17_POLAND_2029_Autoeczematization.indd

Our Dermatology Online

Autoeczematization Id reaction following candidal

diaper dermatitis

Shikhar Ganjoo

, Tulika Gupta

Department of Dermatology & STD, Shree Guru Gobind Singh Tricentenary Medical College and Hospital, Gurugram,

India,

Department of Ophthalmology, Shree Guru Gobind Singh Tricentenary Medical College and Hospital, Gurugram,

India

Corresponding author: Shikhar Ganjoo, MD, E-mail: shikhar[email protected]

INTRODUCTION

Id reactions exhibit multiple clinical presentations,

including localized or widespread vesicular lesions,

maculopapular or scarlatiniform eruptions, erythema

nodosum, erythema multiforme, erythema annulare

centrifugum, Sweet’s syndrome, guttate psoriasis,

and autoimmune bullous disease. The mechanisms

underlying Id reactions vary depending on the type of

clinical presentation. Fergusson et al. studied 52 cases

of diaper dermatitis with psoriasiform Id eruptions and

found Candida albicans to be a causative agent [1].

Other causes include infantile seborrheic eczema,

psoriasis, atopic dermatitis, and ammoniacal diaper

dermatitis [2]. The patient initially presents with

intensely erythematous, papulo-squamous eruption with

satellite lesions and pustules. A secondary generalized

psoriasiform eruption occurs days to weeks later.

CASE REPORT

A six-month-old infant presented with a one-week

history of multiple reddish, scaly skin lesions in the

trunk area. An inspection of the diaper area revealed

multiple reddish, moist, elevated skin lesions. No

history of atopy or psoriasis was present in the family

members. An examination revealed a well-defined

area of intense erythema and papules with some

satellite papules around the larger lesion in the

diaper area also involving the groin folds (Fig. 1a).

Similar lesions were also present in the neck fold

area. Multiple well-defined erythematous plaques

with loosely adherent white scales were seen in the

trunk area (Figs. 1b and 1c). A potassium hydroxide

(KOH) examination of the diaper and neck fold area

revealed budding yeast cells suggestive of Candida

albicans, whereas the trunk lesions showed no fungal

elements (Fig. 2).

Routine blood investigations were done and returned

normal. The patient was treated with oral fluconazole

at a dose of 6 mg/kg of body weight for ten days.

The lesions in the diaper area, neck folds, and

trunk resolved completely with post-inflammatory

hypopigmentation in ten days with no subsequent

reoccurrence (Figs. 3a and 3b).

ABSTRACT

Id reactions are secondary inflammatory reactions that develop from a remote, localized immunological insult. They

may be caused by various fungal, bacterial, viral, and parasitic infections. Diaper dermatitis with psoriasiform Id

eruptions is a rarely reported phenomenon. Herein, we report the case of an infant who developed candidal diaper

dermatitis followed by generalized psoriasiform Id eruptions. Most authors report the resolution of diaper area lesions

with topical antifungals with or without steroids and Id eruptions with topical steroids alone.

Our patient showed

complete resolution of all lesions with oral fluconazole alone.

Key words: Id reaction; Candidal rash; Diaper dermatitis; Psoriasiform ID; Fluconazole

Case Report

How to cite this article: Ganjoo S, Gupta T. Autoeczematization Id reaction following candidal diaper dermatitis. Our Dermatol Online. 2022;13(2):187-189.

Submission: 30.08.2021; Acceptance: 30.01.2022

DOI: 10.7241/ourd.20222.17

www.odermatol.com

DISCUSSION

Diaper dermatitis is a common condition, especially

among newborns and infants. It is an irritating and

inflammatory acute dermatitis of the perineal and

perianal areas resulting from occlusion and irritation

caused by diapers. Diapers create particular conditions

of moisture and friction, and with urine and feces

come increased pH and irritating enzymes (lipases and

proteases) [3]. Fungi may take advantage of all these

factors to cause infection. Candida yeasts, especially

Candida albicans, are responsible for the most frequent

secondary infections.

