scholarly journals Pustular Psoriasis and Acute Generalized Exanthematous Pustulosis

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1004
Author(s):  
Morgan Sussman ◽  
Anthony Napodano ◽  
Simo Huang ◽  
Abhirup Are ◽  
Sylvia Hsu ◽  
...  
Keyword(s):  
Adverse Reaction ◽  
Clinical Course ◽  
Pustular Psoriasis ◽  
Topical Steroids ◽  
Inflammatory Disorder ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Cutaneous Adverse Reaction ◽  
History Of ◽  
Exanthematous Pustulosis ◽  
Crucial Part

The similarity between pustular psoriasis (PP) and acute generalized exanthematous pustulosis (AGEP) poses problems in the diagnosis and treatment of these two conditions. Significant clinical and histopathologic overlap exists between PP and AGEP. PP is an inflammatory disorder that has numerous clinical subtypes, but all with sterile pustules composed of neutrophils. AGEP is a severe cutaneous adverse reaction that is also characterized by non-follicular sterile pustules. Clinical features that suggest a diagnosis of PP over AGEP include a history of psoriasis and the presence of scaling plaques. Histologically, eosinophilic spongiosis, vacuolar interface dermatitis, and dermal eosinophilia favor a diagnosis of AGEP over PP. Importantly, PP and AGEP vary in clinical course and treatment. PP treatment involves topical steroids, oral retinoids, and systemic immunosuppressants. Newer therapies targeting IL-36, IL-23, IL-1, and PDE-4 have been investigated. The removal of the offending agent is a crucial part of the treatment of AGEP.

scholarly journals Rapid Involution of Pustules during Topical Steroid Treatment of Acute Generalized Exanthematous Pustulosis

2017 ◽  
Vol 9 (1) ◽  
pp. 135-139 ◽  
Author(s):  
Christiane Kley ◽  
Carla Murer ◽  
Julia-Tatjana Maul ◽  
Barbara Meier ◽  
Florian Anzengruber ◽  
...  
Keyword(s):  
Topical Steroid ◽  
Steroid Treatment ◽  
Clobetasol Propionate ◽  
Topical Steroids ◽  
First Line ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Cutaneous Adverse Reaction ◽  
Amoxicillin Clavulanic Acid ◽  
Diffuse Erythema ◽  
Exanthematous Pustulosis

Acute generalized exanthematous pustulosis (AGEP) is a dramatic generalized pustular rash of severe onset, which is considered a serious cutaneous adverse reaction to drugs. However, even though the clinical features are impressive and are often accompanied by systemic inflammation, it can be controlled quickly and safely by topical steroids subsequent to interruption of the offending drug. Here, we describe the management of a case and the evolution of the pustular rash. An elderly woman consulted with a generalized crop of 2–3 mm, nonfollicular pustules on erythematous background. In the 4 preceding weeks, she had been using amoxicillin/clavulanic acid for a bacterial implant infection and rivaroxaban. The clinical EuroSCAR criteria including the histology confirmed AGEP. Her medication was stopped and topical clobetasol propionate was used. Within 24 h, the development of new pustules ceased and the patient was discharged after 7 days of hospitalization with only a faint, diffuse erythema and focal desquamation remaining. This and many other cases in the literature suggest that topical steroids should be considered as a first-line treatment option, especially as systemic steroids themselves can sometimes induce generalized pustulosis.

scholarly journals A Case of Ceftriaxone-Induced Acute Generalized Exanthematous Pustulosis/Generalized Pustular Psoriasis Overlap

2018 ◽  
Vol 10 (1) ◽  
pp. 69-75 ◽  
Author(s):  
Jianfeng Zheng ◽  
Yunlu Gao ◽  
Xuemei Yi ◽  
Yangfeng Ding
Keyword(s):  
Pustular Psoriasis ◽  
Whole Body ◽  
Complete Regression ◽  
Clinical Form ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Plaque Type ◽  
Generalized Pustular Psoriasis ◽  
History Of ◽  
Exanthematous Pustulosis ◽  
Missense Substitution

