Acute generalized exanthematous pustulosis: 15-year retrospective multicentre experience

Acute generalized exanthematous pustulosis (AGEP) is a rare skin condition often triggered by medications. Many case reports have been published, but few studies with large cohorts have been reported to date.

To investigate the association between AGEP EuroSCAR score and clinical and laboratory findings, and histopathological examination in a large cohort.

This retrospective, multicentre study analysed 51 cases of patients with AGEP across 4 academic institutions.

The study found that in the majority of patients AGEP was drug-induced, particularly as a result of antibiotics such as amoxicillin. The average time from drug exposure to symptom onset was 10.7 (SD 11.7) days, with hospital admissions lasting an average of 14.5 (SD 11.8) days and recovery averaging 33.3 (SD 4.9) days. Key features included widespread itching, fever and elevated inflammatory markers. Histopathological analysis frequently revealed spongiform pustules and eosinophilic infiltration. Importantly, this study is the first, to our knowledge, to demonstrate a significant association between higher EuroSCAR scores and elevated lactate dehydrogenase (LDH) levels, suggesting a more intense inflammatory response in patients with higher EuroSCAR scores. The findings underscore the need for early diagnosis and management of AGEP, with a particular focus on discontinuing the offending drug and administering corticosteroids.

Despite its retrospective design, this study contributes valuable insights into the systemic implications and histopathological characteristics of AGEP, highlighting the possible role of LDH, and the importance of further research to refine diagnosis, treatment protocols and improve patient outcomes.