Early irritant dermatitis is characterized by erythema,

mild maceration, and edema, while Candida diaper

dermatitis (CDD) is characterized by erythematous and

scaly plaques with maceration and edema, sometimes

with satellite pustules or papules, the latter being the

most characteristic feature of Candida infection [4].

Erosion and ulceration may occur in severe cases.

Id reaction is also known as an auto eczematous response,

as there must be an identifiable initial inflammatory

or infectious skin problem that leads to generalized

eczema. Josef Jadassohn, a German dermatologist

who coined the term Id, observed a dermatophytosis

infection causing secondary allergic skin dermatitis [5].

Alex et al. observed infants who developed erythema

multiforme and psoriasiform-type Id reactions due to a

Candida spp. infection in the diaper area [6]. Fergusson

et al. studied 52 cases of diaper dermatitis and napkin

dermatitis that later evolved into disseminated

psoriasiform Id eruptions [1]. One of the definite causes

was attributed to Candida albicans in these cases. Other

causes included infantile seborrheic eczema, psoriasis,

atopic dermatitis, and ammoniacal diaper dermatitis.

Rattet et al. studied two cases of diaper dermatitis

with the subsequent presence of generalized,

papulosquamous, scaly lesions. Biopsies from these

lesions showed psoriasis-like histological features [2].

Another such case was studied by Balasubramanian

et al., in which a post-ureterostomy infant on prolonged

antibiotic therapy developed candidal diaper dermatitis

followed by generalized psoriasiform Id eruptions [7].

Due to paucity of literature on the topic, we report

a case of an infant who presented with generalized

skin lesions resembling psoriasis clinically, with

the simultaneous presentation of candidal diaper

dermatitis. Most authors report the resolution of

diaper area lesions with topical antifungals with or

without steroids and Id eruptions with topical steroids

alone [8]. Our patient showed complete resolution of

all lesions with oral fluconazole alone.

Consent

The examination of the patient was conducted according to the

principles of the Declaration of Helsinki.

The authors certify that they have obtained all appropriate patient

consent forms, in which the patients gave their consent for images

Figure 2: Potassium hydroxide (KOH) examination of the diaper

and neck fold areas revealing budding yeast cells suggestive of

Candida albicans.

Figure 3: (a and b) Post-treatment pictures of the complete resolution

of the psoriasiform lesions leaving post-inﬂ ammatory hypopigmentation

Figure 1: (a-c) Multiple well-deﬁ ned, erythematous plaques with

loosely adherent white scales present in the anterior and posterior

trunk. Involvement of the neck fold and diaper area with erythema.

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and other clinical information to be included in the journal. The

patients understand that their names and initials will not be

published and due effort will be made to conceal their identity,

but that anonymity cannot be guaranteed.

REFERENCES

1. Fergusson AG, Fraser ND, Grant PW. Napkin dermatitis with

psoriasiform “ide”: A review of ﬁ fty-two cases. Br J Dermatol.

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2. Rattet JP, Headley JL, Barr RJ. Diaper dermatitis with psoriasiform

Id eruption. Int J Dermatol. 1981;20:122-5.

3. Fölster-Holst R. Differential diagnoses of diaper dermatitis. Pediatr

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4. Dutta A, Dutta M, Nag SS. Candidal diaper dermatitis. Indian

Pediatr. 2015;52:1100.

5. Ilkit M, Durdu M, Karakaş M. Cutaneous Id reactions:

A comprehensive review of clinical manifestations, epidemiology,

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6. Alex MP, Mohan L, Singh KK, Mukhiya RD. Erythema annulare

centrifugum due to candida infection. Indian J Dermatol Venereol

Leprol. 1999;65:283-4.

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Anjanayen G. Diaper dermatitis with psoriasiform Id eruptions.

Indian J Dermatol Venereol Leprol. 2015;81:435.

8. Colcannon P, Gisoldi E, Phillips S, Grossman R. Diaper dermatitis:

A therapeutic dilemma. Results of a double-blind, placebo-

controlled trial of miconazole nitrate 0.25%. Pediatr Dermatol.

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Source of Support:

Nil, Conﬂ ict of Interest: None declared.