Abstract：
BACKGROUND: Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), formerly also called baboon syndrome, is characterized by symmetrical erythematous rash with typical localization in the gluteal and intertriginous areas. A type IV delayed hypersensitivity immune response is thought to be responsible for its development. CGRP monoclonal antibodies (CGRP mAbs) are a new class of drugs for the prevention of migraine. We present the first case of SDRIFE occurring in temporal relation to the use of erenumab for migraine prevention.
METHODS: A 48-year-old female patient with migraine received erenumab 140 mg subcutaneously in the thigh area for the prevention of migraine in repetitive cycles, each 1 month apart. Initially, the patient experienced no side effects. After the third cycle, a masseuse incidentally noticed a reddish, circular rash in the buttock area during a back massage. There were no other symptoms. The skin changes resolved spontaneously. Two years later, approximately 40 h after reapplication of erenumab 140 mg, the patient experienced a severe pain in the buttock area centered over the anal crease. The area of pain extended in a circular pattern with approximately 20 cm in diameter. The pain started abruptly and reached a severe intensity within about 30 min. Sitting on the buttocks was no longer possible for the patient. There was marked allodynia and hyperpathia in the entire buttocks region. A flat, broad-based blister-like skin swelling developed in this region. The blisters began opening up on the fourth day after the onset of the skin reaction. In addition, there was a pronounced redness in the entire buttock area. Here, the patient felt a strong burning pain, similar to a scald.
RESULTS: The symptoms lasted for a period of 10 days. From this point on, they fully subsided under concomitant therapy with prednisolone.
CONCLUSIONS: SDRIFE as a rare dermatological side effect should be considered in the monitoring of skin lesions during migraine prophylaxis. In view of the high migraine prevalence, knowledge of this uncommon syndrome is important. It is crucial to recognize the relationship between the medication and the circumscribed exanthema occurring distant from the injection site.
METHODS: A 48-year-old female patient with migraine received erenumab 140 mg subcutaneously in the thigh area for the prevention of migraine in repetitive cycles, each 1 month apart. Initially, the patient experienced no side effects. After the third cycle, a masseuse incidentally noticed a reddish, circular rash in the buttock area during a back massage. There were no other symptoms. The skin changes resolved spontaneously. Two years later, approximately 40 h after reapplication of erenumab 140 mg, the patient experienced a severe pain in the buttock area centered over the anal crease. The area of pain extended in a circular pattern with approximately 20 cm in diameter. The pain started abruptly and reached a severe intensity within about 30 min. Sitting on the buttocks was no longer possible for the patient. There was marked allodynia and hyperpathia in the entire buttocks region. A flat, broad-based blister-like skin swelling developed in this region. The blisters began opening up on the fourth day after the onset of the skin reaction. In addition, there was a pronounced redness in the entire buttock area. Here, the patient felt a strong burning pain, similar to a scald.
RESULTS: The symptoms lasted for a period of 10 days. From this point on, they fully subsided under concomitant therapy with prednisolone.
CONCLUSIONS: SDRIFE as a rare dermatological side effect should be considered in the monitoring of skin lesions during migraine prophylaxis. In view of the high migraine prevalence, knowledge of this uncommon syndrome is important. It is crucial to recognize the relationship between the medication and the circumscribed exanthema occurring distant from the injection site.
摘要：
背景：对称的药物相关的三生间和弯曲性皮疹（SDRIFE），以前也被称为狒狒综合症，以对称的红斑皮疹为特征，典型地定位在臀区和三叉神经区域。IV型迟发型超敏反应被认为是其发展的原因。CGRP单克隆抗体(CGRPmAb)是一类新的预防偏头痛的药物。我们介绍了第一例SDRIFE与使用erenumab预防偏头痛的时间关系。
方法：一名48岁的女性偏头痛患者在大腿区域皮下接受了erenumab140mg，以预防重复周期的偏头痛。相隔一个月。最初，患者没有副作用。在第三个周期之后，一个按摩师偶然注意到一个红色的，背部按摩时臀部出现圆形皮疹。没有其他症状。皮肤变化自发解决。两年后,重新应用erenumab140mg后约40小时，患者经历了以肛门折痕为中心的臀部区域的剧烈疼痛。疼痛区域以直径约20厘米的圆形图案延伸。疼痛突然开始并在约30分钟内达到剧烈强度。患者不再可能坐在臀部上。整个臀部区域有明显的异常性疼痛和过度病变。一个公寓，广泛的水泡样皮肤肿胀发展在这个地区。在皮肤反应开始后的第四天,水泡开始开放。此外,整个臀部都有明显的红肿。这里,病人感到强烈的灼痛，类似于烫伤。
结果：症状持续10天。从现在开始,在联合使用泼尼松龙的治疗下，它们完全消退。
结论：SDRIFE作为一种罕见的皮肤病学副作用，应在偏头痛预防期间监测皮肤损伤。鉴于偏头痛的高患病率，了解这种罕见的综合症很重要。认识到药物和远离注射部位发生的界限性出斑之间的关系是至关重要的。
方法：一名48岁的女性偏头痛患者在大腿区域皮下接受了erenumab140mg，以预防重复周期的偏头痛。相隔一个月。最初，患者没有副作用。在第三个周期之后，一个按摩师偶然注意到一个红色的，背部按摩时臀部出现圆形皮疹。没有其他症状。皮肤变化自发解决。两年后,重新应用erenumab140mg后约40小时，患者经历了以肛门折痕为中心的臀部区域的剧烈疼痛。疼痛区域以直径约20厘米的圆形图案延伸。疼痛突然开始并在约30分钟内达到剧烈强度。患者不再可能坐在臀部上。整个臀部区域有明显的异常性疼痛和过度病变。一个公寓，广泛的水泡样皮肤肿胀发展在这个地区。在皮肤反应开始后的第四天,水泡开始开放。此外,整个臀部都有明显的红肿。这里,病人感到强烈的灼痛，类似于烫伤。
结果：症状持续10天。从现在开始,在联合使用泼尼松龙的治疗下，它们完全消退。
结论：SDRIFE作为一种罕见的皮肤病学副作用，应在偏头痛预防期间监测皮肤损伤。鉴于偏头痛的高患病率，了解这种罕见的综合症很重要。认识到药物和远离注射部位发生的界限性出斑之间的关系是至关重要的。
