Id reaction

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Id reaction
Other namesCutaneous autosensitization
Specialty Dermatology   OOjs UI icon edit-ltr-progressive.svg

Id reactions (also known as disseminated eczema [1] and generalized eczema [1] ) are types of acute dermatitis developing after days or weeks at skin locations distant from the initial inflammatory or infectious site. They can be localised or generalised. [2] [3] This is also known as an autoeczematous response [4] and there must be an identifiable initial inflammatory or infectious skin problem which leads to the generalised eczema. Often intensely itchy, the red papules and pustules can also be associated with blisters and scales and are always remote from the primary lesion. [5] It is most commonly a blistering rash with itchy vesicles on the sides of fingers and feet as a reaction to fungal infection on the feet, athlete's foot. [6] Stasis dermatitis, allergic contact dermatitis, acute irritant contact eczema and infective dermatitis have been documented as possible triggers, but the exact cause and mechanism is not fully understood. [7] Several other types of id reactions exist including erythema nodosum, erythema multiforme, Sweet's syndrome and urticaria. [3]

Contents

Presentation

Complications

Id reactions left untreated may become infected with bacteria. [2]

Causes

Causes include infection with dermatophytosis, Mycobacterium , viruses, bacteria and parasites. Eczematous conditions including contact allergic dermatitis and stasis dermatitis as well as stitches and trauma have also been associated with id reactions. [2] Radiation treatment of tinea capitis has been reported as triggering an id reaction. [8]

Pathogenesis

Potential explanations include

  1. Atypical immune recognition of autologous skin antigens
  2. Stimulation of normal T cells by changing skin constituents
  3. Lower threshold for skin irritation
  4. Spreading of infectious antigens causing a secondary response
  5. Hematogenous dissemination of cytokines from the primary site of inflammation [2]

Diagnosis

Although there are a multitude of varying appearances, the id reaction often presents with symmetrical red patches of eczema with papules and vesicles, particularly on the outer sides of the arms, face and trunk which occur suddenly and are intensely itchy occur a few days to a week after the initial allergic or irritant dermatitis. Most commonly, athlete's foot can lead to localised vesicles on hands, bacterial infections to erythema nodosum and herpes simplex virus to erythema multiforme. [2] [3]

The diagnosis is frequently made by treating the initial triggering skin problem and observing the improvement in the eczematous rash. Both the initial skin problem and the id reaction must be observed to make the diagnosis. [5] [6]

Not all dyshidrotic rashes are id reactions, but id reactions are often dyshidrotic-like. [2]

Initial tests may include isolating a fungus by taking a swab and sending it for culture. Patch testing may be considered if there is suspicion of allergic contact dermatitis. [2]

A skin biopsy is rarely necessary, [2] but if done mostly shows an interstitial granulomatous dermatitis, some lesions being spongiotic. [4] Id reactions cannot be distinguished from other skin diseases by histopathology. However, they can be distinguished from other id reactions by histopathology. [3]

Differential diagnosis

Other rashes that occur in a widespread distribution can look like an id reaction. These include atopic dermatitis, contact dermatitis, dyshidrosis, photodermatitis, scabies and drug eruptions. [2]

Treatment

Id reactions are frequently unresponsive to corticosteroid therapy, but clear when the focus of infection or infestation is treated. [9] [5] : 81  Therefore, the best treatment is to treat the provoking trigger. Sometimes medications are used to relieve symptoms. These include topical corticosteroids, and antihistamines. If opportunistic bacterial infection occurs, antibiotics may be required. [2]

Prognosis

A full recovery is expected with treatment. [2] Recurrent id reactions are frequently due to inadequate treatment of the primary infection or dermatitis and often the cause of recurrence is unknown. [3]

Epidemiology

With no particular affinity to any particular ethnic group, seen in all age groups and equally amongst males and females, the precise prevalence is not known. [2]

History

The suffix -id has its origins in Greek, referring to a father–son relationship. German dermatologist Josef Jadassohn (1863–1936), who coined the term id, had observed a dermatophytosis causing a secondary allergic skin dermatitis. In 1928, Bloch recorded that the peak of the dermatophyte infection corresponded with the id reaction. [3]

See also

Related Research Articles

<span class="mw-page-title-main">Dermatitis</span> Inflammatory disease of the skin

Dermatitis is a term used for different types of skin inflammation, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved can vary from small to covering the entire body. Dermatitis is also called eczema but the same term is often used for the most common type of skin inflammation, atopic dermatitis.

<span class="mw-page-title-main">Tinea cruris</span> Fungal infection

Tinea cruris, also known as jock itch, is a common type of contagious, superficial fungal infection of the groin and buttocks region, which occurs predominantly but not exclusively in men and in hot-humid climates.

