exanthematous pustulosis
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Etiology
- pharmaceuticals
- viral infections in children
- spider bites
Pathology
- spongiform intraepidermal subcorneal pustules
- perivascular infiltrates containing neutrophils, lymphocytes, & eosinophils in the upper dermis[1] (one case)
Genetics
Clinical manifestations
- may occur 1 day after exposure to offending agent[2]
- generally occurs within 2 days (24-73 hours) of exposure to offending agent[3][4]
- widespread edematous erythema covered with numerous discrete, nonfollicular pustules (< 5 mm in diameter) coalescing on the palms[1] (one case)
- yellow hyperplastic papules on the tongue mucosa[1] (one case)
- mucosal involvement less common than SJS-TEN[4]
- fever
* image[3]
Laboratory
- complete blood count (CBC)
- neutrophilia, possibly eosinophilia
- skin biopsy (see pathology)
Differential diagnosis
- drug-induced hypersensitivity
- skin manifestations > 72 hours after exposure, average onset 21 days
Management
- withdrawal of offending medication
- oral antihistamine
- emollients
- topical glucocorticoids
- oral glucocorticoids rarely needed[3]
- lesions resolve within 2 weeks with treatment
More general terms
References
- ↑ 1.0 1.1 1.2 1.3 Zhang Z1, Liu X Images in clinical medicine. Acute generalized exanthematous pustulosis. N Engl J Med. 2015 Jan 8;372(2):161 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/25564899 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1401196
- ↑ 2.0 2.1 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ 3.0 3.1 3.2 3.3 DermNet NZ. (images) Acute generalised exanthematous pustulosis. http://www.dermnetnz.org/reactions/agep.html
- ↑ 4.0 4.1 4.2 NEJM Knowledge+ Question of the Week. Nov 8, 2016 http://knowledgeplus.nejm.org/question-of-week/1452/