Introduction
Many drugs are known for bringing about skin issues following intake. Skin is reported to be an excellent platform for the manifestations of drug-induced undesired events. These reactions range from minor skin rashes to grave skin disorders. Acute generalized exanthematous pustulosis is an alarming skin condition that develops following exposure to certain medicines.
What Is Acute Generalized Exanthematous Pustulosis?
Acute generalized exanthematous pustulosis (AGEP) is a peculiar skin condition where the person develops numerous tiny pus-filled bumps over the skin surface. In the initial stage, it remains restricted to some body regions, and later, it flourishes over the skin surface.
AGEP is not associated with any gender or age preference. It can develop in anyone who is exposed to drugs. However, not all individuals who take the drug need to exhibit AGEP. It is precipitated only in a very small percentage. Most often, it settles by itself in a couple of weeks. However, it can develop complications at times. It is a typical form of severe cutaneous adverse reaction (SCAR).
What Causes Acute Generalized Exanthematous Pustulosis?
Though numerous assumptions exist regarding the causation of acute generalized exanthematous pustulosis, drugs are reported to be the culprit for more than 90 percent of cases. There is a list of medicines that are capable of evoking AGEP, and some of the routinely reported drugs include the following:
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Penicillins antibiotics.
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Terbinafine (antifungal drug).
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Diltiazem (calcium channel blocker).
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Hydroxychloroquine (antimalarial drug).
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Cephalosporin antibiotics.
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Quinolones antibiotics.
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Pristinamycin (streptogramin antibiotic).
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Tetracyclines (antibiotics).
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Carbamazepine (antiepileptic drugs).
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Sulfonamides (antimicrobial drugs).
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Paracetamol and Ibuprofen (non-steroidal anti inflammatory drugs).
Out of these, beta-lactam antibiotics encompassing penicillins, quinolones, and cephalosporins are frequently reported to be in association with AGEP. In addition, certain hypotheses put forward the role of viral, parasitic, and bacterial infections in provoking AGEP, particularly in younger patient groups. Hepatitis B virus, adenovirus, Epstein Barr virus, cytomegalovirus, enterovirus, parvovirus B19, coxsackie virus B4, echinococcus, mycoplasma, escherichia coli, and chlamydia pneumonia are some of the microorganisms that potentially pose the risk of inducing AGEP skin reactions.
Recent researchers have concluded that certain alterations in the genetic makeup make the person prone to developing AGEP. Alteration in the gene that encodes for interleukin 36 receptor antagonist (IL36RA) is reported to be in close relation with AGEP development.
What Are the Signs and Symptoms Associated With Acute Generalized Exanthematous Pustulosis?
Acute generalized exanthematous pustulosis projects various signs and symptoms. Some of the widely reported manifestations include the following:
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Sudden Onset: The skin reactions develop all of a sudden, within 48 hours, following the start of therapy with the suspected drug. The initial reactions develop over the face and body folds, like the underarms and groin. The reactions extend over the hand, legs, and body in a few hours.
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Pustules: Small, small skin bumps develop over the skin surface, filled with pus, and sometimes appear light yellow tinted. These bumps are medically known as pustules. The skin encircling the pustules and the entire affected area appears reddened and erythematous, with considerable swelling over the area. The face often develops puffiness and other signs mimicking an allergic reaction. In addition to skin, occasionally, reactions do develop inside the mouth.
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Itching: The affected person experiences itchiness, stinging, and burning sensation over the area. It makes the person quite uncomfortable and restless.
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Fever: The skin reactions in AGEP are mostly accompanied by other manifestations like fever and general weakness. It is often accompanied by enlargement of the body's tiny lymph nodes (lymphadenopathy). The nodes even elicit pain during manipulation.
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Neutrophilia: The blood picture of the affected person reflects an unexplainable hike in the number of neutrophils in the blood, and that condition is termed neutrophilia.
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Multiorgan Involvement: At times, the patients develop complications that eventually lead to dysfunctions of multiple vital organs. It is a grave sign and can even threaten a person's life.
How Is Acute Generalized Exanthematous Pustulosis Detected?
In-depth analysis of the medical history and clinical findings are the guiding forces in diagnosing acute generalized exanthematous pustulosis. Suspected medicine intake or history of other microbial infections often clear the path of diagnosis. In addition, specific investigative tests are advised to confirm the diagnosis of AGEP. Some of the routinely advised tests include the following:
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Blood Tests: It aids in detecting the abnormalities associated with neutrophil count. In addition, it also helps in assessing the functions of vital organs like kidneys and liver.
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Patch Test: This test helps determine the agent that triggered the skin reaction.
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Biopsy: The cellular changes during the skin reaction can be analyzed by carrying out a biopsy of the skin specimen. It also aids in confirming the diagnosis of the condition.
What Are the Complications Associated With Acute Generalized Exanthematous Pustulosis?
Complications are not frequently reported with acute generalized exanthematous pustulosis. However, at times it does precipitate certain complications.
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AGEP, in its more advanced stage, compromises the functions of certain vital organs like kidneys, lungs, and liver, giving rise to organ dysfunctions.
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AGEP sometimes develops with other skin conditions like toxic epidermal necrolysis (grave skin condition with peeling of the outer skin layer).
What Are the Treatment Interventions Available for Acute Generalized Exanthematous Pustulosis?
Acute generalized exanthematous pustulosis often settles without any interventions. However, at times it may bring about certain grave complications. The chief goal of the treatment is to limit the progression of the reaction. Identifying the triggering factor and immediate withdrawal of the offending drug controls the disease. The treatment strategies are primarily designed to calm down irritated and reactive skin. Itching and soreness in the affected area can be effectively tackled with the help of moisturizers. Oral antihistamines and topical corticosteroids are advised considering the severity of the symptoms. For cases with severe aches and burning sensations, painkillers are also employed to tackle the pain and discomfort. Extensive treatment therapies are only advised if multiorgan associations complicate it.
Conclusion
Acute generalized exanthematous pustulosis is a typical skin reaction in response to medicine intake. In most instances, pustules and the associated skin changes clear off in two weeks if the offensive medicine is withdrawn promptly. Hence, it is critical to notice any form of skin reactions following the consumption of drugs. It generally does not necessitate extensive treatment interventions. However, symptomatic management aids in dealing with discomfort and irritation.
