Risk factors for acute generalized exanthematous pustulosis (AGEP)—results of a multinational case–control study (EuroSCAR)

Abstract

Medications associated with AGEP differ from those associated with Stevens-Johnson syndrome or toxic epidermal necrolysis. Different timing patterns from drug intake to reaction onset were observed for different drugs. Infections, although possible triggers, played no prominent role in causing AGEP and there was no evidence that AGEP is a variant of pustular psoriasis.

Dermatoses neutrofílicas: parte II

“…34 Although the infectious etiology of AGEP is still controversial, 32.36 there are reports of patients with skin lesions compatible with AGEP during an infectious process without use of any medication. 34,35,37 Approximately 90% of the cases are caused by medication. 34.38 Among the drugs commonly associated with the development of AGEP are antibiotics (macrolides and beta-lactams), antifungals, calcium channel blockers, carbamazepine, paracetamol, anti-malarial drugs, among others.…”

“…33.36 It is worth noting that the spectrum of agents associated with toxic epidermal necrolysis/Stevens-Jonhson syndrome differs from the medication associated with AGEP. 35 The EuroScar multicentric study showed that some drugs are more likely (higher odds ratio) to lead to the development of AGEP (Table 1). 35 The sensitization phase is not well understood, but it is believed that antigen-presenting cells activate T cells by presenting the drug to the lymph node.…”

“…35 The EuroScar multicentric study showed that some drugs are more likely (higher odds ratio) to lead to the development of AGEP (Table 1). 35 The sensitization phase is not well understood, but it is believed that antigen-presenting cells activate T cells by presenting the drug to the lymph node. Drug-specific CD 4 and CD 8 lymphocytes multiply and migrate to the dermis and epidermis.…”

“…33 Studies have shown there is no predilection for sex 33 , but the EuroScar has shown a slight female predominance (ratio male/female: 0.86). 35 The clinical manifestations are characterized by sudden onset of erythema and edema on intertriginous areas or face, with craniocaudal spread and emergence of hundreds of small, non-follicular pustules ( Figure 1). It may be preceded or accompanied by fever and pruritus.…”

“…32 However, due to its particular clinical characteristics such as sudden onset of numerous follicular pustules over an exanthem, accompanied by fever, history of frequent use of medication, histopathological differences and rapid spontaneous resolution, the authors considered it as a different entity from psoriasis. Some authors acknowledge that pustular psoriasis and AGEP may share a genetic background that would lead to the attraction of neutrophils [32][33][34][35] The most frequent causes of AGEP are reactions to acute infections (enterovirus), to drugs and mercury. 34 Although the infectious etiology of AGEP is still controversial, 32.36 there are reports of patients with skin lesions compatible with AGEP during an infectious process without use of any medication.…”