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Hung SI, Mockenhaupt M, Blumenthal KG, Abe R, Ueta M, Ingen-Housz-Oro S, Phillips EJ, Chung WH. Severe cutaneous adverse reactions. Nat Rev Dis Primers 2024; 10:30. [PMID: 38664435 DOI: 10.1038/s41572-024-00514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 06/15/2024]
Abstract
Severe cutaneous adverse reactions (SCARs), which include Stevens-Johnson syndrome and toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (also known as drug-induced hypersensitivity syndrome), acute generalized exanthematous pustulosis, and generalized bullous fixed drug eruption, are life-threatening conditions. The pathogenesis of SCARs involves T cell receptors recognizing drug antigens presented by human leukocyte antigens, triggering the activation of distinct T cell subsets. These cells interact with keratinocytes and various immune cells, orchestrating cutaneous lesions and systemic manifestations. Genetic predisposition, impaired drug metabolism, viral reactivation or infections, and heterologous immunity influence SCAR development and clinical presentation. Specific genetic associations with distinct SCAR phenotypes have been identified, leading to the implementation of genetic screening before prescription in various countries to prevent SCARs. Whilst systemic corticosteroids and conventional immunomodulators have been the primary therapeutic agents, evolving strategies, including biologics and small molecules targeting tumour necrosis factor, different cytokines, or Janus kinase signalling pathways, signify a shift towards a precision management paradigm that considers individual clinical presentations.
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Affiliation(s)
- Shuen-Iu Hung
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Department of Medical Research, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department and Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Maja Mockenhaupt
- Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, Medical Center and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Riichiro Abe
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Mayumi Ueta
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Saskia Ingen-Housz-Oro
- Dermatology Department, AP-HP, Henri Mondor Hospital, Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Université Paris Est Créteil EpiDermE, Créteil, France
| | - Elizabeth J Phillips
- Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei/Linkou branches, and Chang Gung University, Taoyuan, Taiwan.
- Department of Dermatology, Chang Gung Memorial Hospital, Xiamen branch, Xiamen, China.
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Luo F, Yuan XM, Xiong H, Yang YZ, Chen CM, Ma WK, Yao XM. Clinical features of acute generalized exanthematous pustulosis caused by hydroxychloroquine in rheumatology patients and exploration of CARD14 gene mutations. Front Med (Lausanne) 2023; 10:1161837. [PMID: 37089611 PMCID: PMC10117770 DOI: 10.3389/fmed.2023.1161837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/20/2023] [Indexed: 04/09/2023] Open
Abstract
IntroductionAcute generalized exanthematous pustulosis (AGEP) is a rare condition characterized by superficial pustules following drug ingestion or infection. Currently, there is no clear link between rheumatism and AGEP. It has been described that hydroxychloroquine (HCQ) is a rare cause of acute generalized epidermal necrolysis (AGEP). Presently, there are limited studies on HCQ-induced AGEP. We aimed to explore the clinical features and associated gene expression of AGEP induced after HCQ treatment exposure in rheumatology patients.MethodsWe assessed patients with HCQ-induced AGEP diagnosed at the Second Affiliated Hospital of Guizhou University of Chinese Medicine between January 1, 2017, and May 1, 2022. We also reviewed similar cases reported in specific databases.ResultsThe study included five females (mean age, 40.2 years), and the mean time from initiation of HCQ treatment to symptom onset was 12.2 d. All patients received steroids and allergy medications after HCQ discontinuation, and the rash completely resolved within an average of 25.2 d. We performed whole exome sequencing and Sanger validation in our patient sample. CARD14 gene mutations were detected in three patients. Additionally, seven mutation sites were detected.DiscussionHCQ-induced AGEP may have a longer latency period and regression time than AGEP induced by other drugs. Our patients all experienced CARD14 gene mutations. AGEP often resolves with topical therapy and drug discontinuation, although some cases require systemic steroid therapy. In the future, patients with rheumatism should pay attention to the effectiveness of HCQ during treatment and be aware of the associated skin toxicity.
