eMedicine Specialties > Dermatology > Allergy & Immunology

Id Reaction (Autoeczematization): Differential Diagnoses & Workup

Author: Matthew P Evans, MD, Dermatology, Dreyer Medical Group
Coauthor(s): Darryl Bronson, MD, MPH, Chairman, Program Director, Division of Dermatology, Department of Medicine, Cook County Hospital of Chicago; Professor, Departments of Dermatology and Pathology, University of Illinois at Chicago
Contributor Information and Disclosures

Updated: Feb 25, 2009

Differential Diagnoses

Atopic Dermatitis
Folliculitis
Contact Dermatitis, Allergic
Gianotti-Crosti Syndrome (Papular Acrodermatitis of Childhood)
Contact Dermatitis, Irritant
Granuloma Annulare
Cutaneous T-Cell Lymphoma
Insect Bites
Cutaneous Tuberculosis
Linear IgA Dermatosis
Dermatitis Herpetiformis
Papulonecrotic Tuberculids
Drug Eruptions
Pityriasis Lichenoides
Dyshidrotic Eczema
Pityrosporum Folliculitis
Eosinophilic Pustular Folliculitis
Prurigo Nodularis
Erysipelas
Scabies

Workup

Laboratory Studies

  • Laboratory workup of id reactions is clearly indicated for dermatophytids.
    • Strict criteria include a proven dermatophyte infection and a positive skin test finding for a group-specific trichophytin antigen.
    • Absence of fungi in the dermatophytid lesions and clearing of the dermatophytid after the fungus is eradicated are necessary to confirm a definitive diagnosis of a dermatophytid reaction.

Other Tests

  • Patch testing may be needed to exclude primary or secondary allergic contact dermatitis.

Procedures

  • Biopsy for routine hematoxylin and eosin staining may be helpful in excluding noneczematous dermatoses, which may appear morphologically similar to an id reaction.
  • Patch testing may be necessary to identify a contact allergen.

Histologic Findings

Histopathology of the typical papulovesicular lesion reveals a superficial perivascular lymphohistiocytic infiltrate with a spongiotic epidermis, often with vesiculation. Small numbers of eosinophils may be present in the dermal infiltrate. By definition, infectious agents should not be found in the specimens.

More on Id Reaction (Autoeczematization)

Overview: Id Reaction (Autoeczematization)
Differential Diagnoses & Workup: Id Reaction (Autoeczematization)
Treatment & Medication: Id Reaction (Autoeczematization)
Follow-up: Id Reaction (Autoeczematization)
References
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References

  1. Brown A, Sorey W. To Itch, Perchance to Scratch. Clin Pediatr (Phila). Nov 17 2008;[Medline].

  2. Brenner S, Ophir J, Krakowski A. Pediculid. An unusual -id reaction to pediculosis capitis. Dermatologica. 1984;168(4):189-91. [Medline].

  3. Cunningham MJ, Zone JJ, Petersen MJ, Green JA. Circulating activated (DR-positive) T lymphocytes in a patient with autoeczematization. J Am Acad Dermatol. Jun 1986;14(6):1039-41. [Medline].

  4. Kasteler JS, Petersen MJ, Vance JE, Zone JJ. Circulating activated T lymphocytes in autoeczematization. Arch Dermatol. Jun 1992;128(6):795-8. [Medline].

  5. 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].

  6. Atzori L, Pau M, Aste M. Erythema multiforme ID reaction in atypical dermatophytosis: a case report. J Eur Acad Dermatol Venereol. Nov 2003;17(6):699-701. [Medline].

  7. 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. Feb 2003;48(2 Suppl):S5-6. [Medline].

  8. Choudhri SH, Magro CM, Crowson AN, Nicolle LE. An Id reaction to Mycobacterium leprae: first documented case. Cutis. Oct 1994;54(4):282-6. [Medline].

  9. Morrison JG, Fourie ED. The papulonecrotic tuberculide. From Arthus reaction to lupus vulgaris. Br J Dermatol. Sep 1974;91(3):263-70. [Medline].

  10. Ackerman AB, Chongchitnant N, Sanchez J, et al. Allergic contact dermatitis/nummular dermatitis/dyshidrotic dermatitis/id reaction. In: Histologic Diagnosis of Inflammatory Skin Diseases. Baltimore, Md: Williams & Wilkins; 1997:184-6.

  11. Belsito DV. Autosensitization dermatitis. In: Freedberg M, Eisen AZ, Wolff K, et al, eds. Fitzpatrick's Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999:1462-4.

  12. Brenner S, Wolf R, Landau M. Scabid: an unusual id reaction to scabies. Int J Dermatol. Feb 1993;32(2):128-9. [Medline].

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  14. Elder DE, Elenitsas R, Jaworsky C, et al. Noninfectious vesiculobullous and vesiculopustular diseases. In: Lever's Histopathology of the Skin. Philadelphia, Pa: Lippincott-Raven; 1997:214.

  15. Freedberg IM, Eisen AZ, Wolff K, et al. Superficial fungal infection. In: Fitzpatrick's Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999:2340-1.

  16. Fritsch P, Reider N. Eczematous Group. In: Bolognia JL, Jorizzo J, Rapini R, eds. Dermatology. Vol 1. Mo: Mosby: St. Louis; 2003:221-2.

  17. Gonzalez-Amaro R, Baranda L, Abud-Mendoza C, Delgado SP, Moncada B. Autoeczematization is associated with abnormal immune recognition of autologous skin antigens. J Am Acad Dermatol. Jan 1993;28(1):56-60. [Medline].

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  23. Lu LK, Dunnick CA. Navel history. Am J Med. Mar 2006;119(3):241-3. [Medline].

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  25. Suwattee P, Warshaw EM. Self-Assessment examination of the American Academy of Dermatology-Generalized itchy eruption. J Am Acad Dermatol. 2006;55(5):923-5.

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Further Reading

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Keywords

Id reaction, autoeczematization, autosensitization, pruritic rash, dermatophytids, dermatophytid reactions, dermatophyte infections, stasis dermatitis

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Contributor Information and Disclosures

Author

Matthew P Evans, MD, Dermatology, Dreyer Medical Group
Matthew P Evans, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Darryl Bronson, MD, MPH, Chairman, Program Director, Division of Dermatology, Department of Medicine, Cook County Hospital of Chicago; Professor, Departments of Dermatology and Pathology, 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, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Donald Belsito, MD, Clinical Professor, Department of Internal Medicine, Division of Dermatology, University of Missouri at Kansas City; Private Practice, American Dermatology Associates, LLC
Donald Belsito, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, Kansas Medical Society, Noah Worcester Dermatological Society, Phi Beta Kappa, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, 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, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Genetech Honoraria Consulting; Celgene Honoraria Consulting

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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