Faculty Opinions recommendation of The histopathological spectrum of acute generalized exanthematous pustulosis (AGEP) and its differentiation from generalized pustular psoriasis.

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.

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Generalized Pustular Psoriasis in an Adolescent Treated with Cyclosporine: A Diagnostic and Therapeutic Challenge

SKIN The Journal of Cutaneous Medicine ◽

10.25251/skin.3.6.16 ◽

2019 ◽

Vol 3 (6) ◽

pp. 447-451

Author(s):

Roya S. Nazarian ◽

John Nia ◽

Nikki Vyas ◽

Garrett Desman ◽

Lauren Geller

Keyword(s):

Cyclosporine A ◽

Pediatric Population ◽

Treatment Options ◽

Pustular Psoriasis ◽

Therapeutic Challenge ◽

Childhood Disease ◽

Acute Generalized Exanthematous Pustulosis ◽

Generalized Pustular Psoriasis ◽

Proper Diagnosis ◽

Exanthematous Pustulosis

Generalized pustular psoriasis (GPP) is rare in the pediatric population, accounting for only 0.5-0.6% of psoriasis cases in children. This presents a diagnostic and therapeutic challenge, and often requires a biopsy to differentiate GPP from similar entities such as acute generalized exanthematous pustulosis, though controversy exists regarding the histologic distinction between the two. We describe a case of GPP in a 15-year-old male presenting with widespread pustular and bullous lesions, fever, and vital instability. The patient was diagnosed with GPP and successfully treated with cyclosporine 3mg/kg/day. He remains in remission on 25 mg acitretin daily. We present this case to highlight available treatment options for GPP in the pediatric population, and to underscore key clinical and histologic findings to aid dermatologists in proper diagnosis and management of this rare childhood disease.

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Steroid-resistant Acute Generalized Exanthematous Pustulosis Mimicking Generalized Pustular Psoriasis Successfully Treated by Methotrexate

Revista da Sociedade Portuguesa de Dermatologia e Venereologia ◽

10.29021/spdv.79.3.1327 ◽

2021 ◽

Vol 79 (3) ◽

pp. 257-260

Author(s):

Khairuddin Djawad

Keyword(s):

Inflammatory Cell ◽

Pustular Psoriasis ◽

Clinical Form ◽

Drug Induced ◽

Laboratory Findings ◽

Steroid Resistant ◽

Pustular Eruption ◽

Acute Generalized Exanthematous Pustulosis ◽

Generalized Pustular Psoriasis ◽

Exanthematous Pustulosis

Acute generalized exanthematous pustulosis is a rare drug-induced eruption that is characterized by sterile non-follicular pustules arising on an often edematous diffuse erythematous background. Generalized pustular psoriasis is an acute and severe clinical form of psoriasis presenting as pustular eruption with erythematous base. Differentiating both diseases is often challenging because of their clinical and histopathological similarities. A 62-year-old woman presented with pustular eruption and fever three days after taking propyphenazone. Laboratory findings revealed leukocytosis and neutrophilia. Histopathological findings revealed a subcorneal spongiform pustule filled with neutrophils and perivascular inflammatory cell infiltration with neutrophils in the dermis. She was initially treated with systemic steroids, however, the lesions showed insignificant improvement. Treatment was then shifted to methotrexate which resulted in a dramatic clinical improvement.

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Immunohistochemical Comparison of IL-36 and the IL-23/Th17 Axis of Generalized Pustular Psoriasis and Acute Generalized Exanthematous Pustulosis

Annals of Dermatology ◽

10.5021/ad.2016.28.4.451 ◽

2016 ◽

Vol 28 (4) ◽

pp. 451 ◽

Cited By ~ 15

Author(s):

Hyo Sang Song ◽

Sang Jin Kim ◽

Tae-In Park ◽

Yong Hyun Jang ◽

Eun-So Lee

Keyword(s):

Pustular Psoriasis ◽

Acute Generalized Exanthematous Pustulosis ◽

Generalized Pustular Psoriasis ◽

Exanthematous Pustulosis

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Acute generalized exanthematous pustulosis (AGEP). Case report

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652005000300011 ◽

2005 ◽

Vol 47 (3) ◽

pp. 171-176 ◽

Cited By ~ 15

Author(s):

Walter Belda Junior ◽

Ana Carolina Junqueira Ferolla

Keyword(s):

Antidepressant Drugs ◽

Corticosteroid Treatment ◽

Beta Lactam ◽

Drug Induced ◽

Acute Generalized Exanthematous Pustulosis ◽

Outpatient Unit ◽

Similar Drug ◽

Generalized Pustular Psoriasis ◽

Inflammatory Drugs ◽

Exanthematous Pustulosis

Acute Generalized Exanthematous Pustulosis (AGEP) is a drug-induced dermatosis characterized by an acute episode of sterile pustules over erythematous-edematous skin. It is accompanied by an episode of fever, which regresses a few days after discontinuation of the drug that caused the condition or as a result of corticosteroid treatment. The main triggering drugs are antibiotics, mainly beta-lactam ones. Other medications, such as antifungal agents, non steroid anti-inflammatory drugs, analgesics, antiarrhythmic, anticonvulsant and antidepressant drugs, may also be responsible. Histologically, it is characterized by the existence of vasculitis, associated with non-follicular subcorneal pustules. A case of a Caucasian female outpatient unit of Dermatology with AGEP, who presented with generalized pustulosis lesions after the use of cephalosporin for urinary infection is related. The diagnosis was confirmed by the clinical and pathological correlations, the resolution of the dermatosis after discontinuation of the drug and use of systemic corticosteroid treatment, and the recurrence of the disorder after the introduction of a similar drug. The importance of the recognition of this drug-induced dermatosis is given by its main differential clinical and histological diagnoses: generalized pustular psoriasis and subcorneal pustulosis.

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

Case Reports in Dermatological Medicine ◽

10.1155/2015/421765 ◽

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.

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