Id Reaction (Autoeczematization) Clinical Presentation
- Author: Matthew P Evans, MD; Chief Editor: Dirk M Elston, MD more...
Id reactions result from a variety of stimuli, including infectious entities and inflammatory skin conditions. Dermatological manifestations vary and depend on the etiology of the eruption. General history may include the following:
- Varying degrees of pruritus are typically noted.
- An acute onset of an extremely pruritic, erythematous, morbilliform, or papulovesicular eruption occurs 1-2 weeks after primary infection or dermatitis. Id reactions associated with stasis dermatitis are usually symmetrical and, in descending order of frequency, involve the forearms, thighs, legs, trunk, face, hands, neck, and feet.
- Id reactions are usually preceded by exacerbation of the preexisting dermatitis induced by infection, scratching, or inappropriate therapy. (Id reaction to tinea incognito has been reported. )
- Reactions have previously been reported after radiation treatment of tinea capitis.
- Vesicles may be present on the hands or feet.
- Fingers may be tender.
- Travel history relating to infectious agent exposure may be relevant.
- A history of cultural or religious practices may indicate possible contact allergens leading to an id reaction.
Clinical lesions of id reactions are quite variable and are largely predicated on the inciting etiology. Lesions are, by definition, at a site distant from the primary infection or dermatitis. They are usually distributed symmetrically. Clinical forms include the following:
- A widespread, symmetrical eruption of small follicular papules associated with a kerion and a pompholyxlike eruption are usually associated with inflammatory tinea pedis (common).
- An acute, intensely pruritic, symmetric maculopapular or papulovesicular reaction that involves the forearms, thighs, legs, trunk, face, hands, neck, and feet (in descending order of frequency) is typical of the id reaction with stasis dermatitis (common).
- Erysipelaslike eruption on the anterior leg secondary to a dermatophytosis may occur (less common).
- Extracutaneous manifestations include fever, anorexia, generalized adenopathy, splenomegaly, and leukocytosis (uncommon).
- The clinical picture may rarely mimic erythema multiforme.
The etiology of id reactions includes the following:
- Immunization reactions
- Papulonecrotic tuberculid 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.
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].
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].
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].
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].
Fritsch P, Reider N. Eczematous Group. Bolognia JL, Jorizzo J, Rapini R, eds. Dermatology. Mo: Mosby: St. Louis; 2003. Vol 1: 221-2.