Acute generalized exanthematous pustulosis: clinical characteristics, etiologic associations, treatments, and outcomes in a series of 28 patients at Mayo Clinic, 1996–2013

• Published in: International journal of dermatology Vol. 56; no. 4; pp. 405 - 414
• Main Authors: Alniemi, Dema T., Wetter, David A., Bridges, Alina G., el‐Azhary, Rokea A., Davis, Mark D. P., Camilleri, Michael J., McEvoy, Marian T.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.04.2017
• Subjects: Acute Generalized Exanthematous Pustulosis - drug therapy; Acute Generalized Exanthematous Pustulosis - etiology; Acute Generalized Exanthematous Pustulosis - pathology; Administration, Cutaneous; Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - adverse effects; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - therapeutic use; Causation; Clindamycin; Clindamycin - adverse effects; Corticoids; Corticosteroids; Dermatitis; Dermatitis - etiology; Drug Therapy, Combination; Eruptions; Etiology; Female; Fluocinolone Acetonide - analogs & derivatives; Fluocinolone Acetonide - therapeutic use; Fluocinonide - therapeutic use; Humans; Hydrocortisone - therapeutic use; Male; Middle Aged; Mucous Membrane; Patients; Prednisone - therapeutic use; Pustulosis; Retrospective Studies; Severity of Illness Index; Side effects; Skin; Skin diseases; Treatment Outcome; Triamcinolone - therapeutic use; Young Adult
• ISSN: 0011-9059; 1365-4632
• DOI: 10.1111/ijd.13434

Background Acute generalized exanthematous pustulosis (AGEP) is a rare skin condition typically caused by medications. The objective of this study was to examine the clinical features, causes, and outcomes of AGEP at a sole tertiary care center. Methods A retrospective review of patients with AGEP (European Study of Severe Cutaneous Adverse Reactions score of ≥ 5) seen at Mayo Clinic (Rochester, MN, USA) between January 1, 1996, and December 31, 2013, was conducted. Results Of 28 patients (mean age at onset: 56 years), 17 (61%) were women. The development of AGEP was attributed to medications in 25 patients (89%), with clindamycin the most common culprit (six patients). Three patients (11%) had mucous membrane involvement, and 21 (75%) showed systemic involvement. Ten patients (36%) received systemic corticosteroids for treatment of AGEP. Skin findings resolved within 15 days in 26 patients (93%) (mean time to resolution: 7.6 days). In three patients (11%), generalized skin eruptions or dermatitis developed weeks to months after the resolution of AGEP. Twenty‐four patients (86%) had a personal history of drug reactions before the development of AGEP. Conclusions A previous history of drug reactions and clindamycin causation were more common in the present cohort than in prior reports. A small subset of patients experienced new‐onset non‐AGEP skin eruptions within a few months of the resolution of AGEP.