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Affiliation(s)
- Feng Luo
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Xue-mei Yuan
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Hong Xiong
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Yu-zheng Yang
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Chang-ming Chen
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Guizhou University of Chinese Medicine, Guiyang, China
| | - Wu-kai Ma
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang, China
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Guizhou University of Chinese Medicine, Guiyang, China
| | - Xue-ming Yao
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang, China
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Guizhou University of Chinese Medicine, Guiyang, China
- *Correspondence: Xue-ming Yao,
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Drug Triggers and Clinic of Acute Generalized Exanthematous Pustulosis (AGEP): A Literature Case Series of 297 Patients. J Clin Med 2022; 11:jcm11020397. [PMID: 35054090 PMCID: PMC8780223 DOI: 10.3390/jcm11020397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 12/20/2022] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a rare skin reaction, commonly caused by drugs. Available evidence mostly relies on small studies or case reports. We collected published AGEP case reports and, subsequently, described the patient characteristics, suspect and concomitant drugs, time to onset, disease management, and clinical prognosis. This study included 297 AGEP patients (64.3% women) obtained from 250 published case reports or case series with individual patient data. AGEP affected patients of all ages, but the majority of patients (88.2%) were ≥25 years old. The most frequently reported suspect drugs were anti-infectives for systemic use (36.5%), particularly antibacterials for systemic use (31.0%), and especially beta-lactam antibacterials (18.3%) and macrolides (4.3%). Other frequent suspect drugs were antineoplastics (12.2%), and anti-inflammatory/anti-rheumatic products (5.2%) plus hydroxychloroquine (12.8%). Mean time to onset was 9.1 days (standard deviation SD 13.94). Some patients developed fever (64.3%) and systemic involvement (18.9%), and most patients (76.4%) received pharmacological treatment for AGEP. Seven patients died, although five of them were already critically ill prior to AGEP. In conclusion, antibiotics remain the most common suspected cause of AGEP. While case mortality rate may be up to 2.5%, disentangling the role of AGEP on the fatal outcome from the role of the preexisting health conditions remains challenging.
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Chaabouni R, Bahloul E, Ennouri M, Atheymen R, Sellami K, Marrakchi S, Charfi S, Boudaya S, Amouri M, Bougacha N, Turki H. Hydroxychloroquine-induced acute generalized exanthematous pustulosis: a series of seven patients and review of the literature. Int J Dermatol 2021; 60:742-748. [PMID: 33598928 DOI: 10.1111/ijd.15419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/07/2020] [Accepted: 12/29/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Hydroxychloroquine (HCQ)-induced acute generalized exanthematous pustulosis (AGEP) is poorly described in the literature. The aim of our study was to characterize the clinical, laboratory, allergological, and genetic features of HCQ-induced AGEP. METHODS We conducted a retrospective study of patients with HCQ-induced AGEP diagnosed between 2011 and 2019. We performed molecular analysis to identify variations in the IL36RN gene. We also reviewed similar cases reported between 1991 and March 2020. RESULTS Seven female patients were included. The mean age was 47 years old, and the average time from HCQ start to onset of symptoms was 40 days. All patients received topical steroids with a full resolution of the rash within an average of 39 days after HCQ withdrawal. Patch tests were performed for three patients with positive results in one case. Genetic analyses were performed for three patients, and no mutation in the IL36RN gene was identified. CONCLUSION The latent period and the duration for resolution of HCQ-induced AGEP may be longer than with other drugs due to the metabolic characteristics of HCQ. Mutations in the IL36RN gene were not identified in our patients.
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Affiliation(s)
- Rim Chaabouni
- Department of Dermatology, Hedi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Emna Bahloul
- Department of Dermatology, Hedi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Mariam Ennouri
- Molecular and Functional Genetics Laboratory, Department of Life Sciences, Faculty of Sciences of Sfax, University of Sfax, Sfax, Tunisia
| | - Rim Atheymen
- Laboratory of Pharmacology, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Khadija Sellami
- Department of Dermatology, Hedi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Slaheddine Marrakchi
- Department of Dermatology, Hedi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Slim Charfi
- Laboratory of Pathological Anatomy, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Sonia Boudaya
- Department of Dermatology, Hedi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Meriem Amouri
- Department of Dermatology, Hedi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Noura Bougacha
- Molecular and Functional Genetics Laboratory, Department of Life Sciences, Faculty of Sciences of Sfax, University of Sfax, Sfax, Tunisia
| | - Hamida Turki
- Department of Dermatology, Hedi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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Mofarrah R, Mofarrah R, Oshriehye M, Ghobadi Aski S, Nazemi N, Nooshiravanpoor P. The necessity of patch testing in determining the causative drug of AGEP. J Cosmet Dermatol 2020; 20:2156-2159. [PMID: 33190407 DOI: 10.1111/jocd.13841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute Generalized Exanthematous Pustulosis (AGEP)is a rare, severe skin reactionmainly caused by medications such as antibiotics, anti fungals, Calcium channel blockers and Anti malarias. Although it resolves spontaneously in most patients, systemic corticosteroids are neededin severe cases. AIMS In order to determine the drug that is causing this condition, patch testing must be performed. Hydroxychloroquine is a medication that is used for the treatment of rheumatic and dermatologic conditions. And although it has been rarely seen to cause this reaction, we report a case of Hydroxychloroquine-induced (HCQ) AGEP which was confirmed by Patch testing. PATIENTS A woman 49 years of age with an18 month history of mild, untreated Rheumatoid Arthritis experienced an acute episode of arthritis in her right elbow. Upon going to a rheumatologist, Prednisolone 5 mg BID and HCQ 200 mg daily were administered for a 30-day period. But after only 17 days of this treatment, the patient developed generalized erythema and painful pustular eruptions. Prednisolone dosage was changedto 7.5 mg per day andHCQ was discontinued one day afterthe appearance of eruptions. The diffuse erythema started improving a week after the patient's hospitalization.Considering the factthat our patient was receiving multiple potentially causative medications, patch testing was necessary to distinguish the drug responsible for this reaction. RESULTS After the patch testing was done, HCQ-induced AGEP was confirmed. CONCLUSIONS Patch testing is the gold standard of determining the responsible drug for an AGEP reaction. It should also be kept in mind that HCQ, although rarely, can cause this condition.
