and scalp had improved, as had his shin lesions. The interest of this case lies in the unusual association of kerion and erythema nodosum, of which only eleven cases have been reported in dermatologic literature, and all cases were kerion induced Trichophyton species.