Acute generalized exanthematous pustulosis secondary to dose-related turmeric supplementation

We present the case of a 55-year-old woman with a 10-day history of a rapidly progressing generalized rash. History was significant for recent increase in turmeric supplement dose. Clinical presentation was notable for diffuse plate-like yellow scaling of the scalp with lesser involvement of the ears. On the trunk and extremities, erythematous circinate plaques studded with pustules were noted with central trailing scale and desquamation. Laboratory results showed slight elevation of white blood cell count from her baseline but within normal range. Histopathological analysis of two punch biopsies showed spongiotic dermatitis with eosinophils, and subcorneal pustules with eosinophils, respectively, without any organisms. These findings were most consistent with acute generalized exanthematous pustulosis (AGEP). Treatment included oral and topical corticosteroids as well as discontinuation of all dietary supplements. AGEP, a severe cutaneous adverse reaction, is associated most often with antibiotics; however, many other medications, including herbal supplements, have been documented as triggers in the literature. This is only the second reported case of potential turmeric-induced AGEP and the first reported case establishing a dose-related association between turmeric and AGEP. It is important to consider herbal supplements as part of the medical history to guide proper management when assessing a patient with AGEP.