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Affiliation(s)
- Ramin Mofarrah
- Department of Dermatology, Faculty of Medicine, Islamic Azad University of Medical Sciences, Sari Branch, Sari, Iran
| | - Ramina Mofarrah
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Oshriehye
- Department of Internal Medicine, Faculty of Medicine, Islamic Azad University of Medical Sciences, Sari Branch, Sari, Iran
| | - Sueshianth Ghobadi Aski
- Student Research Committee, Islamic Azad University of Medical Sciences, Sari Branch, Sari, Iran
| | - Nazanin Nazemi
- Student Research Committee, Islamic Azad University of Medical Sciences, Sari Branch, Sari, Iran
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Sharma AN, Mesinkovska NA, Paravar T. Characterizing the adverse dermatologic effects of hydroxychloroquine: A systematic review. J Am Acad Dermatol 2020; 83:563-578. [DOI: 10.1016/j.jaad.2020.04.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/31/2020] [Accepted: 04/04/2020] [Indexed: 11/26/2022]
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Enos T, Jeong HS, Vandergriff T, Jacobe HT, Chong BF. Acute generalized exanthematous pustulosis induced by empiric hydroxychloroquine for presumed COVID-19. Dermatol Ther 2020; 33:e13834. [PMID: 32542893 PMCID: PMC7323399 DOI: 10.1111/dth.13834] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/03/2020] [Accepted: 06/12/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Tyler Enos
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Haneol S Jeong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Travis Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Heidi T Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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8
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Cyclosporine for treatment of acute generalized exanthematous pustulosis: A retrospective analysis. J Am Acad Dermatol 2020; 83:263-265. [DOI: 10.1016/j.jaad.2020.02.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 02/22/2020] [Accepted: 02/27/2020] [Indexed: 11/21/2022]
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Zhang X, Lu WS, Qin XM. Cytokines/Chemokines: Novel Biomarkers Associated with Severe Cutaneous Adverse Reactions. J Interferon Cytokine Res 2020; 40:172-181. [PMID: 32195616 DOI: 10.1089/jir.2019.0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Although the incidence of severe cutaneous adverse reactions (SCARs) is very low, if it is not diagnosed and treated in time, it can not only cause skin and mucous membrane involvement, but can also cause multiple organ failure and even death. The diagnostic criteria and treatment guidelines for severe drug eruptions have not been unified. Many medical centers have used human leukocyte antigen alleles to diagnose SCARs. Some prospective studies have shown that susceptibility gene testing can prevent SCARs as early as possible, but the widespread implementation of its technology is limited by being ethnically specific. With the unique advantages of cytokine detection technology, cytokines are increasingly important for the diagnosis and treatment of SCARs. Related cytokines/chemokines involved in the pathogenesis, adjuvant diagnosis, and treatment of SCARs are discussed.
