Acute Generalized Exanthematous Pustulosis (AGEP) AGEP is largely a clinical diagnosis based on classical skin findings in a patient who recently started taking one of the commonly implicated agents or had a recent infection. How? The mechanism of development is a T-cell-mediated inflammatory response. Who? Annual incidence of one to five cases per million people. Causes? In about 90% of patients, AGEP is caused by medications. Antibiotics: - cephalosporins - macrolides - aminopenicillins - antifungals - antimalarials - diltiazem Infections: - Parvovirus B19 - Cytomegalovirus - Coxsackievirus - Mycoplasma pneumoniae Diagnostic Criteria: - Fever onset (temperature above 38 degrees Celsius) and pustular rash shortly after starting a potentially triggering medication. - Multiple small pustules with underlying redness. - Elevated white blood cell count with increased neutrophil levels. - Skin biopsy revealing non-bacterial origin. - Rash improvement after stopping the triggering substance. Clinical Presentation? The rash can be associated with: - Facial edema - Purpura - Blisters - Vesicles The rash typically spares mucous membranes, can present with lesions on the lips. During the acute phase, patients often are febrile (temperature greater than 38°C or 100.4°F). Manifestations generally are limited to the skin. Labs? - Leukocytosis and neutrophilia - Elevated transaminases - Reduction in creatinine clearance can occur Typically, the rash resolves spontaneously after removal of the offending agent, with patients unlikely to have any major complications. - Desquamation of the rash typically begins 5 to 7 days after its onset, with full resolution of the rash within 1 to 2 weeks. - AGEP can recur with reexposure to the drug, so patients should be counseled to avoid the offending medication for life. #AGEP #Generalized #Exanthematous #Pustulosis #Dermatology #diagnosis