Acute generalized exanthematous pustulosis, characterized by subcorneal or superficial intraepidermal pustules, is induced by drugs in more than 90% of cases. Psoriasis is an autoimmune disease triggered by different conditions in genetically susceptible people. Generalized pustular psoriasis is an acute and severe clinical form of psoriasis, which usually occurs in patients with psoriasis undergoing aggravating factors. In this report the authors have reported a 40-year-old male patient with primary syphilis who developed generalized pustular dermatosis after the use of ceftriaxone. On the third day after ceftriaxone treatment, complete regression of the syphilis lesions was reached. While on the sixth day, erythematous pustular lesions accompanied with fever were observed on the whole body. A personal history of psoriasis and histopathological findings with psoriasiform changes and subcorneal pustule favored the diagnosis. After discontinuation of ceftriaxone, the patient’s condition slowly improved until he had plaque-type psoriasis 3 weeks later. A heterozygous c.115 + 6T>C missense substitution of IL36RN related to the pathogenesis of acute generalized exanthematous pustulosis/generalized pustular psoriasis was identified.

Acute Generalized Exanthematous Pustulosis in a Patient after Stem Cell Transplantation

2010 ◽  
Vol 14 (4) ◽  
pp. 181-184
Author(s):  
Petra Cetkovská ◽  
Nina Benáková
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem ◽  
Pustular Eruption ◽  
Immune Alteration ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Cutaneous Adverse Reaction ◽  
History Of ◽  
Exanthematous Pustulosis

Background: A severe generalized pustular eruption occurred several months after allogeneic hematopoietic stem cell transplantation for multiple myeloma in a patient being treated with antibiotics for respiratory infection. Neither he nor his donor had a history of psoriasis. Methods: The patient was treated with drug withdrawal and administration of cyclosporine and methylprednisolone without improvement; later, acitretin and methylprednisolone were used successfully. The eruption slowly subsided, and therapy was discontinued. Four months later, the patient experienced a recurrent severe pustular eruption associated with fever and leukocytosis, and the same treatment was used successfully again. Results and Conclusion: The patient has not experienced relapses in the ensuing 3 years. Acute generalized exanthematous pustulosis is a rare cutaneous adverse reaction triggered most commonly by drugs with a tendency to resolve spontaneously. The surprisingly prolonged, refractory, and relapsing course of the eruption in our patient might be due to the immune alteration and the polypharmacologic therapy after stem cell transplantation. Antécédents: Une éruption pustulaire généralisée aiguë s'est produite chez un patient traité aux antibiotiques contre une infection respiratoire, plusieurs mois après une allogreffe de cellules souches hématopoïétiques pour myélome multiple. Ni le patient ni le donneur n'ont des antécédents de psoriasis.

scholarly journals Piperacillin/Tazobactam as Cause of Acute Generalized Exanthematous Pustulosis

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Aikaterini Kyriakou ◽  
Sofia-Chrysovalantou Zagalioti ◽  
Aikaterini Patsatsi ◽  
Nikiforos Galanis ◽  
Elizabeth Lazaridou
Keyword(s):  
Adverse Reaction ◽  
Laboratory Tests ◽  
Groin Pain ◽  
Metastatic Breast ◽  
Intravenous Therapy ◽  
E Coli ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Cutaneous Adverse Reaction ◽  
Severe Infections ◽  
Exanthematous Pustulosis

Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous adverse reaction mainly attributed to antibiotics. It is characterized by numerous, nonfollicular, sterile pustules, arising on an exanthematous and edematous base. It is a serious adverse reaction accompanied by fever and leukocytosis. Piperacillin/tazobactam is indicated for the treatment of patients with moderate to severe infections. Herein is reported a case of AGEP caused by piperacillin/tazobactam. A 78-year-old woman with metastatic breast cancer was presented to the emergency department reporting fever and groin pain. The laboratory analysis and more specifically urine cultivation showed a urinary tract infection by E. coli with sensitivity to piperacillin/tazobactam. She had no known allergies. She was started on intravenous piperacillin/tazobactam; she improved clinically on the second day, but on the fourth day of intravenous therapy, she developed extensive pustular rash on the folds and anterior proximal thighs, accompanied by fever and neutrophilia. Piperacillin/tazobactam administration was interrupted and she was given prednisolone for ten days. The patient improved clinically and her laboratory tests returned to normal after two weeks. AGEP is an uncommon side effect of piperacillin/tazobactam treatment and there are few cases reported.