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Affiliation(s)
- Xiang Zhang
- Department of Dermatology, The Second Affiliated Hospital, WanNan Medical College, Wuhu, China
| | - Wen-Shen Lu
- Department of Dermatology, Affiliated Provincial Hospital, University of Science and Technology of China, Hefei, China
| | - Xiao-Ming Qin
- Department of Dermatology, The Second Affiliated Hospital, WanNan Medical College, Wuhu, China
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10
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İslamoğlu ZGK, Karabağli P. A case of recalcitrant acute generalized exanthematous pustulosis with Sjogren's syndrome: Successfully treated with low-dose cyclosporine. Clin Case Rep 2019; 7:1721-1724. [PMID: 31534735 PMCID: PMC6745342 DOI: 10.1002/ccr3.2352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 12/14/2022] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a reaction attributed mainly to drugs. Hydroxychloroquine is a rare cause of AGEP especially used in rheumatology and dermatology. Systemic corticosteroids are the first-line treatment agents in AGEP. But cyclosporine can be a good choice for patients resistant to systemic corticosteroid treatment in AGEP.
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Affiliation(s)
| | - Pınar Karabağli
- Department of Pathology, Faculty of MedicineSelcuk UniversityKonyaTurkey
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Berth-Jones J, Exton LS, Ladoyanni E, Mohd Mustapa MF, Tebbs VM, Yesudian PD, Levell NJ. British Association of Dermatologists guidelines for the safe and effective prescribing of oral ciclosporin in dermatology 2018. Br J Dermatol 2019; 180:1312-1338. [PMID: 30653672 DOI: 10.1111/bjd.17587] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2018] [Indexed: 02/06/2023]
Affiliation(s)
- J Berth-Jones
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, London, W1T 5HQ, U.K
| | - E Ladoyanni
- Department of Dermatology, Dudley Group NHS Foundation Trust, Dudley, DY1 2HQ, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, London, W1T 5HQ, U.K
| | - V M Tebbs
- formerly of George Eliot Hospital, College Street, Nuneaton, CV10 7DJ, U.K
| | - P D Yesudian
- Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, LL13 7TD, U.K
| | - N J Levell
- Dermatology Department, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, U.K
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12
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Mohaghegh F, Jelvan M, Rajabi P. A case of prolonged generalized exanthematous pustulosis caused by hydroxychloroquine-Literature review. Clin Case Rep 2018; 6:2391-2395. [PMID: 30564334 PMCID: PMC6293130 DOI: 10.1002/ccr3.1811] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/07/2018] [Accepted: 08/19/2018] [Indexed: 11/29/2022] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a self-limited drug reaction. Hydroxychloroquine (HCQ) is an uncommon cause of AGEP with a prolonged recovery course; Thus, the physicians should take the possibility of this rare but severe event in their minds and try to diagnose correctly and better management.
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Affiliation(s)
- Fatemeh Mohaghegh
- Assistant Professor of Dermatology and DermatopathologyDepartment of DermatologyIsfahan University of Medical SciencesIsfahanIran
| | - Minoo Jelvan
- Dermatology ResidentDepartment of DermatologyIsfahan university of Medical SciencesIsfahanIran
| | - Parvin Rajabi
- ProfessorDepartment of PathologyIsfahan University of Medical SciencesIsfahanIran
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Castner NB, Harris JC, Motaparthi K. Cyclosporine for corticosteroid-refractory acute generalized exanthematous pustulosis due to hydroxychloroquine. Dermatol Ther 2018; 31:e12660. [DOI: 10.1111/dth.12660] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/14/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jessica Crabbe Harris
- Department of Dermatology; University of Florida College of Medicine; Gainesville Florida
| | - Kiran Motaparthi
- Department of Dermatology; University of Florida College of Medicine; Gainesville Florida
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Yalçın B, Çakmak S, Yıldırım B. Successful Treatment of Hydroxychloroquine-Induced Recalcitrant Acute Generalized Exanthematous Pustulosis with Cyclosporine: Case Report and Literature Review. Ann Dermatol 2015; 27:431-4. [PMID: 26273160 PMCID: PMC4530154 DOI: 10.5021/ad.2015.27.4.431] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 11/14/2014] [Accepted: 11/21/2014] [Indexed: 11/08/2022] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a cutaneous reaction principally induced by drugs. Spontaneous resolution is observed in most patients. However, severe cases required systemic corticosteroid administration. Hydroxychloroquine, which is used to treat some dermatologic and rheumatologic diseases because of its anti-inflammatory and immunosuppressive effects, is an uncommon cause of AGEP. A 67-year-old female patient presented with severe AGEP due to hydroxychloroquine treatment. She was recalcitrant to supportive care and systemic corticosteroid treatment butwas successfully treated with cyclosporine. Hydroxychloroquine-induced AGEP occurs in women with underlying rheumatologic diseases, has a longer latent period, and has a severe course usually requiring systemic treatment.
