Symmetric drug-related intertriginous and flexural exanthema (SDRIFE) is a type of drug eruption favoring the intertriginous and flexural skin. Systemic symptoms are typically absent. The onset of the rash follows systemic exposure to a medication, most commonly antibiotics (eg, penicillins, beta-lactams, macrolides, trimethoprim-sulfamethoxazole). Other known culprits include antifungals (eg, nystatin), monoclonal antibodies (eg, golimumab, infliximab), everolimus, paracetamol, NuvaRing, zoledronic acid, intravenous immunoglobulin G, NSAIDs (eg, celecoxib), hydroxyzine, cimetidine, rivastigmine, barium sulphate, mitomycin C, opioids (codeine, oxycodone), allopurinol, and radiocontrast media. See Drug Reaction Data.

The latency period could range from hours to days after exposure. The pathogenesis is unknown. It is speculated that a T cell-mediated delayed-type hypersensitivity reaction may mitigate the eruption. Increased drug excretion on the skin folds, which have a high density of eccrine glands, could explain the distribution of the rash.

When the buttocks are predominantly affected, the diagnosis is also known as baboon syndrome, although nomenclature remains a challenge; the relationship between baboon syndrome and SDRIFE is still being evaluated.

Related topic: systemic contact dermatitis