scholarly journals PHẢN ỨNG DA NẶNG DO THUỐC

2020 ◽  
Vol 4 (6) ◽  
Author(s):  
Nguyen Van Khiem ◽  
Le Thi Minh Huong
Keyword(s):  
Adverse Reaction ◽  
Drug Reaction ◽  
Toxic Epidermal Necrolysis ◽  
Drug Eruption ◽  
Fixed Drug Eruption ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Cutaneous Adverse Reaction ◽  
Fixed Drug ◽  
Exanthematous Pustulosis

Phản ứng da nặng (Severe Cutaneous Adverse Reaction, SCAR) do thuốc là một nhóm các phản ứng dị ứng thuốc gây tổn thương nghiêm trọng đến da và niêm mạc, trong những trường hợp nặng có thể ảnh hưởng đến các cơ quan nội tạng, thậm chí gây tử vong. Ngoài thuốc, một số tác nhân nhiễm trùng như Mycoplasma pneumoniacũng có thể gây ra SCAR, đặc biệt ở trẻ em. Trong bài này, xin được tập trung vào SCAR do thuốc. SCAR bao gồm các hội chứng sau: Hội chứng Steven – Johnson (SJS) Hội chứng hoạt tử thượng bì nhiễm độc (Toxic Epidermal Necrolysis, TEN, trước đây còn được gọi là hội chứng Lyell) Hội chứng chuyển tiếp giữa SJS và TEN (SJS/TEN overlap) Hội chứng phản ứng với thuốc có triệu chứng toàn thân và tăng bạch cầu ái toan (Drug Reaction with Eosinophilia and Systemic Symtoms, DRESS). Ban mụn mủ toàn thân cấp tính (Acute Generalized Exanthematous Pustulosis, AGEP). Gần đây, phát ban cố định do thuốc thể bọng nước lan tỏa (Generalized Bullous Fixed Drug Eruption, GBFDE) cũng được một số bác sĩ xếp vào SCAR. Tuy nhiên GBFDE thường ít nguy hiểm hơn cũng như rất hiếm gặp ở trẻ em. Trong các hội chứng trên, SJS, TEN và hội chứng chuyển tiếp SJS/TEN được cho là cùng một bệnh với các mức độ nặng khác nhau. Trong bài này, chúng được kí hiệu chung là SJS-TEN

scholarly journals An Uncommon Side Effect of Bupropion: A Case of Acute Generalized Exanthematous Pustulosis

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Hasan Tak ◽  
Cengiz Koçak ◽  
Gülben Sarıcı ◽  
Nazlı Dizen Namdar ◽  
Mehtap Kıdır
Keyword(s):  
Smoking Cessation ◽  
Side Effect ◽  
Pustular Psoriasis ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Inflammatory Dermatosis ◽  
Rare Side Effect ◽  
Erythematous Skin ◽  
Exanthematous Pustulosis

Acute generalized exanthematous pustulosis (AGEP) is a rare inflammatory dermatosis characterized by multiple nonfollicular pustules that occur on erythematous skin. Despite its similarity to pustular psoriasis and association with fever and leukocytosis, AGEP typically heals quickly. Etiologically, drugs and viruses have been suspected in most cases. Here, we present a case of AGEP, in a woman, that developed 1 day after starting bupropion for smoking cessation, as a rare side effect of the treatment.

scholarly journals The Confusion between Pustular Psoriasis and Acute Generalized Exanthematous Pustulosis as a Cause of Exfoliative Dermatitis: A Case Report

2021 ◽  
Vol 33 (3) ◽  
pp. 224
Author(s):  
Desiana Widityaning Sari ◽  
Cita Rosita Sigit Prakoeswa ◽  
Damayanti Damayanti ◽  
Sylvia Anggraeni ◽  
Menul Ayu Umborowati ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Clinical Manifestations ◽  
Clinical Findings ◽  
Pustular Psoriasis ◽  
History Taking ◽  
Exfoliative Dermatitis ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Physical Examinations ◽  
Erythematous Skin ◽  
Exanthematous Pustulosis