<span class="mw-page-title-main">Irritant diaper dermatitis</span> Medical condition

Irritant diaper dermatitis is a generic term applied to skin rash in the diaper area that are caused by various skin disorders and/or irritants.

<span class="mw-page-title-main">Contact dermatitis</span> Inflammation from allergen or irritant exposure

Contact dermatitis is a type of acute or chronic inflammation of the skin caused by exposure to chemical or physical agents. Symptoms of contact dermatitis can include itchy or dry skin, a red rash, bumps, blisters, or swelling. These rashes are not contagious or life-threatening, but can be very uncomfortable.

<span class="mw-page-title-main">Erythema multiforme</span> Presence of red patches on the hands

Erythema multiforme (EM) is a skin condition that appears with red patches evolving into target lesions, typically on both hands.

<span class="mw-page-title-main">Papule</span> Small, circumscribed, solid elevation of skin with no visible fluid

A papule is a small, well-defined bump in the skin. It may have a rounded, pointed or flat top, and may have a dip. It can appear with a stalk, be thread-like or look warty. It can be soft or firm and its surface may be rough or smooth. Some have crusts or scales. A papule can be flesh colored, yellow, white, brown, red, blue or purplish. There may be just one or many, and they may occur irregularly in different parts of the body or appear in clusters. It does not contain fluid but may progress to a pustule or vesicle. A papule is smaller than a nodule; it can be as tiny as a pinhead and is typically less than 1 cm in width, according to some sources, and 0.5 cm according to others. When merged together, it appears as a plaque.

<span class="mw-page-title-main">Dyshidrosis</span> Inflammatory disease of the skin in humans

Dyshidrosis is a type of dermatitis, characterized by itchy vesicles of 1–2 mm in size, on the palms of the hands, sides of fingers, or bottoms of the feet. Outbreaks usually conclude within three to four weeks, but often recur. Repeated attacks may result in fissures and skin thickening. The cause of the condition is not known.

<span class="mw-page-title-main">Urushiol-induced contact dermatitis</span> Medical condition

Urushiol-induced contact dermatitis is a type of allergic contact dermatitis caused by the oil urushiol found in various plants, most notably sumac family species of the genus Toxicodendron: poison ivy, poison oak, poison sumac, and the Chinese lacquer tree. The name is derived from the Japanese word for the sap of the Chinese lacquer tree, urushi. Other plants in the sumac family also contain urushiol, as do unrelated plants such as Ginkgo biloba.

<span class="mw-page-title-main">Polymorphous light eruption</span> Medical condition

Polymorphous light eruption (PLE) presents with itchy red small bumps on sun-exposed skin, particularly face, neck, forearms and legs. It generally appears 30 minutes to a few hours after sun exposure and may last between one and 14 days. The bumps may become small blisters or plaques and may appear bloody,often healing with minimal scarring.

<span class="mw-page-title-main">Allergic contact dermatitis</span> Inflammation of the skin due to contact with an allergen

Allergic contact dermatitis (ACD) is a form of contact dermatitis that is the manifestation of an allergic response caused by contact with a substance; the other type being irritant contact dermatitis (ICD).

<span class="mw-page-title-main">Erythema migrans</span> A rash in several vector-borne diseases

Erythema migrans or erythema chronicum migrans is an expanding rash often seen in the early stage of Lyme disease, and can also be caused by southern tick-associated rash illness (STARI). It can appear anywhere from one day to one month after a tick bite. This rash does not represent an allergic reaction to the bite, but rather an actual skin infection of one of the Lyme bacteria species from the genus Borrelia. The rash's name comes from Neo-Latin for "migrating redness."

<span class="mw-page-title-main">Cheilitis</span> Inflammation of the lips

Cheilitis is a medical condition characterized by inflammation of the lips. The inflammation may include the perioral skin, the vermilion border, or the labial mucosa. The skin and the vermilion border are more commonly involved, as the mucosa is less affected by inflammatory and allergic reactions.

<span class="mw-page-title-main">Flea allergy dermatitis</span> Skin disease of dogs and cats

Flea allergy dermatitis is an eczematous itchy skin disease of dogs and cats. For both of these domestic species, flea allergy dermatitis is the most common cause of skin disease. Affected animals develop allergic reactions to chemicals in flea saliva. Symptoms of this reaction include erythema (redness), papules (bumps), pustules, and crusts (scabs). If severe, hair loss will occur in the affected area. Dogs with flea allergy dermatitis often show hair loss and eczematous skin rash on the lower back, upper tail, neck, and down the back of the legs. Cats with flea allergy dermatitis may develop a variety of skin problems, including feline eosinophilic granuloma, miliary dermatitis, or self-inflicted alopecia from excessive grooming.

