Acute generalized exanthematous pustulosis



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


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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.




Table 8.2


Drugs and other substances reported to have caused AGEP










































































































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
Antifungals
Amphotericin, fluconazole, itraconazole, nystatin, terbinafine
Antivirals
Lamivudine, lopinavir, ritonavir, zidovudine
Anti-TB drugs
Isoniazid, rifampicin
Proton pump inhibitors
Lansoprazole, omeprazole
Immunosuppressants
Azathioprine
Calcium channel blockers
Diltiazem
Antidepressants
Amoxapine, sertraline
Antihistamines
Clemastine, hydroxyzine
Beta agonists
Buphenine, fenoterol, nadolol
H2 receptor antagonists
Cimetidine, famotidine, ranitidine
Corticosteroids
Dexamethasone, methylprednisolone, prednisolone
Diuretics
Furosemide, hydrochlorothiazide
Anti-neoplastic drugs
Gefitinib, imatinib
Other drugs
Acetazolamide, allopurinol, bleomycin, carbimazole, cytarabine, disulfiram, eperisone hydrochloride, eprazinone, fluindione, icodextrin, interferon, metamizole, pentoxifylline, piperazine, bamifylline, propafenone, aprostadil, pseudoephidrine, psoralen + UVA, quinidine, salbutiamine, senna, simvastatin, sulfasalazine, terazosin, thalidomide, cadralazine, progestogens, dalteparin, carbutamide
Other substances

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Aug 7, 2016 | Posted by in Dermatology | Comments Off on Acute generalized exanthematous pustulosis

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