Acute generalized exanthematous pustulosis induced by bufexamac in an atopic girl

Belhadjali, H.; Ghannouchi, N.; Njim, Leïla; Mohamed, M.; Moussa, Adnène; Bayou, F.; Chakroun, M.; Zakhama, Abdelfattah

doi:10.1111/j.1600-0536.2007.01271.x

Cited by 25 publications

(8 citation statements)

References 7 publications

(6 reference statements)

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“…The role of bufexamac in the induction of AGEP, which had been reported previously [19], was supported in this case by a positive withdrawal test and a positive patch test [40 ]. Thus, it would appear that contact sensitivity to topical agents does play a role in the induction of AGEP, even though evidence is scarce.…”

Section: Contact Sensitivitymentioning

confidence: 61%

Acute generalized exanthematous pustulosis

Halevy¹

2009

Current Opinion in Allergy &Amp; Clinical Immunology

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Section: Contact Sensitivitymentioning

confidence: 61%

Acute generalized exanthematous pustulosis

Halevy¹

2009

Current Opinion in Allergy &Amp; Clinical Immunology

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“…These include ACD with eczematous features and spread of targetlike urticarial papular and plaque lesions distant from the primary site, as well as a systemic reaction following percutaneous absorption of the allergen. 8 There have also been case reports of acute generalised exanthematous pustulosis, 9 bufexamac ACD imitating a baboon syndrome 10 and a pigmented purpuric dermatosis. 11 A case series of associated erythema-multiforme-like eruption 9 and photo Koebner phenomenon in erythema-multiforme-like eruption induced by contact dermatitis caused by bufexamac have also been reported.…”

Section: Discussionmentioning

confidence: 97%

“…8 There have also been case reports of acute generalised exanthematous pustulosis, 9 bufexamac ACD imitating a baboon syndrome 10 and a pigmented purpuric dermatosis. 11 A case series of associated erythema-multiforme-like eruption 9 and photo Koebner phenomenon in erythema-multiforme-like eruption induced by contact dermatitis caused by bufexamac have also been reported. 12 Since bufexamac is generally applied topically to inflammatory dermatoses there is a real danger that bufexamac allergy may not be recognised or misdiagnosed, or as in our patients, misdiagnosed as cellulitis.…”

Section: Discussionmentioning

confidence: 97%

Allergic contact dermatitis to topical preparations of bufexamac

Pan

Nixon

2012

Aust J Dermatology

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In Australia bufexamac is mainly used for pharmacist-initiated local treatment of various dermatoses. The European Medicines Agency's Committee for Medicinal Products for Human Use recently recommended that marketing authorisation for bufexamac-containing preparations be revoked throughout the European Union because of the risk of severe allergic contact dermatitis. We retrospectively reviewed the patch test database at the Skin and Cancer Foundation Inc. and identified 19 cases of positive reactions to bufexamac (5% petrolatum) from 451 people patch tested. The bufexamac reaction was deemed relevant to the presenting dermatitis in 13 of 19 (68%) patients. Bufexamac allergic contact dermatitis is under-reported in the English literature. We wish to emphasise the severity and the unusually polymorphic eruptions observed in some of the cases. Clinicians should consider the possibility of allergic contact dermatitis to bufexamac-containing preparations in all patients where there is a history of exposure, even if used for only a short time.

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“…Sener et al reported a case of AGEP resulting from the oral use of blue dyes after consumption of methylene blue and indigotin . A topical agent can exceptionally cause AGEP, but the mechanism is still unknown. However, systemic delivery is very likely.…”

Section: Discussionmentioning

confidence: 75%

Occupational acute generalized exanthematous pustulosis induced by disperse dyes in a textile

et al. 2019

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K E Y W O R D S : acute generalized exanthematous pustulosis, case report, disperse dyes, occupational dermatitis Acute generalized exanthematous pustulosis (AGEP) is a severe eruption characterized by numerous non-follicular sterile pustules on an erythematous background. AGEP is mostly caused by systemic drugs, mainly antibiotics. Other causes of AGEP, such as contact with mercury, spider bites, and viral infections, have been described. 1 Disperse dyes (DDs) in textiles are frequent causes of contact dermatitis, 2 but have never been reported as being responsible for AGEP. Here, we report the first case of AGEP caused by textile DDs. CASE REPORTA 23-year-old woman with no medical history of interest presented to our dermatology department with non-follicular pustules on oedematous erythema, particularly on her face, trunk, intertriginous areas, and extremities. She had also fever and neutrophilia (16 000/ mm 3 ). No bacteria or fungi were cultured from the pustules. Serological tests gave negative results. Skin biopsy showed subcorneal pustules associated with epidermal spongiosis. Our patient was diagnosed with AGEP according to the EuroSCAR group criteria (score of 11/12, certain) 1 but no evident aetiology was found (eg, drugs or mercury). She was treated with topical clobetasol, and the skin lesions vanished within 4 days. However, as soon as she returned to her work as a textile factory worker, she suffered a relapse within 1 day on the first occasion, and another relapse within 3 hours on the second occasion, with spontaneous rapid healing after being hospitalized. Patch testing was performed with Finn Chambers on Scanpor tape, with the European baseline series and a textile dyes series AMEUR ET AL. 411 (Chemotechnique Diagnostics, Vellinge, Sweden). The occlusion time was 2 days, and reactions were evaluated on day (D) 2 and D3 according to ICDRG guidelines. The results showed positive reactions to Disperse Red 17 (+/++), Disperse Blue 3 (+/++), 4-aminophenol (+/++), 4-aminoazobenzene (+/++), and Disperse Blue mix (+/++). Thus, a diagnosis of occupational AGEP caused by DDs was indicated. To date, 7 years after the patient left her job, no clinical relapse has been observed. DISCUSSIONAccording to the score of the EuroSCAR group criteria, the diagnosis of AGEP in our patient was certain. 1 Work-related AGEP was suspected, and relapse after resumption of work can be considered to be a positive provocation test. The responsibility of DDs was confirmed by patch testing. DDs are the most prevalent causes of textile-related allergic contact dermatitis, 2 but have never been reported as a cause of AGEP.Sener et al reported a case of AGEP resulting from the oral use of blue dyes after consumption of methylene blue and indigotin. 3 A topical agent can exceptionally cause AGEP, 4 but the mechanism is still unknown. However, systemic delivery is very likely. In fact, DDs do not adhere well to fabric, so a relatively large amount of the dye is released from the fabric and absorbed into the skin.

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Acute generalized exanthematous pustulosis induced by bufexamac in an atopic girl

Cited by 25 publications

References 7 publications

Acute generalized exanthematous pustulosis

Acute generalized exanthematous pustulosis

Allergic contact dermatitis to topical preparations of bufexamac

Occupational acute generalized exanthematous pustulosis induced by disperse dyes in a textile

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