- Acute-onset fever & generalized scarlatiniform erythema.
- Associated with many small, sterile, nonfollicular pustules (small blisters filled with white/yellow fluid).
- Typically the rash starts on the face or in the armpits & groin - later becoming more widespread.
- The onset of AGEP is usually within 2 days of exposure to the responsible medication.
- AGEP is more common in patients who have a personal or family history of psoriasis.
- AGEP may have a presentation similar with generalised pustular psoriasis or subcorneal pustular dermatosis.
- AGEP is less serious than these conditions, has more marked hyperleukocytosis with neutrophilia & eosinophilia, & clears up much more quickly.
- Most cases are caused by drugs (primarily antibiotics) often in the first few days of administration.
- Most common drugs are beta-lactam antibiotics, macrolides, & mercury
- Some cases caused by viral infections, mercury exposure, or UV radiation.
- Viral infections - Epstein-Barr virus & cytomegalovirus.
- Spider bites have also been implicated in some cases.
- A - acetaminophen, ACE inhibitors (eg, captopril, ramipril), allopurinol
- B - bufexamac, buphenine
- C - calcium channel blockers, carbamazepine, carbutamide, celecoxib, chloramphenicol, clindamycin, co-trimoxazole, clobazam, cyclins (eg, tetracycline), cytarabine
- D - diltiazem
- F - famotidine, furosemide
- G - gemfibrozil, ginkgo biloba, glyburide
- H - hydrochlorothiazide, hydroxychloroquine
- I - ibuprofen, imatinib, imipenem, isoniazid, IV contrast dye
- L - lopinavir-ritonavir
- M - mexiletine, morphine
- N - nadoxolol, nifedipine, nystatin
- O - olanzapine
- P - phenytoin, pipemidic acid, piperazine, pseudoephedrine, pyrimethamine
- Q - quinidine
- R - ranitidine, rifampicin
- S - salbutiamine, sertraline, simvastatin, streptomycin
- T - terbinafine, thallium
- V - vancomycin
- FBC - increased neutrophils are usually found.
- Skin Biopsy - subcorneal pustules filled with neutrophils.
- Patch Testing - may be helpful to determine allergy. [2]
Prognosis:
References:
- AGEP typically resolves spontaneously & rapidly.
- Fever & pustules lasting ~ 7-10 days followed by desquamation over a few days.
- Most important to stop exposure to the provoking agent.
- Symptomatic relief - analgesics, moisturisers, topical corticosteroids, oral antihistamines.
- 1 - Thakor P, Padmanabhan M, Johnson A, Pararajasingam T, Thakor S, Jorgensen W. Ramipril-induced generalized pustular psoriasis: case report and literature review. Available at http://www.ncbi.nlm.nih.gov/sites/entrez/19531936.
- 2 - Barbaud A. Drug patch testing in systemic cutaneous drug allergy. Toxicology. Apr 15 2005;209(2):209-16.
- "Drug Eruptions" eMedicine (link)
Tags: AGEP - Drug Eruption - Exanthem - Fever - Patch Testing - Pustular Psoriasis - Pustules - Pustulosis
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Posted by Medicalchemy
Medicalchemy Group: History of Medicine - Images - Mnemonics - Syndromes - Acute Medicine - Anaesthesiology - Anatomy - Anthropology - Biochemistry - Cardiology - Dentistry - Dermatology - Drugs - Emergency Medicine - Endocrinology - Family Medicine - Forensic Medicine - Gastroenterology - Genes - Genetics - Geriatrics - Gynecology - Haematology - Health Informatics - Hepatology - Immunology - Infection - Intensive Care - Medical Education - Metabolic Medicine - Microbiology - Nephrology - Neuroanatomy - Neuroscience - Nuclear Medicine - Nutrition - Obstetrics - Occupational Health - Oncology - Ophthalmology - Orthopaedics - Otolaryngology - Paediatrics - Palliative Care - Parasitology - Pathology - Pharmacology - Physiology - Proteomics - Psychiatry - Public Health - Radiology - Respiratory - Rehabilitation - Rheumatology - Sports Medicine - Surgery - Toxicology - Tropical Medicine - Urology - Vascular - Virology.
