Acute generalized exanthematous pustulosis with a focus on hydroxychloroquine: A 10-year experience in a skin hospital

Abstract

Highlights Hydroxychloroquine and antibiotics were the most common drugs associated with AGEP. Hydroxychloroquine was associated with a prolonged treatment duration of AGEP. Seventeen (23%) patients had systemic organ involvement. Recurrence was detected in six (8.1%) patients after resuming the same drug.

Multisystem organ failure secondary to acute generalised exanthematous pustulosis (AGEP) with atypical presentation resembling septic shock

“…Description of the rash, its distribution, timing, and presence of other symptoms are all taken into account. The algorithm yields a score between −10 to +12, and its divided into 'no AGEP' (score −10-0), 'possible AGEP' (score 1-4); 'probable' (score 5-7) and 'definite' (score [8][9][10][11][12]. Applying the AGEP validation score, our patient received a score of +12, confirming the diagnosis.…”

“… 9 Onset of skin manifestation is highly variable, with clinical signs observed in less than 48 hours 8 or up to weeks. 10 11 In most cases, complete resolution of pustules and fever is achieved within 2 weeks following discontinuation of the offending agent, when skin lesions transition from pustules to diffuse exfoliation which may last for extended periods of time. 1 5 The above described presentation is by far the most common way AGEP may manifest.…”

Acute generalized exanthematous pustulosis due to hydroxichloroquine

“…3 In case of HCQ-induced AGEP, the latency period appears to be longer (ranging from 4 to 30 days 6 ) than in antibiotics-related cases, and the eruption tends to be more serious and resistant to treatments. 7,8 A differential diagnosis could have been HCQ-induced generalized pustular figurate erythema (GPFE), which has been recently described in two patients with COVID-19; 9 however, our patient was febrile and the cutaneous presentation was more consistent with AGEP than GPFE.…”

A Case Report of Possibly Related Acute Generalized Exanthematous Pustulosis with Staphylococcus pettenkoferi

“… 3 The significance of systemic corticosteroid administration in shortening the course of the disease is controversial. 22 Supportive care, specifically infection prevention, is crucial when pustules begin to coalesce and large sheets of skin desquamate. In some cases of infection-associated AGEP with clear laboratory evidence, aggressive anti-infective therapy is considered necessary.…”