Apremilast/paracetamol interaction
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Symmetrical drug-related intertriginous and flexural exanthema: case report A 62-year-old woman developed symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) following interaction between apremilast and paracetamol [routes not stated]. The woman was referred to an outpatient clinic for erythematous patches, which were symmetrically located at axillary areas, inguinal folds, nape and sub-mammary areas. She had been receiving apremilast 30mg twice daily for 6 months for long-standing plaque psoriasis. Examination showed sharply demarcated erythematous patches of an irregular oval shape (ranging from 8–17cm), which were symmetrically located at the posterior face of the neck, the axillae, inguinal folds, and sub-mammary areas. Intense itching and burning were also noted. She reported the onset one day after taking paracetamol 1000mg for headache. Previously, she had tolerated paracetamol well. Histological examination of a lesional punch biopsy revealed superficial perivascular infiltrate, neutrophils, extravasated erythrocytes, and eosinophils with mild dermal oedema and slight spongiosis. On the basis of these findings, she was diagnosed with SDRIFE. She did not discontinue apremilast due to the lack of chronological correlation. The woman was treated with zinc oxide, and the skin lesions resolved completely in 10 days. At a 10-month follow-up, no new skin lesions were noted. It was concluded that, the interaction between apremilast and paracetamol led to SDRIFE. Author comment: "Therefore, a hypothetical interaction between [apremilast and paracetamol] cannot definitively be excluded." "In conclusion, we report a case of SDRIFE caused by paracetamol in a patient receiving apremilast therapy." Megna M, et al. Paracetamol-induced symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) in a psoriasis patient receiving apremilast therapy. Contact Dermatitis 81: 451-454, No. 6, Dec 2019. Available from: URL: http:// 803440800 doi.org/10.1111/cod.13358 - Italy
0114-9954/19/1784-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 21 Dec 2019 No. 1784
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