Acute generalized exanthematous pustulosis

Published on 16/03/2015 by admin

Filed under Dermatology

Last modified 16/03/2015

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 3293 times

Acute generalized exanthematous pustulosis

Aysha Javed and Ian Coulson

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

Acute generalized exanthematous pustulosis (AGEP) is characterized by the acute onset of numerous small, non-follicular, sterile pustules arising on a diffuse erythematous base in a febrile patient with an accompanying blood neutrophilia. The majority of cases occur in the context of drug ingestion (commonly within 24 hours). Rapid resolution following drug withdrawal is the usual outcome.

Management strategy

Treatment of AGEP involves establishing the correct diagnosis (Table 8.1) coupled with the withdrawal of any implicated medication (Table 8.2). Pustular psoriasis is its main differential diagnosis. A comprehensive drug history and a personal or family history of psoriasis is therefore required.

image

(From Roujeau, et al., 1991. Arch Dermatol 127, 1333–1338.)

Table 8.2

Drugs and other substances reported to have caused AGEP

Buy Membership for Dermatology Category to continue reading. Learn more here
Drugs
Antibiotics
NSAIDs
Celecoxib, etoricoxib, ibuprofen, naproxen, nimesulide, valdecoxib
ACE inhibitors
Captopril, enalapril
Calcium channel blockers
Nifedipine, nimodipine
Anticonvulsants
Carbamazepine, phenobarbital, phenytoin
Analgesia (opioid/non-opioid)
Acetaminophen, paracetamol, morphine, codeine, dextropropoxyphene
Anti-platelets
Aspirin, ticlopidine, clopidogrel
Benzodiazepines
Clobazam, nitrazepam, tetrazepam
Antimalarials
Chloroquine, hydroxychloroquine, proguanil, pyrimethamine
Antipsychotics
Clozapine, chlorpromazine