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exanthematous pustulosis
Etiology:
- pharmaceuticals
- acetaminophen
- carbamazepine
- diltiazem
- hydroxychloroquine
- sulfonamides
- terbinafine
- tetracyclines
- viral infections in children
- Epstein-Barr virus
- enterovirus
- adenovirus
- cytomegalovirus
- hepatitis B virus & other
- spider bites
Pathology:
- spongiform intraepidermal subcorneal pustules
- perivascular infiltrates containing neutrophils, lymphocytes, & eosinophils in the upper dermis [1] (one case)
Genetics:
- associated with IL36RN gene mutations
Clinical manifestations:
- 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)
Management:
- withdrawal of offending medication
- oral antihistamine
- emollients
- topical glucocorticoids
- oral glucocorticoids rarely needed [3]
- lesions resolve within 2 weeks with treatment
General
pustulosis
exanthem
References
- Zhang Z1, Liu X
Images in clinical medicine. Acute generalized exanthematous
pustulosis.
N Engl J Med. 2015 Jan 8;372(2):161
PMID: 25564899
http://www.nejm.org/doi/full/10.1056/NEJMicm1401196
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015
- DermNet NZ. (images)
Acute generalised exanthematous pustulosis.
http://www.dermnetnz.org/reactions/agep.html
- NEJM Knowledge+ Question of the Week. Nov 8, 2016
http://knowledgeplus.nejm.org/question-of-week/1452/