<span class="mw-page-title-main">Spongiosis</span> Accumulation of fluid in the outermost layer of skin (epidermis)

Spongiosis is mainly intercellular edema in the epidermis, and is characteristic of eczematous dermatitis, manifested clinically by intraepidermal vesicles, "juicy" papules, and/or lichenification. It is a severe case of eczema that affects the epidermis, dermis or subcutaneous skin tissues. The three types of spongiotic dermatitis are acute, subacute and chronic. A dermatologist can diagnose acute spongiotic dermatitis by examining the skin during an office visit, but a biopsy is needed for an accurate diagnosis of the type.

<span class="mw-page-title-main">Lymphangioma circumscriptum</span> Medical condition

Superficial lymphatic malformation is a congenital malformation of the superficial lymphatics, presenting as groups of deep-seated, vesicle-like papules resembling frog spawn, at birth or shortly thereafter. Lymphangioma circumscriptum is the most common congenital lymphatic malformation. It is a benign condition and treatment is not required if the person who has it does not have symptoms from it.

<span class="mw-page-title-main">Nickel allergy</span> Medical condition

Nickel allergy is any of several allergic conditions provoked by exposure to the chemical element nickel. Nickel allergy often takes the form of nickel allergic contact dermatitis (Ni-ACD), a form of allergic contact dermatitis (ACD). Ni-ACD typically causes a rash that is red and itchy and that may be bumpy or scaly. The main treatment for it is avoiding contact with nickel-releasing metals, such as inexpensive jewelry. Another form of nickel allergy is a systemic form: systemic nickel allergy syndrome (SNAS) can mimic some of the symptoms of irritable bowel syndrome (IBS) and also has a dermatologic component.

<span class="mw-page-title-main">Lip licker's dermatitis</span> Medical condition

Lip licker's dermatitis is a type of skin inflammation around the lips due to damage by saliva from repetitive lip licking and is classified as a subtype of irritant contact cheilitis. The resulting scaling, redness, chapping, and crusting makes a well-defined ring around the lips. The rash may extend as far as the tongue can reach and usually does not occur at the corners of the mouth. It commonly occurs during winter months but some people can have it year-round if lip licking is a chronic habit.

Two feet-one hand syndrome(TFOHS), is a long-term fungal condition where athlete's foot or fungal toe nail infections in both feet is associated with tinea manuum in one hand. Often the feet are affected for several years before symptoms of a diffuse scaling rash on the palm of one hand appear, which is when most affected people then seek medical help.

References

  1. 1 2 Rapini RP, Bolognia JL, Jorizzo JL (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. p. 224. ISBN   978-1-4160-2999-1. Archived from the original on 2020-08-22. Retrieved 2018-06-15.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 Ferri FF (2018). Ferri's Clinical Advisor 2018: 5 Books in 1. Philadelphia, PA: Elsevier. p. 690. ISBN   978-0-323-28049-5. OCLC   989151714.
  3. 1 2 3 4 5 6 Ilkit M, Durdu M, Karakaş M (August 2012). "Cutaneous id reactions: a comprehensive review of clinical manifestations, epidemiology, etiology, and management". Critical Reviews in Microbiology. 38 (3): 191–202. doi:10.3109/1040841X.2011.645520. PMID   22300403. S2CID   43906095.
  4. 1 2 Patterson JW, Hosler G (2014-12-07). Weedon's skin pathology (Fourth ed.). pp. 103–134. ISBN   978-0-7020-6200-1. OCLC   900724639.
  5. 1 2 3 Fitzpatrick JE, High WA (2017-07-28). Urgent care dermatology: symptom-based diagnosis. Philadelphia, PA: Elsevier. pp. 135–162. ISBN   978-0-323-48553-1. OCLC   994056971.
  6. 1 2 Habif TP (2016). Clinical Dermatology: A color guide to diagnosis and therapy (Sixth ed.). St. Louis, Mo.: Elsevier. pp. 90–125. ISBN   978-0-323-26607-9. OCLC   911266496.
  7. ↑ "International Classification of Diseases 11th Revision". World Health Organization.
  8. ↑ Evans MP, Bronson D, Belsito D (October 2020). Vinson RP, Callen JP, Elston DM (eds.). "Id Reaction (Autoeczematization) Clinical Presentation: History, Physical Examination, Causes". emedicine.medscape.com. Retrieved 2017-11-25.
  9. ↑ James WD, Berger T, Elston D (2006). Andrews' diseases of the skin : clinical dermatology (10th ed.). Philadelphia: Saunders Elsevier. ISBN   978-0-7216-2921-6.
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