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Parisi R, Shah H, Navarini AA, Muehleisen B, Ziv M, Shear NH, Dodiuk-Gad RP. Acute Generalized Exanthematous Pustulosis: Clinical Features, Differential Diagnosis, and Management. Am J Clin Dermatol 2023:10.1007/s40257-023-00779-3. [PMID: 37156992 PMCID: PMC10166469 DOI: 10.1007/s40257-023-00779-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 05/10/2023]
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a rare, acute, severe cutaneous adverse reaction mainly attributed to drugs, although other triggers, including infections, vaccinations, ingestion of various substances, and spider bites, have also been described. AGEP is characterized by the development of edema and erythema followed by the eruption of multiple punctate, non-follicular, sterile pustules and subsequent desquamation. AGEP typically has a rapid onset and prompt resolution within a few weeks. The differential diagnoses for AGEP are broad and include infectious, inflammatory, and drug-induced etiologies. Diagnosis of AGEP depends on both clinical and histologic criteria, as cases of overlap with other disease processes have been reported. Management includes removal of the offending drug or treatment of the underlying cause, if necessary, and supportive care, as AGEP is a self-limited disease. This review aims to provide an overview and update on the epidemiology, pathogenesis, reported precipitating factors, differentials, diagnosis, and management of AGEP.
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Affiliation(s)
- Rose Parisi
- Albany Medical College, Albany, New York, NY, USA
| | - Hemali Shah
- Albany Medical College, Albany, New York, NY, USA
| | - Alexander A Navarini
- Department of Dermatology and Allergy, University Hospital of Basel, Basel, Switzerland
| | - Beda Muehleisen
- Department of Dermatology and Allergy, University Hospital of Basel, Basel, Switzerland
| | - Michael Ziv
- Department of Dermatology, Emek Medical Center, Afula, Israel
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada
| | - Roni P Dodiuk-Gad
- Department of Dermatology, Emek Medical Center, Afula, Israel.
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada.
- Department of Dermatology, Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, 3525433, Israel.
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de Oliveira GV, Maia MLP, Leão FAA, Sad EF, Silva MR, Ramos-E-Silva M. What to expect when AGEP is induced by terbinafine? case report and critical review of the literature. Mycoses 2022; 65:918-925. [PMID: 35876217 DOI: 10.1111/myc.13506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute Generalized Exanthematous Pustulosis (AGEP) is a rash with multiple sterile intraepidermal or sub corneal non-follicular pustules on edematous papules, with a sudden development and rapid evolution, triggered by drugs, vaccination, insect bites, exposure to mercury and allergens. OBJECTIVES AND METHODS We describe a female patient who developed extensive and abnormally prolonged AGEP following exposure to terbinafine and Sars-COV Vaccine. A detailed review of terbinafine-induced-AGEP cases was performed, with the aim of evaluating if the AGEP criteria would follow a different pattern when the disease is triggered by this drug. A pubmed search helped retrieve all terbinafine induced AGEP case reports. AGEP specific Sideroff criteria were analyzed in Terbinafine-induced cases, and compared to other trigger causes. CONCLUSIONS when AGEP causative drug was terbinafine, a delay in recovery was observed, compared to the existing AGEP criteria when other causes are considered. Terbinafine frequently leads to delayed resolution AGEP probably due to the presence of the drug in the skin during several weeks after exposure, even after discontinuation, and the disease severity may be potentialized by additional factors such as concomitant viral infections or vaccination.
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Affiliation(s)
- Gisele Viana de Oliveira
- Luxemburgo Hospital, Instituto Mario Penna.,GREMCIQ- Group for Multicenter studies on Hypertrophic scars and Keloids/ GV Dermatology- Des. Jorge Fontana 476-802 BH, MG, Brazil
| | | | | | | | | | - Marcia Ramos-E-Silva
- Sector of Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil.,GREMCIQ- Group for Multicenter studies on Hypertrophic scars and Keloids/ GV Dermatology- Des. Jorge Fontana 476-802 BH, MG, Brazil
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Ross CL, Shevchenko A, Mollanazar NK, Hsu S, Motaparthi K. Acute generalized exanthematous pustulosis due to terbinafine. Dermatol Ther 2018; 31:e12617. [DOI: 10.1111/dth.12617] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/11/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Casey L. Ross
- Department of Dermatology; Lewis Katz School of Medicine at Temple University Hospital; Philadelphia, Pennsylvania
| | - Alina Shevchenko
- Department of Dermatology; Lewis Katz School of Medicine at Temple University Hospital; Philadelphia, Pennsylvania
| | - Nicholas K. Mollanazar
- Department of Dermatology; Lewis Katz School of Medicine at Temple University Hospital; Philadelphia, Pennsylvania
| | - Sylvia Hsu
- Department of Dermatology; Lewis Katz School of Medicine at Temple University Hospital; Philadelphia, Pennsylvania
| | - Kiran Motaparthi
- Department of Dermatology; University of Florida College of Medicine; Gainesville, Florida
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