ABSTRACT
Acute generalized exanthematous pustulosis (AGEP), also known as toxic pustuloderma, is a rare cutaneous pustular eruption, classified as a severe cutaneous adverse reaction. It is a rare disorder, with incidence being about one to five cases/million/year. In at least 90% of the cases, AGEP is caused by drugs. Drugs with high risk to trigger AGEP were identified as ampicillin/amoxicillin, pristinamycin, quinolones, chloroquine, sulfonamides, terbinafine, and diltiazem. Contact sensitivity and infectious agents have also been implicated in the causation of AGEP. It is characterized by the rapid appearance of dozens to hundreds of small, pinhead-sized, nonfollicular sterile pustules, often preceded by erythema and edema. There is usually accentuation in the intertriginous areas and the face. Fever almost always accompanies the skin eruption. Other signs of systemic inflammation like leukocytosis, elevated levels of C-reactive protein, and increased levels of neutrophils can be seen. Pustular psoriasis is the most common differential diagnosis. Mainly managed with topical steroids, systemic corticosteroids are required for severe manifestations.