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Affiliation(s)
- Başak Yalçın
- Department of Dermatology, Yildirim Beyazit University, Ankara, Turkey
| | - Seray Çakmak
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Betül Yıldırım
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
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15
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Di Lernia V, Ricci C. Fluconazole-induced acute generalized exanthematous pustulosis. Indian J Dermatol 2015; 60:212. [PMID: 25814733 PMCID: PMC4372937 DOI: 10.4103/0019-5154.152572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction and is usually caused by drugs. It is characterized by fever and acute, extensive occurrence of disseminated sterile pustules, accompanied by fever, malaise and peripheral blood leucocytosis. There have been several reports to date of AGEP following exposure to antifungals. In particular, terbinafine is included in the list of the agents conferring the highest risk of AGEP. The authors report the case of a 70-year-old male patient who developed AGEP shortly after commencing treatment with fluconazole, which has been reported in association with AGEP in a single case report. To our knowledge, this is the first reported case of AGEP associated with positive fluconazole patch test.
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Affiliation(s)
- Vito Di Lernia
- Department of Internal Medicine and Medical Specialities, Dermatology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Cinzia Ricci
- Department of Internal Medicine and Medical Specialities, Dermatology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
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Kostopoulos T, Krishna S, Brinster N, Ortega‐Loayza A. Acute generalized exanthematous pustulosis: atypical presentations and outcomes. J Eur Acad Dermatol Venereol 2014; 29:209-214. [DOI: 10.1111/jdv.12721] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/28/2014] [Indexed: 12/11/2022]
Affiliation(s)
- T.C. Kostopoulos
- Department of Dermatology Virginia Commonwealth University Medical Center Richmond VA USA
| | - S.M. Krishna
- Department of Dermatology Virginia Commonwealth University Medical Center Richmond VA USA
| | - N.K. Brinster
- Department of Dermatology Virginia Commonwealth University Medical Center Richmond VA USA
| | - A.G. Ortega‐Loayza
- Department of Dermatology Virginia Commonwealth University Medical Center Richmond VA USA
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Abstract
Cutaneous adverse drug reactions range from mild to severe and from those localized only to skin to those associated with systemic disease. It is important to distinguish features of cutaneous drug reactions which help classify the underlying mechanism and likely prognosis as both of these influence management decisions, some of which necessarily have to be taken rapidly. Severe cutaneous reactions are generally T cell-mediated, yet this immunological process is frequently poorly understood and principles for identification of the culprit drug are different to those of IgE mediated allergic reactions. Furthermore, intervention in severe skin manifestations of drug allergy is frequently necessary. However, a substantial literature reports on success or otherwise of glucocorticoids, cyclophsphamide, ciclosporin, intravenous immunoglobulin and anti-tumour necrosis factor therapy for the treatment of toxic epidermal necrolysis without clear consensus. As well as reviewing the recommended supportive measures and evidence base for interventions, this review aims to provide a mechanistic overview relating to a proposed clinical classification to assist the assessment and management of these complex patients.
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Affiliation(s)
- Michael R Ardern-Jones
- Division of Infection, Inflammation and Immunity, University of Southampton School of Medicine, Mailpoint 825, Level F, South Block, Sir Henry Wellcome Laboratories, Southampton General Hospital, Southampton SO16 6YD, UK.
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Razera F, Olm GS, Bonamigo RR. Dermatoses neutrofílicas: parte II. An Bras Dermatol 2011; 86:195-209; quiz 210-1. [DOI: 10.1590/s0365-05962011000200001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Indexed: 11/22/2022] Open
Abstract
Neste artigo são abordadas as dermatoses neutrofílicas, complementando o artigo anterior (parte I). São apresentadas e comentadas as seguintes dermatoses: pustulose subcórnea de Sneddon-Wilkinson, dermatite crural pustulosa e atrófica, pustulose exantemática generalizada aguda, acroder matite contínua de Hallopeau, pustulose palmoplantar, acropustulose infantil, bacteride pustular de Andrews e foliculite pustulosa eosinofílica. Uma breve revisão das dermatoses neutrofílicas em pacientes pediátricos também é realizada.
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Affiliation(s)
- Fernanda Razera
- Universidade Federal de Ciências da Saúde de Porto Alegre; Universidade Federal de Ciências da Saúde de Porto Alegre; Hospital Mãe de Deus, Brasil
| | - Gislaine Silveira Olm
- Hospital Mãe de Deus, Brasil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil
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Messeguer F, Agustí-Mejias A, Requena C, Pérez-Ferriols A. Claves diagnósticas de la pustulosis exantemática aguda generalizada. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.piel.2010.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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