Background: Pustular psoriasis and Acute Generalized Exanthematous Pustulosis (AGEP) are grouped under pustular diseases, in which their clinical manifestations are similar. Those diseases can lead to exfoliative dermatitis. Purpose:To evaluate a specific histopathological examination in differentiating Pustular Psoriasis and AGEP. Case: A 55-year-old woman presented with sudden redness and diffused scaly skin with multiple pustules and also fever. She had taken Cefadroxil 2 days before the scales and pustules appeared. Leukocytosis and histopathological examination results from biopsy supported the diagnosis of AGEP. The patient was then hospitalized and received steroid therapy. Within the first week of tapering off, the scales disappeared but the pustules increased. After such clinical findings, the histopathological examination results were revisited and reassessed. Thus, we considered changing the diagnosis to Pustular Psoriasis, and the therapy was switched to Methotrexate. The patient had a better outcome, and the pustules slowly disappeared entirely. Discussion: It is often difficult to differentiate between the pustules in pustular psoriasis and AGEP unless by thorough history-taking and physical examinations. AGEP is characterized by a widespread of pustules with an acute febrile onset; while pustular psoriasis is an acute variant of psoriasis where pustules are spread over erythematous skin and accompanied by high fever and leukocytosis. Conclusion: Histopathological examination is the gold standard for the establishment of pustular psoriasis diagnosis. The histopathological characteristics of pustular psoriasis and AGEP are difficult to differentiate. Therefore, we need detailed history-taking and physical examination to establish the diagnosis.

scholarly journals Histopathologic interpersonal overview of generalized pustular cutaneous reaction to Hydroxychloroquine (HCQ): New challenging clinical manifestation

2021 ◽  
Vol 15 (6) ◽  
pp. 2102-2106
Author(s):  
Alireza Ghanadan ◽  
Zahra Naraghi ◽  
Kambiz Kamyab- Hesari ◽  
Azita Nikoo ◽  
Zahra Halaji ◽  
...  
Keyword(s):  
Clinical Judgment ◽  
Lymphocytic Infiltration ◽  
Final Diagnosis ◽  
Pustular Psoriasis ◽  
Cutaneous Eruption ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Clinical Presentations ◽  
Diagnostic Report ◽  
Exanthematous Pustulosis ◽  
Pathology Review

Background: Pathologic examination of Acute Generalized Exanthematous Pustulosis (AGEP) and Pustular Psoriasis (PP) are similar. We encountered many patients with PP or AGEP who cannot be distinguished clinically, pathologically and based on disease course from each so we designed a comprehensive interpersonal histopathologic overview of these patients' samples. Method: Histopathological data of 16 patients over 3.5 years were analyzed. Four pathologists separately reviewed specimens based on eighteen criteria (9 Epidermal and 9 Dermal). Severity score for each criterion was considered as to be (0 to 3+). We compared the final pathologic diagnosis with primary one. Results: Neutrophilic and lymphocytic infiltration in dermis were seen in all cases of AGEP while intraepithelial pustules. Subcorneal and intraepithelial pustules, spongiosis, neutrophilic exocytosis, neutrophilic and lymphocytic infiltration in dermis were observed in all cases of PP. The most severe neutrophilic inflammation; acanthosis and neutrophilic or lymphocytic infiltration were seen in PP. The authors of this study have been reported generalized pustular clinical presentations of patients have been taken HCQ, and in the recent pandemic it is also one of the concerns that many studies have been focused (....). Conclusion: When primary histopathologic report is AGEP/PP overlap, clinical judgment is the best way to manage and it is more probable that the final diagnosis being PP. When only AGEP or PP is histopathologic diagnostic report, it is usually enough to make final diagnosis and appropriate management. Key words: hydroxychloroquine, HCQ, generalized pustular cutaneous eruption, Pustular Psoriasis (PP), Acute Generalized Exanthematous Pustulosism, AGEP, Histopathological overview, pathology, review

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