Acute generalized exanthematous pustulosis

Acute generalized exanthematous pustulosis (AGEP) is a rare skin condition characterized by the rapid onset of widespread pustules on an erythematous background, accompanied by fever, leukocytosis, and neutrophilia. It is most commonly triggered by medications, particularly antibiotics and calcium channel blockers, but can also be caused by viral infections or mercury exposure.

Etiology

The exact cause of AGEP is not fully understood, but it is believed to be a hypersensitivity reaction to certain medications or infections. The most common drugs associated with AGEP are aminopenicillins, macrolides, and quinolones. Other potential triggers include antifungal drugs, antimalarial drugs, terbinafine, and diltiazem. In some cases, AGEP can be triggered by a viral infection or exposure to mercury.

Clinical Presentation

Patients with AGEP typically present with a sudden onset of numerous small, non-follicular pustules on an erythematous background. The rash usually begins in the folds of the skin and then spreads to the rest of the body. Other symptoms may include fever, malaise, and leukocytosis. In severe cases, patients may develop systemic symptoms such as hepatitis, nephritis, or acute respiratory distress syndrome (ARDS).

Diagnosis

Diagnosis of AGEP is primarily based on clinical presentation and history of drug exposure. Skin biopsy may be performed to confirm the diagnosis. The histological findings typically show subcorneal and intraepidermal pustules, edema of the papillary dermis, and a dense infiltrate of neutrophils.

Treatment

The primary treatment for AGEP is discontinuation of the offending drug. Supportive care, including hydration and fever control, is also important. In severe cases, systemic corticosteroids may be used. The prognosis for AGEP is generally good, with most patients recovering within two weeks of discontinuing the offending drug.

See Also

• Pustular psoriasis
• Drug eruption
• Stevens-Johnson syndrome
• Toxic epidermal necrolysis