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Tetart F, Walsh S, Milpied B, Gaspar K, Vorobyev A, Tiplica GS, Didona B, Welfringer-Morin A, Kucinskiene V, Bensaid B, Marvanova E, Salavastru C, Brezinova E, Chua SL, Lovgren ML, Hammers CM, Barbaud A, Mortz CG, Horvath B, Meyersburg D, Lebrun-Vignes B, Bodemer C, Brüggen MC, French LE, Ingen-Housz-Oro S. Acute generalized exanthematous pustulosis: European expert consensus for diagnosis and management. J Eur Acad Dermatol Venereol 2024. [PMID: 39023187 DOI: 10.1111/jdv.20232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/09/2024] [Indexed: 07/20/2024]
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a rare, usually drug-induced, acute pustular rash. Despite the lack of strong data supporting the effectiveness of topical or systemic corticosteroids in this drug reaction, they are widely used. More generally, there is no consensus on the diagnostic modalities and the management of patients with AGEP. We aimed to provide European expert recommendations for the diagnosis and management or patients with AGEP. Members of the ToxiTEN group of the European Reference Network (ERN)-skin, all dermatologists and/or allergologists with expertise in drug reactions, elaborated these recommendations based on their own experience and on a review of the literature. Recommendations were separated into the following categories: professionals involved, assessment of the diagnosis of AGEP, management of the patient and allergological work-up after the acute phase. Consensus was obtained among experts for the list of professionals involved for the diagnosis and management of AGEP, including the minimum diagnostic work-up, the setting of management, the treatments, the modalities and the timing of allergological work-up and follow-up. European experts in drug allergies propose herein consensus on the diagnosis and management of patients with AGEP. A multidisciplinary approach is warranted, including dermatologists, allergologists and pharmacovigilance services.
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Affiliation(s)
- F Tetart
- Department of Dermatology and Allergology, Charles Nicolle University Hospital, Rouen, France
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL Reference Center, AP-HP, Henri Mondor Hospital, Créteil, France
| | - S Walsh
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Department of Dermatology, King's College Hospital, London, UK
| | - B Milpied
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL Reference Center, AP-HP, Henri Mondor Hospital, Créteil, France
- Department of Dermatology, University Hospital of Bordeaux, Bordeaux, France
| | - K Gaspar
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - A Vorobyev
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - G S Tiplica
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Department of Dermatology II, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - B Didona
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Center of Rare Diseases IDI-IRCCS-Rome, Rome, Italy
| | - A Welfringer-Morin
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Department of Dermatology, Necker-Enfants Malades University Hospital, Paris, France
| | - V Kucinskiene
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LUHS), Hospital of LUHS Kauno Klinikos, Kaunas, Lithuania
| | - B Bensaid
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL Reference Center, AP-HP, Henri Mondor Hospital, Créteil, France
- Department of Dermatology, Edouard Herriot University Hospital, Lyon, France
| | - E Marvanova
- Department of Dermatovenereology, Faculty of Medicine, St. Ann's University Hospital, Masaryk University, Brno, Czech Republic
| | - C Salavastru
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Department of Paediatric Dermatology, Colentina University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - E Brezinova
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Department of Dermatovenereology, Faculty of Medicine, St. Ann's University Hospital, Masaryk University, Brno, Czech Republic
| | - S L Chua
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Department of Dermatology, University Hospitals Birmingham, Birmingham, UK
| | - M L Lovgren
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - C M Hammers
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Department of Dermatology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - A Barbaud
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL Reference Center, AP-HP, Henri Mondor Hospital, Créteil, France
- Department of Dermatology and Allergology, Tenon Hospital, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidemiologie et de Sante Publique, AP-HP Sorbonne Universite, Paris, France
| | - C G Mortz
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Department of Dermatology and Allergy Center, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - B Horvath
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - D Meyersburg
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - B Lebrun-Vignes
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL Reference Center, AP-HP, Henri Mondor Hospital, Créteil, France
- Regional Pharmacovigilance Centre, Pitié-Salpêtrière Hospital, APHP, Sorbonne Université, Paris, France
| | - C Bodemer
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL Reference Center, AP-HP, Henri Mondor Hospital, Créteil, France
- Department of Dermatology, Necker-Enfants Malades University Hospital, Paris, France
| | - M C Brüggen
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | - L E French
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - S Ingen-Housz-Oro
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN Skin), Paris, France
- Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL Reference Center, AP-HP, Henri Mondor Hospital, Créteil, France
- Department of Dermatology, AP-HP, Henri Mondor University Hospital, Créteil, France
- Univ Paris Est Créteil EpiDermE, Créteil, France
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Nusbaum KB, Walker TD, Himed S, Trinidad JC, Spaccarelli N, Chung C, Kaffenberger BH. Patient Care Outcomes in Hospitalized Patients with Acute Generalized Exanthematous Pustulosis: A Cross-Sectional Database Study. Am J Clin Dermatol 2023; 24:299-304. [PMID: 36306105 DOI: 10.1007/s40257-022-00737-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Current understanding of the etiology, natural history, and outcomes of acute generalized exanthematous pustulosis (AGEP) has been limited, with most available studies consisting of small or heterogenous cohorts. OBJECTIVES The aim of this study was to further characterize associated factors and disease outcomes of AGEP. METHODS A cross-sectional study design was employed with formal inclusion and causality criteria. Patients were identified from an inpatient database at an academic medical center, including 65 patients with AGEP and a control group of 61 patients with non-severe cutaneous adverse reactions. RESULTS Increased age and body mass index (BMI) were associated with higher risk of AGEP (p < 0.001). Length of stay was longer for both the overall AGEP cohort (13.1 days) and a subcohort with a primary discharge diagnosis of AGEP (9.7 days) compared with the control group (3.6 days) [p < 0.001]. Patients with AGEP were more likely to be discharged to a long-term care facility compared with control patients (p < 0.001). CONCLUSIONS AGEP was associated with longer length of hospitalization, higher rates of discharge to long-term care facilities, and higher mortality compared with non-severe cutaneous adverse drug reaction (SCAR) medication reactions. Future research should examine the association between morbid obesity and this particular drug reaction, and the possibility of decreasing hospitalization length given the relatively low risk of mortality among patients with AGEP.
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Affiliation(s)
- Kelsey B Nusbaum
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Trent D Walker
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Sonia Himed
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - John Christopher Trinidad
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, 1328 Dublin Road, Suite 100, Columbus, OH, 43212, USA
| | - Natalie Spaccarelli
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, 1328 Dublin Road, Suite 100, Columbus, OH, 43212, USA
| | - Catherine Chung
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, 1328 Dublin Road, Suite 100, Columbus, OH, 43212, USA.,Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, 1328 Dublin Road, Suite 100, Columbus, OH, 43212, USA.
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