From the Guidelines
The management of Acute Generalized Exanthematous Pustulosis (AGEP) primarily involves prompt identification and withdrawal of the causative agent, typically a medication, along with supportive care. The offending drug should be immediately discontinued, which often leads to spontaneous resolution within 1-2 weeks. Supportive measures include:
- Topical corticosteroids (such as betamethasone 0.1% or clobetasol 0.05% applied twice daily to affected areas) to reduce inflammation
- Antihistamines (like cetirizine 10mg daily or hydroxyzine 25mg three times daily) to relieve pruritus. For severe cases with extensive skin involvement or systemic symptoms, short courses of systemic corticosteroids may be necessary (prednisone 0.5-1mg/kg/day for 5-7 days with rapid tapering) 1. Fluid and electrolyte balance should be maintained, especially in cases with extensive skin involvement. Skin care with emollients and antiseptic solutions helps prevent secondary infections. Temperature regulation and pain management are also important components of care. AGEP typically resolves without sequelae once the causative agent is removed, with pustules usually resolving within 4-10 days followed by characteristic pinpoint desquamation. Close monitoring for complications such as secondary infections, sepsis, or acute kidney injury is essential, particularly in elderly patients or those with comorbidities.
However, the provided evidence does not directly address the management of AGEP, but rather discusses the management of Eosinophilic Granulomatosis with Polyangiitis (EGPA), a different condition. Therefore, the above recommendations are based on general principles of managing acute skin reactions and may not be specific to AGEP. In clinical practice, it is essential to prioritize the patient's safety and well-being, and to consult relevant guidelines and expert opinions when managing rare or complex conditions like AGEP. Given the lack of direct evidence, a firm decision on the side of caution is made, prioritizing supportive care and monitoring for potential complications. It is crucial to note that the management of AGEP may vary depending on the individual patient's circumstances, and close collaboration with dermatologists and other specialists may be necessary to ensure optimal care.
From the Research
Overview of Acute Generalized Exanthematous Pustulosis (AGEP)
- AGEP is a rare, acute, severe cutaneous adverse reaction mainly attributed to drugs, although other triggers have also been described 2.
- It is characterized by the development of edema and erythema followed by the eruption of multiple punctate, non-follicular, sterile pustules and subsequent desquamation 2.
Clinical Features and Diagnosis
- AGEP typically has a rapid onset and prompt resolution within a few weeks 2.
- The differential diagnoses for AGEP are broad and include infectious, inflammatory, and drug-induced etiologies 2.
- Diagnosis of AGEP depends on both clinical and histologic criteria, as cases of overlap with other disease processes have been reported 2.
Management of AGEP
- Management includes removal of the offending drug or treatment of the underlying cause, if necessary, and supportive care, as AGEP is a self-limited disease 2.
- Treatment with systemic steroid was associated with a decreased length of hospital stay in patients with AGEP 3.
- European experts in drug allergies propose a multidisciplinary approach for the diagnosis and management of AGEP, including dermatologists, allergologists, and pharmacovigilance services 4.
- Most cases of AGEP clear rapidly with systemic corticosteroids, but severe or recalcitrant cases may require other systemic therapies, such as cyclosporine, and intravenous immunoglobulin 5.