Id Reaction (Autoeczematization)
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Id reaction, or autoeczematization, is a generalized acute cutaneous reaction to a variety of stimuli, including infectious and inflammatory skin conditions. The pruritic rash that characterizes the id reaction, which is considered immunologic in origin, has been referred to as dermatophytid, [1] pediculid, [2] or bacterid when associated with a corresponding infectious process. [3] Clinical and histopathological manifestations are variable and depend on the etiology of the eruption.
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While the exact cause of the id reaction is unknown, the following factors are thought to be responsible: (1) abnormal immune recognition of autologous skin antigens, (2) increased stimulation of normal T cells by altered skin constituents, [4, 5] (3) lowering of the irritation threshold, (4) dissemination of infectious antigen with a secondary response, and (5) hematogenous dissemination of cytokines from a primary site. Some cases have been related to medications and intravenous immune globulin. [6] Id reaction has also been noted with BCG therapy. [7]
The etiology of id reactions includes the following:
Infections with dermatophytes, pulmonary histoplasmosis, [8] mycobacteria, [9] viruses, [10] bacteria, or parasites (pediculosis) [2]
Contact dermatitis, stasis dermatitis, or other eczematous dermatoses [11, 12]
Immunization reactions
Papulonecrotic tuberculid [13] and some other tuberculids: These are now thought to be true cutaneous forms of tuberculosis and not id reactions because of the identification (by polymerase chain reaction) of Mycobacterium tuberculosis in lesions. However, id reactions have been reported following BCG vaccination. [14]
The exact prevalence of id reaction is not known. Dermatophytid reactions are reported to occur in 4-5% of patients with dermatophyte infections. Id reactions have been reported in up to 37% of patients with stasis dermatitis. Furthermore, an estimated two thirds of patients with contact dermatitis superimposed on stasis dermatitis develop an id reaction.
The condition has no known predilection for any racial or ethnic group.
The condition has no known predilection for either sex.
Predilections according to age group are unknown but are influenced by the primary cause of the reaction.
Prognosis is good once the inciting etiology has been identified and appropriately treated. Morbidity results from symptoms of the id reaction and the acute onset of the primary eruption.
Brown A, Sorey W. To Itch, Perchance to Scratch. Clin Pediatr (Phila). 2008 Nov 17. [Medline].
Brenner S, Ophir J, Krakowski A. Pediculid. An unusual -id reaction to pediculosis capitis. Dermatologica. 1984. 168(4):189-91. [Medline].
Chao SC, Lee YP, Lee JY. Eosinophilic cellulitis and panniculitis with generalized vesicular pustular id reaction after a molten aluminum burn. Dermatitis. 2010 Jun. 21(3):E11-5. [Medline].
Cunningham MJ, Zone JJ, Petersen MJ, Green JA. Circulating activated (DR-positive) T lymphocytes in a patient with autoeczematization. J Am Acad Dermatol. 1986 Jun. 14(6):1039-41. [Medline].
Kasteler JS, Petersen MJ, Vance JE, Zone JJ. Circulating activated T lymphocytes in autoeczematization. Arch Dermatol. 1992 Jun. 128(6):795-8. [Medline].
Brazzelli V, Grassi S, Savasta S, Ruffinazzi G, Carugno A, Barbaccia V, et al. Pompholyx of the hands after intravenous immunoglobulin therapy for clinically isolated syndrome: a paediatric case. Int J Immunopathol Pharmacol. 2014 Jan-Mar. 27 (1):127-30. [Medline].
Lowther C, Miedler JD, Cockerell CJ. Id-like reaction to BCG therapy for bladder cancer. Cutis. 2013 Mar. 91 (3):145-6, 151. [Medline].
Crum N, Hardaway C, Graham B. Development of an idlike reaction during treatment for acute pulmonary histoplasmosis: a new cutaneous manifestation in histoplasmosis. J Am Acad Dermatol. 2003 Feb. 48(2 Suppl):S5-6. [Medline].
Choudhri SH, Magro CM, Crowson AN, Nicolle LE. An Id reaction to Mycobacterium leprae: first documented case. Cutis. 1994 Oct. 54(4):282-6. [Medline].
Netchiporouk E, Cohen BA. Recognizing and managing eczematous id reactions to molluscum contagiosum virus in children. Pediatrics. 2012 Apr. 129(4):e1072-5. [Medline].
Lian J, Dundas G, Tron V, Lauzon G, Roa W. radiotherapy-induced ID reaction. Am J Clin Oncol. 2005 Feb. 28(1):105-6. [Medline].
Trattner A, David M. Tefillin dermatitis. J Am Acad Dermatol. 2005 May. 52(5):831-3. [Medline].
Morrison JG, Fourie ED. The papulonecrotic tuberculide. From Arthus reaction to lupus vulgaris. Br J Dermatol. 1974 Sep. 91(3):263-70. [Medline].
Lowther C, Miedler JD, Cockerell CJ. Id-like reaction to BCG therapy for bladder cancer. Cutis. 2013 Mar. 91 (3):145-6, 151. [Medline].
Al Aboud K, Al Hawsawi K, Alfadley A. Tinea incognito on the hand causing a facial dermatophytid reaction. Acta Derm Venereol. 2003. 83(1):59. [Medline].
Gorgievska-Sukarovska B, Skerlev M, Žele-Starčević L, Husar K, Halasz M. Kerion Celsi due to Microsporum canis with a Dermatophytid Reaction. Acta Dermatovenerol Croat. 2017 Jul. 25 (2):151-154. [Medline].
Atzori L, Pau M, Aste M. Erythema multiforme ID reaction in atypical dermatophytosis: a case report. J Eur Acad Dermatol Venereol. 2003 Nov. 17(6):699-701. [Medline].
Fritsch P, Reider N. Eczematous Group. Bolognia JL, Jorizzo J, Rapini R, eds. Dermatology. Mo: Mosby: St. Louis; 2003. Vol 1: 221-2.
Matthew P Evans, MD Chair, Department of Dermatology, Dreyer Medical Clinic
Matthew P Evans, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Chicago Dermatological Society
Disclosure: Nothing to disclose.
Darryl Bronson, MD, MPH Consultant and Immediate Past Chairman, Division of Dermatology, Department of Medicine, Cook County Hospital of Chicago; Instructor, Department of Dermatology, University of Illinois at Chicago
Darryl Bronson, MD, MPH is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, Illinois State Medical Society, Noah Worcester Dermatological Society, Society for Investigative Dermatology
Disclosure: Nothing to disclose.
Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society
Disclosure: Nothing to disclose.
Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology
Disclosure: Received income in an amount equal to or greater than $250 from: Lilly; Amgen <br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Allergen; Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.
Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.
Donald Belsito, MD Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center
Donald Belsito, MD is a member of the following medical societies: New York County Medical Society, Noah Worcester Dermatological Society, Phi Beta Kappa, American Contact Dermatitis Society, Dermatology Foundation, Dermatologic Society of Greater New York, Alpha Omega Alpha, American Academy of Dermatology
Disclosure: Nothing to disclose.
Id Reaction (Autoeczematization)
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