​Kembara Xtra - Medicine - Id Reaction

​Kembara Xtra - Medicine - Id Reaction 
A widespread skin rash linked to different inflammatory cutaneous or infectious (fungal, bacterial, viral, or parasitic) diseases that are not at the primary disease location 
"Id" is frequently used in conjunction with a root to represent the causal agent (for example, bacterid, syphilid, and tuberculid). The most frequently mentioned id response is dermatophytid. In an autosensitization reaction known as a dermatophytid, a secondary cutaneous reaction takes place far from the location of the first fungal infection. The eruption often starts 1 to 2 weeks after the main lesion first appears or after the main lesion worsens. Localized vesicular lesions, erythema nodosum, and erythema multiforme are most frequently seen. more rarely, can result in the development of pustules and vesicles.
Systems impacted: exocrine and/or cutaneous
Synonym(s): autoeczematization, trichophytid, dermatophytid

Epidemiology: All ages; Males predominate; Females predominate; All races predominate.
Incidence Unknown
Prevalence Common


Pathophysiology and Etiology 

Pathophysiology details are unclear. Antibodies may react with circulating antigens in skin sensitive regions. Also possible is an aberrant immune response to autologous skin antigens. The hematogenous dissemination of cytokines from the initial site of inflammation may also be involved in lowering the skin's tolerance to irritation.

the cause
- Contaginous
Trichophyton mentagrophytes, Trichophyton rubrum, Epidermophyton floccosum, and Candida spp. are examples of fungi that can cause infections.
 Bacterial infections: Mycobacterium TB, Staphylococcus aureus, and Streptococcus pyogenes HSV, Molluscum contagiosum, orf, and milker's nodules are examples of viral infections. Parasitic illnesses include Leishmania species and Sarcoptes scabiei.
- Sensitive
Patients with allergies to nickel and aluminum experience severe responses.
- Unspecified
infrequently, id reaction has been recorded in patients undergoing intravesical BCG live therapy for transitional cell carcinoma. Id reaction infrequently develops owing to retained postoperative sutures, cyanoacrylate application, ionizing radiation, acute trauma, and red tattoo ink.

Risk factors include stasis dermatitis and skin fungus infections, particularly tinea pedis.

In order to prevent fungal infections, practice good skin cleanliness, especially in intertriginous areas, and promptly treat any fungal infections that do appear.

Stasis dermatitis and primary fungal infection are related conditions.


Introducing History 

Itchy rash: Check for any lesions (usually bacterial or fungal) that may have caused the same reaction in the days or weeks prior.


clinical assessment 

Symmetric, itchy vesicles most frequently found on the lateral sides of fingers and the palms are common. - Foot tinea; contact dermatitis or other eczematous dermatitis; bacterial, fungal, or viral skin infection Less frequently - Papules - Lichenoid eruption Eczematoid eruption

Differential diagnoses include pustular psoriasis, drug eruptions, contact dermatitis, foliculitis, scabies, and pompholyx (dyshidrotic eczema).

Laboratory Results 

There are no fungi at the location of the id reaction. Potassium hydroxide (KOH) or fungal culture of the initial lesion.
Skin has a positive trichophyton reaction during special tests.
A favorable response is defined as a wheal >10 mm at 20 minutes and an induration >5 mm at 72 hours.

Tests in the Future & Special Considerations
It is crucial to identify dermatophytids from drug-induced allergic reactions since ongoing treatment is necessary to eradicate the underlying infection. The id reaction goes away once the basic skin problem has been successfully treated.

Histology test interpretation

Vesicles in the upper dermis, a superficial perivascular lymphohistiocytic infiltration with few eosinophils, and an enlarged granular cell layer are all signs of skin cancer. The biopsy specimen does not contain any infectious agents.

Treatment of the underlying infection or eczematous dermatitis in an outpatient setting. Symptomatic relief of pruritus using topical steroids and/or antihistamines as needed (may require class 1 or 2 steroid).
Secondary bacterial infection therapy

First Line of Medicine
Antihistamines by mouth for itchiness (2) Chlorpheniramine: 4 mg PO q4-6h PRN; max 24 mg/24 hr (pediatric: 2 mg PO q4-6h PRN; max 12 mg/24 hr; 12 years, refer to adult dose) Diphenhydramine: 25 to 50 mg PO q4-6h PRN; maximum 400 mg/24 hr (pediatric: 5 mg/kg/24 hr divided q6h PRN; 2 to 5 years maximum 37.5 mg/24 hr; 6 to 11 years maximum 150 mg/24 hr; 12 years, refer to adult dose) - Hydroxyzine: 25 to 100 mg PO q6-8h PRN; maximum dose of 600 mg/24 hours (pediatric dose: 2 mg/kg/24 hours divided q6h PRN)
Topical pruritus medications include ointments containing triamcinolone 0.1%. Hydrocortisone 0.5%, 1%, or 2.5%: up to QID on a TID basis.
- Cream with 0.025% and 0.075% capsaicin Apply EMLA (2.5% lidocaine + 2.5% prilocaine) 30 to 60 minutes before capsaicin to lessen burning. Apply TID-QID.
- Doxepin cream, 5%: Use QID (to a maximum of 10% of the body) for up to 8 days.
- Cream with 5% permethrin (for scabies)
After a bath, apply from the neck down.
In 8 to 12 hours, properly rinse off with water.
Permethrin 1% cream rinse (for lice): shampoo, rinse, towel dry, saturate hair and scalp (or other affected region), leave on for 10 minutes, and rinse. This procedure may be repeated in 7 days.
Repeatable in 7 days - Petroleum emollients in white: Apply after taking a brief shower or bath in warm water.
Only use systemic steroids (such as prednisone 20 mg) if the reaction is severe or widespread. 

Second Line: Tinea cruris/corporis topical and/or systemic antifungals for known related fungal infections
Conazole (Spectazole) and ketoconazole (Nizoral) are topical azole antifungal medications that are typically applied BID for 2 to 4 weeks. Terbinafine (Lamisil) is an over-the-counter (OTC) medication that can be applied daily or BID for 1 to 2 weeks. Butenafine (Mentax) is a medication that is applied once daily for 2 weeks and is also very effective for Tinea capitis.
○ PO griseofulvin for Trichophyton and Microsporum spp.; microsized preparation available; dosage 20 to 25 mg/kg/day divided BID or as a single dose daily for 6 to 12 weeks ○ PO terbinafine can be used for Trichophyton spp. at 62.5 mg/day in patients weighing 10 to 20 kg, 125 mg/day if weight 20 to 40 kg, 250 mg/day if weight >40 kg, and use for 4 to 6 weeks.
Systemic or topical antibiotics for any bacterial secondary illness
Erythema multiforme linked to HSV requires antiviral medication treatment.

Continuous  Care 

Avoid hot, humid weather since it encourages the growth of fungi.
Wear sandals or open shoes to aerate vulnerable body parts. To prevent the growth of fungi, it is best to wear loose-fitting clothing and undergarments, pat dry moist skin after bathing, and apply powders and antiperspirants. Primary dermatitis needs urgent treatment.


After receiving the proper care, the condition should fully resolve within a few days or weeks.

Postinflammatory hyperpigmentation is a typical complication after dermatophytid resolution and goes away without therapy in a month. Complications include secondary bacterial infection (cellulitis).

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